Delayed Interval Delivery following Early Loss of the Leading Twin

Abstract

This was a case of a nulliparous woman with reduced chance of conception following unilateral salpingectomy and years of infertility. She eventually conceived following ovulation induction resulting in twin pregnancy. She had miscarriage that led to loss of one of the twins at 17 weeks of gestational age. The pregnancy was however continued for 116 days following meticulous management with eventual delivery of a live female baby with good outcome.

Delayed-Interval Delivery in Dichorionic Twin Pregnancies: A Case Report of 154 Latency Days

“…Cerclage, tocolysis, hospitalization, and antibiotic therapy are all still controversial procedures. 1,2,[7][8][9]13 The use of prophylactic cerclage is the most controversial issue among the recommended procedures. 7,8,11,13,14 For some authors, it is a routine procedure, while for others it is recommended only if the etiology of the spontaneous delivery is cervical insuffiency.…”

“…1,2,[7][8][9]13 The use of prophylactic cerclage is the most controversial issue among the recommended procedures. 7,8,11,13,14 For some authors, it is a routine procedure, while for others it is recommended only if the etiology of the spontaneous delivery is cervical insuffiency. 7,8,11 Zhang et al 15 concluded that in cases of delayed-interval delivery, immediate cervical cerclage after the first delivery is associated with a significantly longer delivery interval between twins without increasing the rate of intrauterine infection.…”

Obstetric Management of Delayed-Interval Delivery

“…First of all, this patient fullfield the conditions for deferred delivery of the second fetus: birth of the first fetus before 24WG, biamniotic pregnancy, intact membranes of the second fetus, absence of intra-amniotic infection and absence of fetal or maternal pathology involving urgent termination of pregnancy [13] . Secondly, the counseling and consent process of the parents addressed the benefits and risks of delayed-interval delivery, including maternal, fetal and neonatal risk of infection and the consequences of prolonging the pregnancy from a previable to a periviable gestational age [9] , [14] .…”

“…Secondly, the counseling and consent process of the parents addressed the benefits and risks of delayed-interval delivery, including maternal, fetal and neonatal risk of infection and the consequences of prolonging the pregnancy from a previable to a periviable gestational age [9] , [14] . Thereafter, our active management was based on what is reported in the literature, despite the lack of a consensual protocol for the handling of potential candidates for asynchronous delivery [1] , [2] , [3] , [4] , [5] , [7] , [8] , [9] , [11] , [13] , [15] , [16] , [17] .…”

“…Cervical cerclage was not placed in this patient, due to progressive closing of cervix after the delivery of the first fetus. The use of cerclage is the most controversial issue among the treatment modalities [4] , [6] , [8] , [10] , [11] , [12] , [13] , [15] , [16] , [18] . Some authors defend the systematic placement of cerclage [4] , [10] , [16] , [17] , while others are against this procedure [2] .…”