Delayed-interval delivery in twin pregnancies: report of three cases and literature review

Vielba, Marta Benito; Torralba, Carlos De Bonrostro; Arnal, Victoria Pallarés; Serrano, Rebeca Herrero; Cabrejas, Eva Lucía Tejero; Maza, José Manuel Campillos

doi:10.1080/14767058.2017.1378336

Cited by 16 publications

(15 citation statements)

References 17 publications

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“…A cervical cerclage was not performed in this case as an ultrasound showed the cervix to be long and closed. The idea behind cerclage in DID is that it can only stabilise the cervix but minimise exposure of the foetal membranes to vaginal bacteria [ 12 ]. Some authors have opted for routine cervical cerclage [ 5 ], while others have not [ 5 , 12 – 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The idea behind cerclage in DID is that it can only stabilise the cervix but minimise exposure of the foetal membranes to vaginal bacteria [ 12 ]. Some authors have opted for routine cervical cerclage [ 5 ], while others have not [ 5 , 12 – 14 ]. The idea of cerclage is controversial without cervical incompetence as some suggest that the actual procedure puts the patient at risk of further infection and can contribute to the rupture of membranes of the remaining foetus [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Delayed Interval Delivery in Preterm Premature Rupture of Membranes in Dichorionic Triamniotic Triplets: Ethical Considerations for Maternal Health Case Report

Hosiani

Brown

Alahakoon

2022

Case Reports in Obstetrics and Gynecology

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Background. Although there are numerous studies on delayed interval delivery in twins, this study is one of few reporting on preterm premature rupture of membranes in triplets and even fewer on dichorionic triamniotic triplet twins. The case presented here highlights the important interplay between informed consent and patient autonomy. Case Presentation. A 37-year-old woman gravida 1, para 0 with a dichorionic triamniotic triplet pregnancy experienced preterm premature rupture of membranes of the singleton triplet at 15 weeks and six days of gestation. Delayed interval delivery was offered to the parents, who chose to continue the pregnancy while acknowledging the risks for maternal and foetal health. The patient was treated with prophylactic intravenous antibiotics and discharged on oral antibiotics after an eight-day admission. Two days after being discharged, she was readmitted with clinical signs of chorioamnionitis. Within six hours, the preterm premature rupture of membranes singleton was delivered. Three days later, she again presented to the hospital with preterm premature rupture of membranes of one of the dichorionic twins. After discussion with the maternal foetal medicine team, the parents chose to terminate the pregnancy. Delayed interval delivery was not successful in this patient, and it is unclear at which gestational age it is too early to offer expectant management. Conclusions. The case affirmed the very poor foetal survival rate when the first delivery occurs at under 20 weeks’ gestation. A standardised management of delayed interval delivery should be established to assist with consistent parental counselling.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Delayed Interval Delivery in Preterm Premature Rupture of Membranes in Dichorionic Triamniotic Triplets: Ethical Considerations for Maternal Health Case Report

Hosiani

Brown

Alahakoon

2022

Case Reports in Obstetrics and Gynecology

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“…2,10,15 The median interdelivery interval was 8 and 25 days in patients without and with cervical cerclage respectively. 10 Cerclage can minimize the exposure longo descrito na literatura. A tentativa de diferir o parto do segundo feto na periviabilidade é uma opção que deve ser oferecida aos progenitores, após aconselhamento e desde que se cumpram os critérios clínicos de elegibilidade.…”

Section: Discussionunclassified

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

Frias

Queirós

Simões

2020

Rev Bras Ginecol Obstet

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Premature delivery often complicates multifetal pregnancies, placing neonates at risk of serious morbidity and mortality. In select cases, preterm birth of one sibling may not require delivery of the remaining fetus(es), which may remain in utero for a delayedinterval delivery, consequently improving neonatal morbidity and mortality. Currently, there is no consensus on the best protocol for the optimal management of these cases. We report one case of delayed-interval delivery of a dichorionic pregnancy assisted in our center. In this case, prophylactic cerclage, tocolytic therapy and administration of broad-spectrum prophylactic antibiotics enabled delivery at 37 weeks, corresponding to 154 days of latency, which is, to our knowledge, the longest interval described in the literature. The attempt to defer the delivery of the second fetus in peri-viability is an option that should be offered to parents after counseling, providing that the clinical criteria of eligibility are fulfilled. The correct selection of candidates, combined with the correct performance of procedures, as well as fetal and maternal monitoring and early identification of complications increase the probability of success of this type of delivery.

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“…However, these cases are rare and therefore, there is no consensus yet on how to manage this situation. Tocolysis and antibiotic treatment are rather undisputed measures, whereas the performance of a rescue cerclage is a controversial matter 5–9. After the delivery of the first infant, the management of the placenta is described similarly in most reports: the umbilical cord is usually ligated as close to the placenta as possible and then cut, the placenta remains in situ until the delivery of the remaining infant(s) 8 9.…”

Section: Introductionmentioning

confidence: 99%

Successful delayed interval delivery of a triplet pregnancy using conservative management

Eckel,

Klebermass-Schrehof,

Bago-Horvath

et al. 2023

BMJ Case Rep

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Preterm birth is a significant cause of perinatal morbidity and mortality, especially in multiple pregnancies. Delayed interval delivery can prolong pregnancy for the remaining fetus(es) in an imminent stillbirth or extremely preterm birth of the first fetus, improving the lastborn’s outcomes. We present a case of delayed interval delivery of a triplet pregnancy following preterm prelabour rupture of membranes and progressive cervical insufficiency. Following vaginal delivery of the first fetus at 24+1 gestational weeks, the patient received antibiotics and tocolysis. Cerclage was not conducted as the mother had a vaginal infection. A 15-day delivery interval for the second and third fetuses was achieved. The firstborn required mechanical ventilation and inotropic support, while the others only required continuous positive airway pressure. There is no consensus on the best way to perform delayed interval delivery. We achieved a complications-free interval of 15 days with conservative management in a triplet pregnancy.

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Delayed-interval delivery in twin pregnancies: report of three cases and literature review

Abstract: Delayed delivery of the second twin before 28 weeks of gestation can be an alternative for the obstetrician since it could prolong the pregnancy until a gestational age which confers a better prognosis and a better perinatal outcome for the second twin.

Cited by 16 publications

References 17 publications

Delayed Interval Delivery in Preterm Premature Rupture of Membranes in Dichorionic Triamniotic Triplets: Ethical Considerations for Maternal Health Case Report

Delayed Interval Delivery in Preterm Premature Rupture of Membranes in Dichorionic Triamniotic Triplets: Ethical Considerations for Maternal Health Case Report

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

Successful delayed interval delivery of a triplet pregnancy using conservative management

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