Delayed-Interval Delivery of Twin Gestation via Cesarean Section: A Case Report

Abstract

Patient: Female, 21 Final Diagnosis: Preterm prelabor rupture of membrane Symptoms: Cord prolapse • rupture of membranes Medication: — Clinical Procedure: Cesarean section Specialty: Obstetrics and Gynecology Objective: Unusual clinical course Background: Multifetal pregnancies are at high risk for preterm delivery. Under certain circumstances, delayed vaginal delivery of the second twin is performed to improve morbidity and mortality. Most of the information on optimal management of delayed-interval delivery comes from published case reports in which the first twin was delivered vaginally. This case report is unique in that twin A was delivered via cesarean section. Case Report: Our patient was a 21-year-old G2P1, with dichorionic diamniotic twins of unknown gestational age, with prenatal care at a different facility, who presented with preterm prelabor rupture of membranes and cord prolapse. Twin A, with an estimated weight by ultrasound of 528 g, was delivered via cesarean section and twin B was left in utero until the patient went into preterm labor 10 days later. Obstetrical management included tocolytic protocol from the Management of Myelomeningocele Study trial, preterm prelabor rupture of membrane antibiotics with broad-spectrum coverage, and judicious use of fetal lung maturity steroids and magnesium sulfate. Conclusions: This case is important as we have demonstrated that cesarean section in the setting of delayed-interval delivery may be an option to improve survival at the limits of viability. We also discussed our treatment approach and how we delayed delivery of the second twin by 10 days. Unexpectedly, the surviving twin was the one born first, at 22 4/7 weeks determined 2 days after birth by prenatal records.

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

“…Maternal morbidity is common with DID. Up to half of the documented patients suffer intrauterine infections leading to fulminant maternal sepsis [ 5 , 6 ].…”

“…After the delivery of the singleton triplet, the patient was treated with the same antibiotics mentioned above. There is no published recommended routine antibiotic regimen, duration, or route, but most clinicians have opted for administration of prophylactic therapy [ 5 , 6 , 9 , 10 ]. Most of the antibiotics of choice were the same as those typically used for PPROM, as it is believed that the cause and route of infections are essentially the same [ 5 ].…”