No abstract

Müllerian duct anomalies (MDA) are an uncommon but can be a treatable form of infertility [ ]. Patients with MDA are known 1 to have higher incidences of infertility, repeated first trimester spontaneous abortions, fetal intra-uterine growth retardation, fetal malposition, pre-term labour and retained placenta [

In twin pregnancies, usually the delivery of both the babies occur together with a difference of few minutes. However, in very rare situations the first fetus gets aborted during second trimester and the cervix gets reformed. In such rare situations after the abortion (vaginal expulsion) of the first fetus, prolonging pregnancy is a real challenge. The risks of haemorrhage, chorioamnionitis, coagulopathies and immediate abortion of the second fetus are very high. In such event, if the pregnancy is prolonged, preterm delivery of the second twin within next few weeks is very common.We report a case of diamniotic, dichorionic pregnancy achieved through In Vitro Fertilisation (I.V.F.) in a 43 years old woman who also had diabetes mellitus. This patient had spontaneous onset of uterine contractions and leaking which resulted into expulsion of the first fetus at 17 weeks of gestation. The placenta of the first fetus and intact gestational sac of the other twin, were left in utero.The management included vigilant maternal monitoring, use of tocolytics antibiotics and delayed cervical cerclage. The pregnancy was prolonged for 115 days. The patient required caesarean section at 34 weeks for the development of severe pre-eclampsia and delivered a healthy male baby of 2.1 kg who required a brief stay of twelve days in NICU. Placentas of both the fetuses were removed during caesarean section. This case is exceptional and there are no validated medical protocols for the management; the scientific evidence is still controversial.Our care supports the prolongation of the pregnancy of the second twin with high medical vigilance.