Double Fetal Demise (FDIU) in Triplet Pregnancy

---

Figure-1

📄 Report Sample Line - Double Fetal Demise (FDIU) in Triplet Pregnancy

Ultrasound evaluation demonstrates a triplet gestation. Two of the three fetuses (Fetus A and Fetus B) show absence of cardiac activity and fetal movement, with reduced amniotic fluid volume. Biometric measurements of both demised fetuses correspond to approximately XX and YY weeks, respectively. There is evidence of fetal maceration in Fetus A (or B), including overlapping cranial bones and skin edema. No gross structural anomalies are identified. The third fetus (Fetus C) exhibits normal cardiac activity, fetal movements, biometry appropriate for gestational age, and adequate amniotic fluid. Placental evaluation suggests a [trichorionic triamniotic / dichorionic triamniotic / monochorionic triamniotic] configuration. No signs of twin-twin transfusion syndrome or cord entanglement are present. Maternal adnexa appear normal.

Conclusion: 📋 Intrauterine Fetal Demise (FDIU) of two fetuses (Fetus A and B) in a triplet pregnancy. Fetus C remains viable with normal sonographic findings.

Recommendation: Urgent referral to maternal-fetal medicine. Close surveillance of the surviving fetus with serial growth, Doppler, and wellbeing assessments. Investigations to determine possible causes of fetal demise (e.g., thrombophilia, infection, placental pathology) are advised. Multidisciplinary counseling regarding pregnancy continuation, risks, and delivery planning is essential.

---

Note: If you select English, answer all questions in English.
यदि आप हिंदी चुनते हैं, तो सभी प्रश्न हिंदी में हल करें।

1. “Double fetal demise” in a triplet pregnancy means: 1. ट्रिपलेट प्रेगनेंसी में "डबल फेटल डिमाइस" का क्या अर्थ है?
A. Death of two fetuses in utero while one fetus remains alive
B. Death of all three fetuses
C. Intrauterine growth restriction in two fetuses
D. Twin pregnancy with one fetal demise

2. The single most important factor that determines risk to the surviving fetus after double FDIU is: 2. डबल FDIU के बाद जीवित शिशु के जोखिम को निर्धारित करने वाला सबसे महत्वपूर्ण कारक कौन सा है?
A. Chorionicity / placental sharing (e.g., monochorionic vs dichorionic)
B. Maternal age
C. Fetal sex of the survivor
D. Time of day when demise occurred

3. In a monochorionic pregnancy, demise of co-fetuses can most directly cause which problem in the surviving twin? 3. मोनोकोरियोनिक गर्भावस्था में सह-भ्रूणों के मृत्यु होने से जीवित जुड़वाँ में सबसे सीधे किस समस्या का कारण बन सकता है?
A. Maternal DIC immediately in all cases
B. Placental abruption in every case
C. Acute hemodynamic shift causing ischemic brain injury / neurological damage
D. Guaranteed normal outcome for survivor

4. After detecting double fetal demise in a triplet pregnancy, the most appropriate immediate step is: 4. ट्रिपलेट प्रेगनेंसी में डबल फेटल डिमाइस मिलने के बाद सबसे उपयुक्त तत्काल कदम क्या है?
A. Confirm chorionicity and perform detailed ultrasound with fetal Dopplers and infection screen; counsel parents
B. Immediate cesarean delivery in all cases
C. Start immediate chemotherapy
D. No further evaluation required

5. Maternal coagulopathy (DIC) after fetal demise is: 5. भ्रूण मृत्यु के बाद मातृ कोआगुलोपैथी (DIC) कितनी बार होती है?
A. Very common immediately after any fetal demise
B. Rare but possible, especially with prolonged retention of dead fetus and infection
C. Impossible — never occurs
D. Only occurs if the fetus is above 40 weeks gestation

6. Best surveillance plan for the surviving fetus after double demise (if expectant management) includes: 6. डबल मृत्यु के बाद जीवित भ्रूण के लिए (यदि प्रत्याशित प्रबंधन) सर्वश्रेष्ठ निगरानी योजना में क्या शामिल है?
A. Serial ultrasound for growth, umbilical and middle cerebral artery Dopplers, CTG/NST as indicated, and MRI brain if suspicious findings
B. One-time ultrasound and then no follow-up
C. Immediate termination of pregnancy only
D. Start empiric anticoagulation for mother always

7. Which management is usually recommended if there is no maternal compromise and the surviving fetus is stable? 7. यदि माँ की स्थिति सामान्य है और जीवित भ्रूण स्थिर है तो आमतौर पर कौन सा प्रबंधन सुझाया जाता है?
A. Immediate delivery regardless of gestation
B. Immediate aggressive surgery on placenta
C. Expectant management with close surveillance and counseling
D. Routine home care with no monitoring

8. Which statement about prognosis is true? 8. किस कथन के बारे में पूर्वानुमान सही है?
A. Surviving fetus outcome is uniformly poor regardless of chorionicity and GA
B. Prognosis is better in trichorionic pregnancies compared with monochorionic due to lack of placental vascular anastomoses
C. Outcome solely depends on fetal sex
D. There is no risk to the surviving fetus ever

9. Indication for earlier delivery of the surviving fetus would include: 9. जीवित भ्रूण के जल्दी जन्म के लिए संकेत में क्या शामिल होगा?
A. Evidence of fetal distress, abnormal Dopplers or maternal sepsis/coagulopathy
B. Parental anxiety only, without clinical abnormalities
C. Maternal hair color change
D. Always deliver at 24 weeks regardless of status

10. Key counseling point to parents after double FDIU in triplets is: 10. ट्रिपलेट में डबल FDIU के बाद माता-पिता को दिया जाने वाला प्रमुख परामर्श क्या है?
A. There is no risk to the survivor and no monitoring needed
B. Explain increased risk of preterm delivery and possible neurological compromise (depending on chorionicity and timing); outline close surveillance plan and possible neonatal care needs
C. Immediately recommend pregnancy termination always
D. Suggest no obstetric follow-up until term