With the evolution of assisted reproduction, the number of multiple pregnancies has increased dramatically, and so have the associated complications. Multiple gestation is associated with a high loss rate in the first and second trimester. Only in rare cases can the process of abortion be stopped after the loss of one or two fetuses, and attempts made to keep the remaining fetuses inside the uterus. The following report describes two cases where, in spite of a series of complications, it was possible to delay the delivery of two fetuses after one fetus had been delivered. Case Reports Case 1 A 26-year-old woman had one miscarriage, and after two years of infertility was treated with ovulation induction. Triplets were diagnosed on ultrasound (US) examination. At 18 weeks, she passed fluid per vagina. On clinical examination, the uterus was appropriate for dates. Speculum examination revealed a 3 cm dilated cervix, bulging membranes and clear liquor, indicating a hindwater leak. US confirmed that all fetuses were alive and apparently normal. Both parents urgently requested the most aggressive management to maintain the pregnancy. After 24 hours' observation, a McDonald suture was placed. Eighteen days later the patient developed a temperature of 38.1°C, contractions and bleeding. The suture was removed and a stillborn infant delivered. The cord was cut at the cervix, which appeared closed. Contractions and bleeding stopped, however, US examination two days later showed membranes at the level of the external cervical os. The couple asked that everything be done to support the remaining fetuses. Another suture was placed without any problem. Over the next three weeks the patient developed mild uterine tenderness and bleeding on several occasions. Contractions were controlled with a combination of indomethacin suppositories, magnesium sulfate and beta-mimetic drugs. At 24½ weeks, the membranes ruptured, and contractions and bleeding increased. The suture was removed and the patient delivered a 600 g stillborn female, and a 570 g live female, who expired shortly afterwards. The patient requested discharge within 24 hours, but was readmitted two days later with severe localized left lower quadrant pain. On US the tenderness was specifically related to a 6 cm diameter left ovarian cyst. The cyst was aspirated transabdominally under US guidance without any problems, and the pain resolved completely. The patient was discharged within 24 hours in stable condition, and on follow-up had no further problems. Case 2 A 30-year-old gravida 2, with one previous vaginal delivery at term, was treated with ovulation induction for secondary infertility. US revealed triplet pregnancy, and at 10 weeks, emergency admission for severe left abdominal pain was required. On US, the left ovary was 15x11x10 cm with multiple cysts, and the tenderness was localized over the center of the ovary. Laparoscopy was performed, which showed the left ovary to be twisted and dark blue in color. It was untwisted endoscopically, multiple cysts were aspira...

Background Our objective was to determine the predictive value of the prenatal diagnosis of isolated clubfoot in twin gestations compared to singleton gestations. Methods A prospectively entered ultrasound database was reviewed for all pregnancies scanned at our institution from 2002 to 2014. Cases of suspected clubfoot were identified. Neonates with associated anomalies or aneuploidy, and patients who delivered at other institutions were excluded. Neonatal charts were reviewed for the confirmation of clubfoot. The chi-squared (χ2) test, Fisher’s exact test and the Mann-Whitney U test were used in the analysis, with p < 0.05 considered significant. Results Of those women who had prenatal ultrasound and subsequently delivered at our hospital, 84 pregnancies had isolated clubfoot suspected in the antenatal period. Of these pregnancies, 20 were twin gestations and 64 were singleton gestations. Overall, 51/84 (60.7%) pregnancies had clubfoot confirmed during the neonatal period. Of the twin pregnancies, only 35% (7/20) had a confirmed diagnosis of clubfoot at birth compared to 68.8% (44/64) of the singleton pregnancies (P = 0.008). Gestational age at diagnosis, breech presentation, neonatal gender, unilateral vs. bilateral clubfoot and suspicion of clubfoot in the presenting twin (Twin A) vs. the non-presenting twin (Twin B) did not correlate with an accurate diagnosis of clubfoot in twins. Conclusion False-positive prenatal diagnosis of isolated clubfoot is more common in twin gestations compared to singletons. This may be due to transient malpositioning or a result of diminished space. Obstetric providers should consider the possibility of a false-positive diagnosis and use caution when counseling patients about a prenatal suspicion for clubfoot, especially in twin gestations.

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