Monochorionic Pregnancy Complicated by Selective Intrauterine Fetal Death and Severe Anemia of the Co-Twin: The Role of Intrauterine Transfusion - Systematic Review of the Literature.

Introduction: The management of selective intrauterine demise in monochorionic pregnancies has high rates of adverse outcomes in the surviving co-twin. One of the complications might be severe anemia. The aim of this systematic review was to evaluate the role of intrauterine transfusion in case of selective intrauterine fetal death in monochorionic pregnancies with the surviving co-twin diagnosed with severe anemia.

Methods: We carried out literature search from PubMed, Google Scholar, and Scopus. Cases with ultrasound signs of severe fetal anemia in the surviving co-twin and treated through fetal intrauterine rescue transfusion alone were included.

Results: We selected 7 articles and 45 cases for our review. After an intrauterine transfusion procedure, the percentage of alive and apparently healthy newborns resulted to be 55.5% (25/45), with 15 premature and 10 full-term newborns. Long-term outcomes were not available for the majority of cases.

Conclusion: We provide available evidence on the outcome after the rescue intrauterine transfusion for severe anemia in surviving co-twin in selective intrauterine fetal death in monochorionic pregnancy performed within 24 h from the diagnosis. Our results suggest a better outcome compared to expectant management, where delivery is not indicated due to prematurity. This is a useful information for physicians managing these cases and for parents' counseling.