Delayed Interval Delivery in Multiple Pregnancies. Is Optimism Justified?

Abstract

Acta Obstet Gynecol Scand 1999; 78: 710-715. C Acta Obstet Gynecol Scand 1999 Objective. Evaluation of the success of delayed interval delivery in multiple pregnancies. Method. Retrospective analyses of all multiple pregnancies with the birth of one child at a gestational age of 16-31 weeks (nΩ80). Three groups were defined: group I, unsuccessful attempt to temporize delivery, group II, interval between the first child and the other child or children 3 hours or more, with delivery of the remaining children before 28 weeks and group III, prolongation of pregnancy beyond 28 weeks. Results. In 15 multiple pregnancies (ten sets of twins, five sets of triplets), the aim was to postpone the delivery of the second (and third) child. The mean gestational age at admittance was 25 weeks. Delay of the delivery of the second child was achieved in ten cases, five in group II and five in group III. In groups II and III, the mean interval of delivery was 12 days; the gestational age at the delivery of the remaining children in these ten patients was 27 5/7 weeks. No relation could be found between the reason for admittance and the interval in delivery between the first and the other children. The only severe maternal complication was blood loss exceeding 2 liters. In the neonatal outcome of first and second children (with a gestational age of 28 weeks or more) no striking differences were observed. Conclusion. Delayed delivery in multiple pregnancies after the birth of the first child is only successful in a minority of patients and should be considered prior to the birth of the first child.

Prolonged latency period of 70 days in a diamniotic and dichorionic twin pregnancy complicated by early second trimester rupture of membrane in one sac and its outcome

“…CRP is considered as good prognostic index for incipient chorioamnitis. 1,6,12 As repeated high vaginal swab culture and sensitivity came to positive for Klebsiella infection in spite of treatment. We have stopped antibiotics and kept her under coverage of probiotics.…”

“…In our case as there was no evidence of intrauterine infection hence administration of steroid is beneficially. 12 She entered into labour at 31 weeks after a latent period of 70 days which is significant.…”

Management of Delayed-Interval Delivery in Multiple Gestations

“…In our series, the gestational age at the fi rst delivery was 17-26.5 (median 23) weeks. Arias et al [26] and Seince et al [28] propose a limit gestational age of 28 weeks, van Doorn et al [29] and Kalchbrenner et al [25] 30 weeks, Farkouh et al [3] 31 weeks and Porreco et al [24] 32 weeks. Abboud et al [6] and De Jong et al [27] demonstrated a trend to better outcome for the second twin when the fi rst was delivered earlier in pregnancy.…”

“…The mean latency interval tends to be longer among women with cerclage, although statistical analysis is not possible with all cases because of various protocols ( fi g 2 ). A study [32] case series using the same protocol [3,17,25,26,29,33] suggests that cerclage after the fi rst delivery is associated with a longer inter-delivery interval without increasing the risk of intrauterine infection. Knight et al [9] propose cervix ultrasonographic monitoring to indicate a cerclage in case of persistent dilatation.…”

Delayed Interval Delivery of a Second Twin: A Case Report and Review of the Literature

“…Modem management procedures, including tocolytics, corticosteroids, antibiotics and cervical cerclage would appear to be important in the overall success of treatment in a retained twin. Although both tocolytics and cerclage appear to prolong the mean delivery interval, no statistical difference in survival was found concerning cerclage, antibiotic therapy, tocolysis and hospitalization (I, [3][4]. The use of prolonged bed rest, cervical cerclage, tocolysis, antibiotics and corticosteroids compose complex, frequently debatable issues.…”