Intrauterine foetal death in multiple gestation: to conserve or intervene

Abstract

There is an increasing incidence of higher order gestations especially due to fertility treatments, associated with higher morbidity and mortality. This is a case of a primigravida with triplet gestation with first foetal demise at 14 weeks who was referred for termination of pregnancy which she declined. Patient was on close followup with weekly ultrasounds. The second demise occurred at 21 weeks. At 26 weeks, patient was noted to have absent foetal movements and Doppler studies revealed a Restrictive Index (R.I) of 1 and Biophysical Profile (BPP) of 2/8.She was to be admitted for emergency hysterotomy but theydeclined. The third foetal demise occurred two days later. The patient was induced and delivered 3 macerated still births (MSBs). Grossly post-delivery umbilical cord entanglement. All the foetuses were male. Patient declined a post-mortem.