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Hüner B, Essers J, Schiefele L, Schütze S, Reister F, Janni W, Deniz M. Obstetric and fetal short- and long-term outcomes of delayed-interval delivery in multiple pregnancies. J Gynecol Obstet Hum Reprod 2022; 51:102486. [DOI: 10.1016/j.jogoh.2022.102486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/07/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022]
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Mei-Dan E, Jain V, Melamed N, Lim KI, Aviram A, Ryan G, Barrett J. Directive clinique no 428 : Prise en charge de la grossesse gémellaire bichoriale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:835-851.e1. [DOI: 10.1016/j.jogc.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mei-Dan E, Jain V, Melamed N, Lim KI, Aviram A, Ryan G, Barrett J. Guideline No. 428: Management of Dichorionic Twin Pregnancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:819-834.e1. [PMID: 35798461 DOI: 10.1016/j.jogc.2022.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To review evidence-based recommendations for the management of dichorionic twin pregnancies. TARGET POPULATION Pregnant women with a dichorionic twin pregnancy. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in this guideline may improve the management of twin pregnancies and reduce neonatal and maternal morbidity and mortality. EVIDENCE Published literature was retrieved through searches of PubMed and the Cochrane Library using appropriate controlled vocabulary (e.g., twin, preterm birth). Results were restricted to systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies. There were no date limits, but results were limited to English- or French-language materials. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the principal authors. The Board of the SOGC approved the final draft for publication. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE Obstetricians, family physicians, nurses, midwives, maternal-fetal medicine specialists, radiologists, and other health care providers who care for women with twin pregnancies. SUMMARY STATEMENTS RECOMMENDATIONS.
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Nassef A, Ahmed D, Abd Elwahab M. Achievement of a 136-day delayed-interval delivery of a second twin with minimum intervention. AL-AZHAR ASSIUT MEDICAL JOURNAL 2022. [DOI: 10.4103/azmj.azmj_9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Chen Y, Sun L, Hua X, Li M, Yu S, Zhang J. Defining intertwin birth weight discordance and optimal delivery time in dichorionic twins: a retrospective cohort study. J Matern Fetal Neonatal Med 2020; 35:3915-3922. [PMID: 33249949 DOI: 10.1080/14767058.2020.1843627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A high birth weight discordance (BWD) places twins at high risks of adverse perinatal outcomes; however, there is no commonly accepted definition of intertwin BWD. Given that gestational age (GA) is closely associated with both BWD and adverse neonatal outcomes, the aim of our study is to develop a measure that takes both BWD and GA into account to define BWD and explore the potentially optimal delivery time in dichorionic twins, with the balance against the risk of intrauterine demise and adverse neonatal outcomes. METHODS About 99,000 mixed gender twin pairs from the US matched multiple birth file from 1995 to 2000 were enrolled in our study. We set up a two-dimensional matrix model to select the BWD cutoff point related to outcomes. The optimal delivery time was identified based on the risks of adverse neonatal outcomes and fetal death by GA. RESULTS The combination of BWD and GA had a higher predictive performance for adverse neonatal outcomes than BWD alone (area under ROC curve (AUC): 0.816 vs. 0.523, p < .001). When GA was controlled for, the growth discordant cutoff point was BWD at the 40% level. The optimal delivery time suggested in dichorionic twins with BWD higher than 40% was identified at 33-34 gestational weeks. CONCLUSIONS The combination of BWD and GA was a better predictor for adverse neonatal outcomes than BWD alone. In dichorionic twins with BWD >40%, pregnancy may be continued till 33-34 gestation weeks if there is no indication for immediate delivery.
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Affiliation(s)
- Yan Chen
- Department of Neonatology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Luming Sun
- Department of Fetal Medicine, First Maternity and Infant Hospital Affiliated to Shanghai Tongji University, Shanghai, China
| | - Xiaolin Hua
- Department of Obstetrics, First Maternity and Infant Hospital Affiliated to Shanghai Tongji University, Shanghai, China
| | - Meng Li
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Stella Yu
- Center for Global Health and Health Policy, Global Health and Education Projects, Inc, Riverdale, MD, USA
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abstract
Periviable deliveries (less than 26 weeks) are a small percentage of deliveries but account for a disproportionately high number of long-term morbidities. Few studies describe interventions and outcomes for periviable preterm premature rupture of membranes (PPROM). The available reports may include only those neonates who received resuscitation, making interpretation and application difficult. Counseling should consider the impact of oligohydramnios on fetal lung development. This article discusses standard and experimental interventions that may offer neonatal benefit. Antenatal corticosteroids, antibiotics, and magnesium sulfate may improve outcomes but data to support an improvement in outcome are limited. Studies specifically evaluating these interventions are needed.
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Affiliation(s)
- Kelly S Gibson
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Case Western Reserve University, The MetroHealth System, Suite G240, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA.
| | - Kerri Brackney
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Case Western Reserve University, The MetroHealth System, Suite G240, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA
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Louchet M, Dussaux C, Luton D, Goffinet F, Bounan S, Mandelbrot L. Delayed-interval delivery of twins in 13 pregnancies. J Gynecol Obstet Hum Reprod 2020; 49:101660. [DOI: 10.1016/j.jogoh.2019.101660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/20/2019] [Accepted: 11/27/2019] [Indexed: 11/28/2022]
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Imachi Y, Hidaka N, Kai S, Hachisuga M, Kato K. Prolongation of Second Twin's Delivery Until Term: A Rare Case of Delayed-Interval Delivery. Clin Med Res 2019; 17:37-40. [PMID: 31160478 PMCID: PMC6546275 DOI: 10.3121/cmr.2019.1464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 11/18/2022]
Abstract
Although some cases describing delayed birth of the second twin have been published recently, delay of delivery beyond 36 weeks seems scarce. We report a case of delayed-interval delivery wherein prolongation of the second twin's delivery until term with a subsequent favorable infantile outcome. In this case, the stillbirth of the first twin occurred at 25 weeks' gestation. Prophylactic tocolysis was performed with ritodrine and magnesium sulfate, and a McDonald cerclage was performed 2 days after delivery of the first twin. Ampicillin and gentamicin were also administered for the purpose of prevention of intrauterine infection. No clinical sign of chorioamnionitis was found thereafter, and full term uneventful delivery was achieved. With this experience, we believe that delayed-interval delivery can be effective in prolonging gestation and should be an option if the first twin developed an extreme preterm delivery.
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Affiliation(s)
- Yuzo Imachi
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuhiro Hidaka
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shotaro Kai
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Hachisuga
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Cao S, Walter L, Valenzuela GJ, Roloff K. Delayed-Interval Delivery of Twin Gestation via Cesarean Section: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:739-742. [PMID: 31127078 PMCID: PMC6558120 DOI: 10.12659/ajcr.915196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Suzanne Cao
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Logan Walter
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, CA, USA
| | | | - Kristina Roloff
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, CA, USA
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Delayed interval delivery in multiple gestations: the Munich experience. Arch Gynecol Obstet 2018; 299:339-344. [PMID: 30386991 DOI: 10.1007/s00404-018-4959-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/26/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate delayed interval deliveries in multiple gestations in regard of delayed interval and neonatal survival and to provide a protocol. METHODS Data of multiple pregnancies with delayed interval delivery at a tertiary maternity unit between 2002 and 2017 were collected. Contraindications for evaluation of a delay of the delivery of the remaining child were: severe maternal blood loss, poor maternal general condition, preeclampsia, placental abruption, fetal distress, serious congenital malformations of the remaining child, chorioamnionitis, and premature rupture of membranes of the second fetus. A total of 14 cases was included in this retrospective monocentric analysis. RESULTS The cohort comprised nine twin and five triplet pregnancies. Mean gestational age at delivery of the first fetus was 21 + 6 and 26 + 0 of the retained fetus, respectively. The earliest delivery of the first fetus was at 15 + 2 weeks. The mean interval of the delay was 29.3 days (2-82 days). Mortality of the first fetuses was 53.3%, while it was 17.6% for the retained fetuses. Maternal outcome was good in general: two cases of major blood loss occurred with the necessity of a blood transfusion. CONCLUSION Delayed interval delivery is a reasonable approach in cases of an imminent preterm birth in multiple gestations which can be performed with a good fetal outcome and limited maternal risks. The situation when this procedure may be an option always comes unexpected. Therefore, the team of perinatologists should keep it in mind as one potential therapeutic approach. In addition, a standard protocol for the procedure should be established in the perinatal center.
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Koo YJ. Successful delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a twin pregnancy. Yeungnam Univ J Med 2018; 35:135-139. [PMID: 31620585 PMCID: PMC6784672 DOI: 10.12701/yujm.2018.35.1.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/02/2018] [Accepted: 06/02/2018] [Indexed: 11/30/2022] Open
Abstract
There has been a significant increase in the number of multiple pregnancies that are associated with a high risk of preterm delivery among Korean women. However, to date, delayed-interval delivery in women with multiple pregnancy is rare. We report a case of delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a dichorionic diamniotic twin pregnancy. The patient presented with vaginal leakage of amniotic fluid at 16 weeks of gestation and was diagnosed with a preterm premature rupture of membranes. Three days later, the first twin was delivered, but the neonate died soon after. The second twin remained in utero, and we decided to retain the fetus in utero to reduce the morbidity and mortality associated with a preterm birth. The patient was managed with antibiotics and tocolytics. Cervical cerclage was not performed. The second twin was delivered vaginally at 34 weeks and 5 days of gestation, 128 days after the delivery of the first-born fetus. This neonate was healthy and showed normal development during the 1-year follow-up period. Based on our experience with this case, we propose that delayed-interval delivery may improve perinatal survival and decrease morbidity in the second neonate in highly selected cases.
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Affiliation(s)
- Yu-Jin Koo
- Department of Obstetrics and Gynecology, Yeungnam University College of Medicine, Daegu, Korea
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Farghali M, Abdelazim I, Abdelrazek K. Delayed second twin delivery: benefits and risks. J Matern Fetal Neonatal Med 2017; 32:1626-1632. [PMID: 29198155 DOI: 10.1080/14767058.2017.1413547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND An increasing number of reports describe the delayed second twin delivery for days, or weeks with good results in the majority of the cases, and different survival rate between centers, without reported randomized controlled trials (RCTs). OBJECTIVES This study was designed to evaluate the suggested management of the delayed second twin delivery in the Sabah Maternity Hospital regarding its outcome, possible risks, and benefits. PATIENTS AND METHODS Forty-seven twin pregnancies with preterm labor (PTL) of the first fetus between 20-30 weeks, and delayed delivery of the second twin were included in this study. Studied women signed informed consent about the possible risks of keeping the live fetus in the hostile intrauterine environment, and benefits of the prolonged gestation for the second twin. Throughout the conservative treatment of the second twin, the studied women were hospitalized with regular follow up for infections, consumptive coagulopathy parameters, and wellbeing of the second twin. RESULTS There was significant difference in the gestational age at delivery between the first and second twin (22.6 ± 3.4 versus 34.3 ± 2.5 weeks; respectively, p = .01). There was significant difference in the birth weight between the first and second twin (435 ± 91.2 versus 1472 ± 61.5 g; respectively, p = .004). The rate of the cesarean delivery was significantly high during delivery of the second twin compared with the first twin (23.4% (11/47) versus 0% (0/47); respectively, p = .0001) with high survival rate for the second twin (85.1% (40/47)) after the delayed second twin delivery. CONCLUSIONS The birth weight, the gestational age, and the survival rate of the studied second twin significantly increased after the suggested management of the delayed second twin delivery.
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Affiliation(s)
- Mohamed Farghali
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Ain Shams University , Cairo , Egypt
| | - Ibrahim Abdelazim
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Ain Shams University , Cairo , Egypt
| | - Khaled Abdelrazek
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Ain Shams University , Cairo , Egypt
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Benito Vielba M, De Bonrostro Torralba C, Pallares Arnal V, Herrero Serrano R, Tejero Cabrejas EL, Campillos Maza JM. Delayed-interval delivery in twin pregnancies: report of three cases and literature review. J Matern Fetal Neonatal Med 2017; 32:351-355. [DOI: 10.1080/14767058.2017.1378336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marta Benito Vielba
- Departamento de Obstetricia y Ginecología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Victoria Pallares Arnal
- Departamento de Obstetricia y Ginecología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Rebeca Herrero Serrano
- Departamento de Obstetricia y Ginecología, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Daniilidis A, Mavromichali M, Klearhou N, Karagiannis T, Karagiannis V. Delayed Interval Delivery of a Second Twin: A Case Report and Review of the Literature. EUR J INFLAMM 2016. [DOI: 10.1177/1721727x0700500208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of diamniotic, dichorionic pregnancy that presented at 26 weeks with premature rupture of the first amniotic sac. Nine days later, premature labour and delivery of the first male twin took place, with death of the first twin. The second twin was left in utero. The management included combination of tocolytics, antibiotics and cervical cerclage. Caesarean section was performed 48 days later, at 34 weeks due to breech presentation and contractions. We delivered a live male infant with apgar scores 4/1 and 7/5 and 1680 gr weight. The infant was discharged home 29 days later.
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Affiliation(s)
| | - M. Mavromichali
- First Department of Neonates Hippokratio University Hospital of Thessaloniki, Greece
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Yodoshi T, Tipton E, Rouse CA. A Case of Delayed Interval Delivery with a Successful Hospital Move. Case Rep Pediatr 2015; 2015:802097. [PMID: 26413366 PMCID: PMC4568053 DOI: 10.1155/2015/802097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/23/2015] [Indexed: 11/17/2022] Open
Abstract
This report is the first case of delayed interval twin delivery in which the first infant and mother survived without major morbidity following transport to another facility. In addition, this case is only the second report of asynchronous delivery in which both twins survived and neither suffered any major morbidity. A 30-year-old G5P1031 African American female with a diamniotic/dichorionic twin pregnancy presented to U.S. Naval Hospital Okinawa, Japan, at 22 + 5 weeks due to vaginal bleeding. At 23 + 2 weeks, Twin A was born secondary to advanced cervical dilation. Twin A's birth weight was 650 g with APGAR scores of 6 (1 min) and 7 (5 min). Following delivery of Twin A, Placenta A was left in utero with high ligation of the umbilical cord. Due to a scheduled hospital move, the mother and Twin A were transported to the new facility at Camp Foster. Three weeks later, Twin B was delivered at 26 + 4 weeks. Twin B's birth weight was 930 g with APGAR scores of 3 (1 min) and 7 (5 min). Both twins were discharged without IVH, PVL, ROP, or CLD. This case demonstrates the possibility of transporting both the mother and surviving infant A to a higher level of care prior to delivery of subsequent fetuses.
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Affiliation(s)
- Toshifumi Yodoshi
- Department of Pediatrics, United States Naval Hospital Okinawa, Camp Foster, Futenma, Ginowan, Okinawa, Japan
| | - Elizabeth Tipton
- Department of Obstetrics and Gynecology, United States Naval Hospital Okinawa, Camp Foster, Futenma, Ginowan, Okinawa, Japan
| | - Christopher A. Rouse
- Department of Neonatology, United States Naval Hospital Okinawa, Camp Foster, Futenma, Ginowan, Okinawa, Japan
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Ghorbani M, Moghadam S. A Triplet Pregnancy With Spontaneous Delivery of a Fetus at Gestational Age of 20 Weeks and Pregnancy Continuation of Two Other Fetuses Until Week 33. Glob J Health Sci 2015; 8:88-92. [PMID: 26383220 PMCID: PMC4803941 DOI: 10.5539/gjhs.v8n2p88] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/23/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The prevalence of pregnancies with triplet or more has been increased due to using assisted reproductive treatments. Meanwhile, multiple pregnancies have higher risks and long-term maternal-fetal complications compared to twin and singleton pregnancies. Delayed interval delivery (DID) is a new approach in the management of multiple pregnancies following delivery or abortion. The purpose of this paper is to evaluate the benefits of DID and present a case that used this method. METHODS This paper covers a report on a case of triplet pregnancy resulting from assisted reproductive techniques with spontaneous delivery of a fetus at gestational age of 20 weeks and the use of conservative DID for two other fetuses until the 33rd week. RESULTS In our case, the delivery of two other fetuses occurred spontaneously at gestational age of 33 weeks after the delivery of the first fetus at week 20. CONCLUSIONS Using DID is a useful and reliable method, but requires careful monitoring, especially in patients with a history of infertility.
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Delayed Interval Delivery following Early Loss of the Leading Twin. Case Rep Obstet Gynecol 2015; 2015:213852. [PMID: 25688311 PMCID: PMC4320913 DOI: 10.1155/2015/213852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 01/12/2015] [Indexed: 11/17/2022] Open
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.
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Doger E, Cakiroglu Y, Ceylan Y, Kole E, Ozkan S, Caliskan E. Obstetric and neonatal outcomes of delayed interval delivery in cerclage and non-cerclage cases: An analysis of 20 multiple pregnancies. J Obstet Gynaecol Res 2014; 40:1853-61. [DOI: 10.1111/jog.12435] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 02/20/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Emek Doger
- Department of Obstetrics and Gynecology; School of Medicine; Kocaeli University; Kocaeli Turkey
| | - Yigit Cakiroglu
- Department of Obstetrics and Gynecology; School of Medicine; Kocaeli University; Kocaeli Turkey
| | - Yasin Ceylan
- Department of Obstetrics and Gynecology; School of Medicine; Kocaeli University; Kocaeli Turkey
| | - Emre Kole
- Department of Obstetrics and Gynecology; School of Medicine; Kocaeli University; Kocaeli Turkey
| | - Sebiha Ozkan
- Department of Obstetrics and Gynecology; School of Medicine; Kocaeli University; Kocaeli Turkey
| | - Eray Caliskan
- Department of Obstetrics and Gynecology; School of Medicine; Kocaeli University; Kocaeli Turkey
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Neonatal outcome from triplet interval delayed delivery: a case report. Case Rep Obstet Gynecol 2014; 2013:451360. [PMID: 24383022 PMCID: PMC3872106 DOI: 10.1155/2013/451360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/08/2013] [Indexed: 11/17/2022] Open
Abstract
In the past decades, we have observed a large increase in the number of multifetal pregnancies, which is mainly associated with the introduction of assisted reproductive techniques. Even though neonatal intensive care of very premature infants has improved significantly, the risk of mortality and long-term morbidity is still much higher among these newborns. A longer interdelivery period may reduce perinatal mortality and morbidity. The authors report the case of a delayed interval delivery in trichorionic, triamniotic triplet pregnancy. After the labor of the first fetus in the 22nd week of gestation, a 75-day interval was achieved before the delayed delivery. To save the surviving fetuses, the umbilical cord was ligated at the cervical level immediately after the first delivery. The patient received antibiotics, tocolytics, and corticosteroids. A baby boy who weighed 1750 g and a girl who weighed 1700 g were successfully delivered by cesarean section in the 33rd week of pregnancy. The babies were discharged home at the age of 28 days. A follow-up examination 20 weeks later showed that their neurological development was normal and without any major problems. The maternal postpartum course was uneventful; the patient stayed in hospital taking care of the babies.
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Temur I. A twin pregnancy provided with ICSI, an abortion of the first fetus at the 18th week and live birth of the second fetus at the end of the 36th week: a case report and literature review. J Matern Fetal Neonatal Med 2013; 26:1355-8. [PMID: 23488587 DOI: 10.3109/14767058.2013.784253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this report was to evaluate and present the fourth longest delay among twin and multiple pregnancies described in the literature. METHODS How can we optimize the health of the remaining fetus or fetuses after spontaneous abortion of the first fetus in multiple pregnancies? By considering one of our cases, we try to answer that question in light of the published literature. RESULTS In our case, the second fetus was born at the end of the 36th week after abortion of the first fetus at the beginning of the 18th week. Delayed interval delivery was postponed 132 gestational days. CONCLUSIONS The implementation of delayed intentional delivery is a reliable and required approach especially for infertility patients when they are selected carefully and monitored closely.
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Affiliation(s)
- Ismail Temur
- Department of Obstetrics and Gynecology of Medical Faculty, University of Kafkas, Kars, Turkey.
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Delayed interval delivery of a second twin after the preterm labor of the first one in twin pregnancies: delayed delivery in twin pregnancies. Case Rep Obstet Gynecol 2012; 2012:573824. [PMID: 22762005 PMCID: PMC3384896 DOI: 10.1155/2012/573824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 05/14/2012] [Indexed: 11/17/2022] Open
Abstract
A diamnionic dichorionic twin pregnant women (due to in vitro fertilization) admitted to emergency department at the 21st week of gestation because of regular contractions. By gynecological examination, we observed 8 cm dilated cervix with 80% effacement. Amniotic membrane was also bulging through the cervix. After evaluation delivery of the presenting fetus occurred quickly. The baby's weight was 610 gr and no heart activity was detected. Placenta of the first fetus expulsed immediately. We decided to retain the second fetus to allow the improvement in the outcome. McDonald cerclage was performed and the patient treated with tocolytics and antibiotics, and she was continuously monitored up to the 28th week of pregnancy. After she was discharged in the 28th week, she was controlled weekly in obstetrics clinic. At the 36th gestational week which was 101 days after the cerclage procedure, 3639 g male fetus was delivered with cesarean section and had an uneventful neonatal course. Delayed-interval delivery is useful and acceptable therapeutic option for the management of the remaining fetus in twin pregnancies even after the expulsion of the placenta. Antibiotic and tocolytic administration with cervical cerclage application can be associated with longer interdelivery interval.
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Kaneko M, Kawagoe Y, Oonishi J, Yamada N, Sameshima H, Ikenoue T. Case report and review of delayed-interval delivery for dichorionic, diamniotic twins with normal development. J Obstet Gynaecol Res 2012; 38:741-4. [DOI: 10.1111/j.1447-0756.2011.01761.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sivertsen HF. [Delayed-interval delivery of twin 2]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:164-6. [PMID: 22278274 DOI: 10.4045/tidsskr.11.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Delayed-interval delivery of an in vitro-fertilized triplet pregnancy with premature rupture of membranes in the second trimester. Arch Gynecol Obstet 2009; 281:269-72. [PMID: 19847453 DOI: 10.1007/s00404-009-1172-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The incidence of multiple pregnancies is increasing with the availability of assisted reproductive techniques. Preterm labor and preterm rupture of membranes are major complications in such pregnancies. Preterm delivery of the first fetus is often followed by delivery of the remaining fetuses. However, conservative management in such circumstances might allow for fetal lung maturity in the remaining fetuses. CASE We present a case of conservative management of an in vitro-fertilized triplet pregnancy with early loss of the leading triplet. A 33-year-old woman in the 21st week of a triplet pregnancy delivered her one of the fetuses, 4 days after the preterm rupture of membranes. To save the surviving fetuses, ligation of the umbilical cord at the cervical level was performed. Patient received antibiotics, tocolytics and corticosteroids after then. The second and the third fetuses were successfully delivered by cesarean section in the 28th week of pregnancy, 43 days after the first fetus was born. CONCLUSION We can improve the life expectancy of the retained fetuses by conservative management using tocolytics, antenatal steroids to stimulate lung maturation and antibiotics following the delivery of the first fetus.
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Liang YL, Kuo TC, Hung KH, Chen TH, Wu MH. Oxytocin Antagonist for Repeated Implantationfailure and Delay of Delivery. Taiwan J Obstet Gynecol 2009; 48:314-6. [DOI: 10.1016/s1028-4559(09)60314-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstracts of the First World Congress on Twin Pregnancy. Venice, Italy. April 16-18, 2009. J Matern Fetal Neonatal Med 2009; 22 Suppl 1:20-70. [PMID: 19294582 DOI: 10.1080/14767050902777811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chandiramani M, Enguell H, Shennan AH. Transvaginal ultrasonographic assessment of cervical length following mid-trimester loss of one twin. J OBSTET GYNAECOL 2009; 29:60-1. [PMID: 19280502 DOI: 10.1080/01443610802628619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M Chandiramani
- Maternal and Fetal Research Unit, Division of Reproduction and Endocrinology, King's College London, St Thomas' Hospital, London.
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Arabin B, van Eyck J. Delayed-interval delivery in twin and triplet pregnancies: 17 years of experience in 1 perinatal center. Am J Obstet Gynecol 2009; 200:154.e1-8. [PMID: 19110229 DOI: 10.1016/j.ajog.2008.08.046] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 06/02/2008] [Accepted: 08/20/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE There are few prospective cohorts of delayed-interval delivery for twin and triplet pregnancies. Nonetheless, the procedure is an option to improve perinatal outcome. STUDY DESIGN A standard protocol was designed before candidates for delayed interval were managed by the 2 authors from 1991 to 2007. Perinatal as maternal outcomes were evaluated up to 1 year. RESULTS In 93 twin and 34 triplet pregnancies, the inclusion criteria were fulfilled; in 45 twin and 8 triplet pregnancies, there were contraindications to prolong pregnancy; and in 10 twin and 26 triplet pregnancies, asynchronous delivery was not possible because of immediate delivery of the remaining multiples. Thus, the procedure was performed in only 41% (38/93) of twin and 35% (12/34) of triplet pregnancies admitted with threatening early delivery. Among twin pregnancies, the mean delay was 19 (1-107) days. When the first delivery was less than 25 weeks, no first twin but 9 of 18 second twins (50%) survived (P < .001). Survival rate of first twins born beyond 25 weeks was 13 of 20 (65%) compared with 19 of 20 (95%) (P = .03) in corresponding second twins. In 7 of 12 triplet pregnancies with the first born less than 25 weeks, 2 of 14 remaining triplets survived after an interval of 118 days. Beyond 25 weeks, 3 of 5 first and 4 of 10 remaining triplets survived after intervals of 2-13 days (P = n.s.). Delay between second and third triplet was never longer than 2 days. Frequent maternal complications were chorioamnionitis (22%), postpartum hemorrhage, retained placenta (10%), and abruption (6%). CONCLUSION Our study provides data to assist physicians in the informed consent process when asynchronous delivery is considered and feasible.
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Bagga R, Keepanasseril A, Suri V. Is gestation greater than 28 weeks a contraindication to attempting delayed-delivery in twin pregnancies? J OBSTET GYNAECOL 2007; 27:734-5. [PMID: 17999309 DOI: 10.1080/01443610701667130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- R Bagga
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
Due to a surge in the availability of assisted reproductive techniques (ART), the incidence of multiple pregnancies is increasing. Preterm labor is a major complication in such pregnancies. Preterm delivery of the first fetus is often followed by delivery of the remaining fetuses. However, conservative management and delayed interval delivery in the remaining fetuses might allow for fetal lung maturity and would reduce perinatal morbidities. A 32-year-old female had a quadruplet pregnancy after receiving ART. Fetal reduction to triplet pregnancy was performed at 11 weeks of gestation. The remaining triplet pregnancy was stable until 29 weeks of gestation, when the first triplet was delivered after spontaneous rupture of membranes. Under intensive monitoring, the remaining 2 fetuses were delivered by cesarean section at 31 weeks of gestation. Only the first fetus had retinopathy after discharge. In conclusion, delayed interval delivery of the remaining fetuses should be attempted after preterm delivery of the first fetus.
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Affiliation(s)
- Sheng-Po Kao
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi Medical Center, Hualien City, Taiwan, ROC
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Shah S, Grey J, Bolisetty S. Delayed delivery interval between twins: a viable option? A case report. Aust N Z J Obstet Gynaecol 2006; 45:534-5. [PMID: 16401225 DOI: 10.1111/j.1479-828x.2005.00494.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Obstetrical complications unique to multiple gestations pose a number of unique challenges. The presence of more than one fetus complicates the diagnosis and management of a pregnancy when one fetus has a structural or chromosomal abnormality, intrauterine demise, preterm premature rupture of the membranes, or delivers prematurely. Similarly, the diagnosis and management of monoamniotic twins and conjoined twins is challenging. These obstetrical complications that are unique to multiple gestations require thorough counseling of the expectant parents, as well as care by physicians with expertise in the management of multiple gestations.
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Affiliation(s)
- George M Graham
- Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96826, USA.
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Abstract
This article reviews the common maternal complications encountered in multifetal gestations.
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Affiliation(s)
- Cynthia Gyamfi
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Mount Sinai School of Medicine, The Mount Sinai Hospital, 5 East 98th Street, 2nd floor, Box 1171, New York, NY 10029, USA.
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Oyelese Y, Ananth CV, Smulian JC, Vintzileos AM. Delayed interval delivery in twin pregnancies in the United States: Impact on perinatal mortality and morbidity. Am J Obstet Gynecol 2005; 192:439-44. [PMID: 15695984 DOI: 10.1016/j.ajog.2004.07.055] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To estimate the incidence of delayed interval delivery in twin pregnancies in the United States and evaluate the impact of delayed delivery on perinatal outcomes. STUDY DESIGN A population-based retrospective cohort study was performed using the U.S. "matched multiple birth" file (1995 to 1998), restricting our analysis to twin sets in which the first twin was delivered vaginally at 22 to 28 weeks (n = 4257). Outcomes examined included perinatal and infant mortality and small-for-gestational-age births. Outcomes of second twins in pregnancies that underwent delayed interval delivery of 1, 2, 3, and >/=4 weeks were compared with those in which both twins were delivered contemporaneously. RESULTS In this cohort, 6.1% (n = 258) of twins had delayed delivery (>/=1 week) of the second twin. Decreases in perinatal and infant mortality were observed only when the first twin was delivered at 22 to 23 weeks and when the delivery interval was </=3weeks. However, for intervals >/=4 weeks or when the first twin was delivered at 24 to 28 weeks (regardless of delivery interval), there was no benefit in perinatal or infant mortality. Delayed delivery of >/=4 weeks was associated with increased risk of small-for-gestational-age birth in the second twin, regardless of gestational age at delivery of the first. CONCLUSION When a first twin was delivered at 22 to 23 weeks, delayed delivery of the second twin was associated with reduced perinatal and infant mortality of the second twin if the interval was less than 3 weeks. Delayed delivery of the second twin when the first was delivered at >/=24 weeks had no benefit on mortality.
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Affiliation(s)
- Yinka Oyelese
- Division of Maternal-Fetal Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School/Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
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