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Eckel F, Klebermass-Schrehof K, Bago-Horvath Z, Farr A. Successful delayed interval delivery of a triplet pregnancy using conservative management. BMJ Case Rep 2023; 16:e254705. [PMID: 37714554 PMCID: PMC10510915 DOI: 10.1136/bcr-2023-254705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
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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Affiliation(s)
- Fanny Eckel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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2
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Cheung KW, Seto MTY, Wang W, Lai CWS, Kilby MD, Ng EHY. Effect of delayed interval delivery of remaining fetus(es) in multiple pregnancies on survival: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; 222:306-319.e18. [PMID: 31394069 DOI: 10.1016/j.ajog.2019.07.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The management of the pregnancy after delivery of the first fetus during a second-trimester miscarriage or very early preterm birth has not been well defined. OBJECTIVE The objective of the study was to evaluate whether delayed interval delivery of the remaining fetus(es) in twins/triplets is associated with improved survival, when compared with immediate delivery, after miscarriage or very preterm birth of the first fetus in multiple pregnancy. DATA SOURCES PubMed, MEDLINE, and Cochrane Library were systematically searched through January 2019. STUDY ELIGIBILITY CRITERIA (STUDY DESIGN, POPULATIONS, AND INTERVENTIONS): The following eligibility criteria applied: full-text original article; included at least 5 cases of delayed interval delivery for remaining fetus(es); and reported the survival rate of the first-born and the remaining fetus(es). STUDY APPRAISAL AND SYNTHESIS METHODS K.W.C. and W.W. searched, screened, and reviewed the articles. The quality of the studies was assessed according to the Strengthening the Reporting of Observational studies in Epidemiology checklist. If possible, data were stratified for assigned chorionicity. Effect sizes were pooled through a meta-analysis. RESULTS A total of 2295 published article and abstracts were identified. Only 16 studies met inclusion criteria. Meta-analysis of 492 pregnancies (432 twins [88%], 56 triplets [11%], 3 quadruplets and 1 quintuplets) showed that delayed interval delivery significantly improved the perinatal survival of remaining fetus(es) compared with the first born (odds ratio, 5.22, 95% confidence interval, 2.95-9.25, I2 = 53%), before 20+0 weeks (odds ratio, 6.32, 95% confidence interval, 1.99-20.13, I2 = 0%), between 20+0 and 23+6 weeks (odds ratio, 3.31, 95% confidence interval, 1.95-5.63, I2 = 0%), and after 24+0 weeks (odds ratio, 1.92, 95% confidence interval, 1.21-3.05, I2 = 0%), in dichorionic twin pregnancy (odds ratio, 14.89, 95% confidence interval, 6.19-35.84, I2 = 0%), and unselected triplet pregnancy (odds ratio, 2.33, 95% confidence interval, 1.02-5.32, I2 = 0%. ). Among the survivors, there were no significant differences in the short-term and long-term neonatal morbidities between the first-born and the remaining fetus(es). Serious maternal morbidity was reported in 39% of pregnancy after delayed interval delivery (71 of 183). In addition, 2 cases were managed by postpartum hysterectomy and 1 reported postoperative uterovaginal fistula. There were no recorded cases of maternal mortality. CONCLUSION Delayed interval delivery when a fetus has delivered in a multiple pregnancy is an effective management option to increase the survival rate of the remaining fetus(es). About 39% of women may experience morbidity following this management option.
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Affiliation(s)
- Ka Wang Cheung
- Department of Obstetrics and Gynecology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
| | - Mimi Tin Yan Seto
- Department of Obstetrics and Gynecology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Weilan Wang
- Department of Obstetrics and Gynecology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Carman Wing Sze Lai
- Department of Obstetrics and Gynecology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Mark D Kilby
- Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, United Kingdom; Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynecology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
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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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Giunta G, Fichera M, Caruso S, La Rosa B, Ferrara M, Iuculano A, Monni G, Cianci A. 35-Week twin delivery after embryo reduction at 11 weeks and subsequent expulsion of a dead foetus at 20. J OBSTET GYNAECOL 2018; 39:539-540. [PMID: 30370801 DOI: 10.1080/01443615.2018.1496075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Giuliana Giunta
- a Department of General Surgery and Medical Surgical Specialties , Obstetrics and Gynecology Unit, Policlinico G. Rodolico , University of Catania , Catania , Italy
| | - Michele Fichera
- a Department of General Surgery and Medical Surgical Specialties , Obstetrics and Gynecology Unit, Policlinico G. Rodolico , University of Catania , Catania , Italy
| | - Salvatore Caruso
- a Department of General Surgery and Medical Surgical Specialties , Obstetrics and Gynecology Unit, Policlinico G. Rodolico , University of Catania , Catania , Italy
| | - Beatrice La Rosa
- a Department of General Surgery and Medical Surgical Specialties , Obstetrics and Gynecology Unit, Policlinico G. Rodolico , University of Catania , Catania , Italy
| | - Martina Ferrara
- a Department of General Surgery and Medical Surgical Specialties , Obstetrics and Gynecology Unit, Policlinico G. Rodolico , University of Catania , Catania , Italy
| | - Ambra Iuculano
- b Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy , Microcitemico Pediatric Hospital , Cagliari , Italy
| | - Giovanni Monni
- b Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy , Microcitemico Pediatric Hospital , Cagliari , Italy
| | - Antonio Cianci
- a Department of General Surgery and Medical Surgical Specialties , Obstetrics and Gynecology Unit, Policlinico G. Rodolico , University of Catania , Catania , Italy
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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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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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7
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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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8
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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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9
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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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10
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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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11
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Emergency cervical cerclage after miscarriage of the first fetus in dichorionic twin pregnancies: obstetric and neonatal outcomes of delayed delivery interval. Arch Gynecol Obstet 2012; 286:613-7. [DOI: 10.1007/s00404-012-2362-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
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12
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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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13
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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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14
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Khan R, Indrees M, Palamarchuk T, Dawlatly B. Successful term delivery of the second twin after rescue cervical cerclage at 21 weeks with the placenta of the first twinin situ. J OBSTET GYNAECOL 2009; 28:346-7. [DOI: 10.1080/01443610802048065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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16
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Prolongation of triplet pregnancy after abortion of the presenting fetus. Arch Gynecol Obstet 2008; 279:61-3. [PMID: 18379805 DOI: 10.1007/s00404-008-0633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 03/13/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND The management of delayed delivery in a triplet pregnancy is described. CASE A 25-year-old woman with an in vitro fertilization pregnancy aborted the presenting fetus at 19th gestational week. As she decided to carry on, cervical cerclage, tocolysis and antimicrobial prophylaxis were performed. The remaining fetuses survived until 29th gestational week. CONCLUSION Prolongation of multiple pregnancies after the abortion of presenting fetuses is a possible approach, which is especially justified in women with a history of infertility.
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Shah AN, Farrall L, Goswami K. Intentional delay in delivery of second twin to improve neonatal outcome. J OBSTET GYNAECOL 2006; 26:162-4. [PMID: 16483981 DOI: 10.1080/01443610500460018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A N Shah
- Department of Obstetrics and Gynaecology, University Hospital of Coventry and Warwickshire, Coventry CV3 5PH, UK.
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18
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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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Rosbergen M, Vogt HP, Baerts W, van Eyck J, Arabin B, van Nimwegen-Hamberg JMM, van Lingen RA. Long-term and short-term outcome after delayed-interval delivery in multi-fetal pregnancies. Eur J Obstet Gynecol Reprod Biol 2005; 122:66-72. [PMID: 16154041 DOI: 10.1016/j.ejogrb.2004.11.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/26/2004] [Accepted: 11/19/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess a possible difference in the short- and long-term outcome between infants born from a delayed-interval delivery. STUDY DESIGN We included all neonates that were either born between November 1991 and December 2000 from a delayed-interval delivery in the Isala Clinics, Zwolle, The Netherlands, or admitted to our clinic after birth. Gestational age, time of delay, birth weight, mortality, morbidity, long-term development and adverse outcome were compared between groups. Moreover, the 'delayed infants' group was compared to a reference group. The following statistical tests were used: prevalence ratio, the Wilcoxon test and the t-test. RESULTS Twenty-nine delivery-delaying procedures were successfully performed in our hospital. We included 17 sets of twins and 3 sets of triplets. The mean delay of 19.6 days accounted for a significant increase in birth weight and neonatal survival as well as a decrease in adverse outcome and presence of a number of disease; a negative effect on long-term development could not be shown. The reference group showed less sepsis than the delayed infants group. No serious maternal complications were observed. CONCLUSION Delaying the delivery of a second or third infant has a positive effect on short-term outcome. Long-term outcome is comparable to children with the same gestational age.
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MESH Headings
- Birth Weight
- Case-Control Studies
- Delivery, Obstetric/adverse effects
- Delivery, Obstetric/statistics & numerical data
- Female
- Gestational Age
- Humans
- Infant Mortality
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/mortality
- Male
- Netherlands/epidemiology
- Pregnancy
- Pregnancy Outcome
- Pregnancy, Multiple
- Prevalence
- Time Factors
- Triplets
- Twins
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Affiliation(s)
- Meinke Rosbergen
- Princess Amalia Department of Pediatrics, Division of Neonatology, Isala Clinics, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands
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20
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Cristinelli S, Fresson J, André M, Monnier-Barbarino P. Management of Delayed-Interval Delivery in Multiple Gestations. Fetal Diagn Ther 2005; 20:285-90. [PMID: 15980642 DOI: 10.1159/000085087] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Accepted: 05/04/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Proving that delayed delivery is possible, debating its modality, suggesting a guideline for its managing. METHOD Six cases of delayed delivery were treated at the Maternity Hospital of Nancy, between 1979 and 2001, and the results were compared to a literature review of 148 found thanks to Medline database. RESULTS Delayed delivery reduces the risk of neonatal mortality and morbidity. The delivery interval is 2-93 (median 7) days in our experience and 2-153 (median 31) days in the literature. After the first expulsion, cerclage was used in 60% of the cases, prophylactic tocolysis and antibiotics in 79% and 71%, respectively. CONCLUSION There is no consensus for its management but it must be performed with precise conditions to restrict both maternal and fetal risks. Our study is supporting an interventionist attitude with cerclage, prophylactic tocolysis and antibiotics.
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Affiliation(s)
- Stéphane Cristinelli
- Materno-Fetal Medicine Department and Neonatal Intensive Care, Maternity Hospital, Nancy, France
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Abstract
PURPOSE OF REVIEW Emergency uterine relaxation may decrease the morbidity and mortality of the mother and her fetus. Obstetricians need to be aware of the indications, pharmacological methods, efficacy and complications of acute tocolysis. RECENT FINDINGS A variety of pharmacological agents are used to suppress uterine contractions. Newer agents like cyclo-oxygenase-2 inhibitors (Celecoxib) and oxytocin antagonists (atosiban) have been introduced into clinical practice with the hope of reducing the complications of betasympathomimetic drugs. Calcium-channel blockers are used but there are recent case reports of acute pulmonary oedema with the use of these agents. Most of the trials on tocolytics have been for suppression of preterm labour. Nitroglycerin has been used successfully as an acute tocolytic during Caesarean sections and manual removal of placenta. A recent randomized trial has suggested that atosiban may be an option for acute intrapartum tocolysis. This article will review the recent literature on the use of pharmacological agents used to suppress uterine contractions in emergency obstetric situations. SUMMARY Acute tocolysis may be indicated in antepartum, intrapartum and postpartum periods for a variety of indications. It may help reduce maternal and fetal morbidity and mortality. The ideal tocolytic is yet to be developed. Research is needed to develop a drug which has a greater uterospecificity with no effect on other organs with a rapid onset and a short duration of action.
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Affiliation(s)
- Edwin Chandraharan
- Division of Obstetrics and Gynaecology, St. George's Hospital Medical School, London SW17 0RE, UK
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22
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Ghulmiyyah LM, Wehbe SA, Schwartz SA, Sills ES. Successful obstetrical management of 110-day intertwin delivery interval without cerclage: counseling and conservative management approach to extreme asynchronous twin birth. BMC Pregnancy Childbirth 2004; 4:23. [PMID: 15581427 PMCID: PMC539248 DOI: 10.1186/1471-2393-4-23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2004] [Accepted: 12/06/2004] [Indexed: 11/13/2022] Open
Abstract
Background This report describes a patient counseling approach and non-surgical management of a dichorionic-diamniotic twin pregnancy where delivery of the second twin followed the delivery of the first by 110 days. Case presentation An early transvaginal sonogram at 19 1/2 weeks suggested cervical dilation with protruding amniotic membranes. Tocolytic and antibiotic therapy was initiated; no cerclage was placed. Spontaneous rupture of membranes and cord prolapse occurred 48 h later, resulting in delivery of a stillborn female infant. Conservative management was offered after counseling for possible risks associated with maternal sepsis, need for extended hospitalization, potential for hysterectomy and death. The cervix appeared closed after delivery and the umbilical cord was ligated, with subsequent spontaneous cord retraction in utero. Reassuring fetal status was observed for twin B without evidence of contractions or chorioamnionitis. A viable male infant (2894 g) was delivered vaginally at 35 1/2 weeks. Conclusions This report outlines a counseling approach useful for patients with premature delivery of one twin, and presents application of conservative obstetrical management principles for the aftercoming twin even when delivery interval is extreme.
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Affiliation(s)
- Labib M Ghulmiyyah
- Department of Obstetrics and Gynecology, Atlanta Medical Center; Atlanta GA 30321 USA
| | - Salim A Wehbe
- Department of Obstetrics and Gynecology, Atlanta Medical Center; Atlanta GA 30321 USA
| | - Seth A Schwartz
- Department of Obstetrics and Gynecology, Atlanta Medical Center; Atlanta GA 30321 USA
| | - Eric Scott Sills
- Georgia Reproductive Specialists LLC/Reproductive Endocrinology Division, Department of Obstetrics and Gynecology, Atlanta Medical Center, Atlanta GA 30321 USA
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23
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Livingston JC, Livingston LW, Ramsey R, Sibai BM. Second-Trimester Asynchronous Multifetal Delivery Results in Poor Perinatal Outcome. Obstet Gynecol 2004; 103:77-81. [PMID: 14704248 DOI: 10.1097/01.aog.0000103995.79536.9c] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study is to estimate the maternal and fetal morbidities associated with asynchronous delivery. METHODS A review of maternal and fetal medical records was performed at 2 tertiary care centers over 12 years. Charts were identified by the International Classification of Diseases, 9th Revision, Clinical Modification codes for twin and triplet gestations. Asynchronous delivery was defined as an active attempt (tocolysis and/or emergent cerclage placement) to increase latency between delivery of the first fetus and subsequent fetuses. RESULTS Fourteen cases of asynchronous delivery were identified out of 96922 deliveries including 1352 pregnancies complicated by multifetal gestation. The occurrence rate of asynchronous delivery was 0.14 per 1000 births. The etiology of preterm birth of the first fetus in 12 (86%) of 14 cases was second-trimester rupture of membranes. The mean gestational age for delivery of the first fetus was 21.+/- 2.0 weeks. All women received tocolysis and intravenous antibiotics. Two of 3 attempts at cerclage placement were successful. Median latency obtained was 2 days (range less than 1-70 days). There was 1 survival of a first born. There were 19 retained fetuses, 2 died in utero, 10 died between birth and day 57 of life, and 7 survived (37%; 95% confidence interval 16%, 62%) until hospital discharge. Six of 7 survivors had major sequelae from prematurity. One of 19 fetuses was discharged without major sequelae (5%; 95% confidence interval 0%, 25%). Maternal morbidity included 2 placental abruptions and 8 cases of infectious morbidity including 1 case of septic shock. CONCLUSION Attempts at asynchronous deliveries are uncommon and are associated with a high rate of perinatal death. Most fetal survivors have significant damage from preterm birth.
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Affiliation(s)
- Jeffrey C Livingston
- Department of Obstetrics and Gynecology, Carilion Center for Women and Children, Roanoke, Virginia 24013, USA.
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24
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Zhang J, Johnson CD, Hoffman M. Cervical cerclage in delayed interval delivery in a multifetal pregnancy: a review of seven case series. Eur J Obstet Gynecol Reprod Biol 2003; 108:126-30. [PMID: 12781398 DOI: 10.1016/s0301-2115(02)00479-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine whether cervical cerclage after the first delivery prolongs the inter-delivery interval in delayed interval deliveries. STUDY DESIGN We identified 66 case reports and case series of delayed interval delivery published between 1880 and 2002. We selected seven case series that identified all cases of delayed interval delivery in their institutions during a specified period. RESULTS Despite routine use of broad-spectrum prophylactic antibiotics, the average incidence of clinical intrauterine infection after the first delivery was 36% (95% confidence interval (CI): 26-46%). The incidence of maternal sepsis was 4.9% (95% CI: 0.2-9.6%). Studies in which cerclage was infrequently used reported a shorter inter-delivery interval compared to studies where cerclage was used in all cases (median is equal to 9 days versus 26 days, respectively, P<0.001) despite similar gestational ages at the first delivery, types of antibiotics, tocolytics, and incidence of infection. After controlling for other factors, the use of cerclage did not significantly increase the risk of intrauterine infection (adjusted relative risk=1.1, 95% CI: 0.4-3.5). CONCLUSION Cervical cerclage after the first delivery is associated with a longer inter-delivery interval without increasing the risk of intrauterine infection.
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Affiliation(s)
- Jun Zhang
- Epidemiology Branch, National Institute of Child Health and Human Development, National Institutes of Health, NIH Building 6100, Room 7B03, Bethesda, MD 20892, USA.
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