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Cui H, Li H, Yin Z. Emergency cervical cerclage in delayed-interval delivery of twin pregnancies: a scoping review. BMC Pregnancy Childbirth 2024; 24:323. [PMID: 38671355 PMCID: PMC11046782 DOI: 10.1186/s12884-024-06515-x] [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] [Received: 11/20/2023] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The protocol for delayed-interval delivery of the second twin in twin pregnancies has not been standardized. Cervical cerclage is often performed, but its use is debated. To conduct a scoping review on cervical cerclage for prolonging the intertwin delivery interval and improving second twin survival and maternal outcomes after preterm delivery or spontaneous abortion of the first twin in twin pregnancies. METHODS Seven Chinese and English language databases were searched from inception to March 1, 2023, including PubMed, The Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP Chinese Science Journal Database, and Sinomed. Relevant observational studies that assessed the effectiveness of the use of cervical cerclage in delayed-interval delivery of twins were screened and selected, and raw data were extracted, and descriptive statistics and chi-square analysis were performed. RESULTS A total of 102 articles were retrieved. After screening and exclusion of duplicate and irrelevant articles, 22 articles meeting the inclusion criteria were obtained. Studies in which cerclage was performed reported longer intertwin delivery intervals than those that did not perform cerclage, and the difference was statistically significant. The cerclage group also tended to have lower rates of chorioamnionitis and maternal complications, but the difference between the two groups was not statistically significant. CONCLUSION After excluding patients with contraindications, emergency cervical cerclage can be considered in cases of spontaneous abortion of the first twin in twin pregnancies to prolong the gestation and improve the prognosis of the remaining fetus until it becomes viable and increases its birth weight.
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Affiliation(s)
- Hong Cui
- Department of Gynaecology and Obstetrics, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Huan Li
- Department of Gynaecology and Obstetrics, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning, 110004, People's Republic of China.
| | - Zhihua Yin
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, People's Republic of China.
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Gadeer RH, Alhinai A, Fung-Kee-Fung K, Werlang A. Delayed-Interval Delivery in Multiple Pregnancy: A Single-Center Experience of Five Cases. AJP Rep 2024; 14:e156-e161. [PMID: 38784941 PMCID: PMC11115972 DOI: 10.1055/s-0044-1787112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/27/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives To describe the obstetric management and perinatal outcomes in multiple pregnancies with delayed-interval delivery (DID) of the cotwin in a tertiary hospital. Methods This is a retrospective chart review of all cases of DID between December 2021 and 2022 at The Ottawa Hospital. Five cases of DID were identified and reviewed to obtain information on obstetric management and maternal-neonatal outcomes. We included eligible twins and triplets. No multiples were excluded. We obtained ethics approval for this case series. Results Four sets of dichorionic diamniotic twins and one trichorionic triamniotic triplet were included. Our patients were admitted between 17 3/7 and 21 5/7 weeks of gestation. We achieved an interval delivery range between 1 and 36 days. Four out of six multiples did not survive in DID. The two surviving newborns were born at 23 0/7 and 23 2/7 , stayed in the neonatal intensive care unit (NICU) for 111 and 131 days, discharged with a weight of 3,594 and 2,743 g, respectively. All DID cases were delivered spontaneously except for two patients that required augmentation due to maternal sepsis. Conclusion Despite the high risk of maternal, fetal, and neonatal morbidity and mortality, if delivery of the first twin occurs before 20 gestational weeks, DID could be considered in selected cases to improve outcomes for the cotwin.
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Affiliation(s)
- Roaa Hassan Gadeer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Newborn Care, The Ottawa Hospital, Ontario, Canada
| | - Ahlam Alhinai
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Newborn Care, The Ottawa Hospital, Ontario, Canada
| | - Karen Fung-Kee-Fung
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Newborn Care, The Ottawa Hospital, Ontario, Canada
| | - Ana Werlang
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Newborn Care, The Ottawa Hospital, Ontario, Canada
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Li Y, Chu R, Li Y, Zhang M, Ma Y. Delayed interval delivery in a quadruplet pregnancy: a case report and literature review. BMC Pregnancy Childbirth 2023; 23:353. [PMID: 37189021 DOI: 10.1186/s12884-023-05647-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/25/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND As the rate of multiple pregnancies increases, delayed interval delivery (DID) is increasingly being implemented to improve perinatal outcomes. But there are no international guidelines for DID in multiple pregnancies. We report a case of DID in a quadruplet pregnancy and review the relevant literature to summarize the management of DID in multiple pregnancies. CASE PRESENTATION A 22-year-old woman, 22 2/7 weeks' gestation, with quadruplets, was admitted to the hospital for a first cervical cerclage due to cervical dilation. Twenty-five days later, it was found that the cervix was dilated again, so after removing the cervical cerclage, the first quadruplet was delivered vaginally (25 6/7 weeks), and a second cervical cerclage was performed. Four days later, due to re-dilation of the cervix, after removal of the cervical cerclage, the second quadruplet was delivered vaginally (26 3/7 weeks), followed by a third cervical cerclage. Six days later, the pregnancy was terminated by cesarean section due to fetal distress, and the third and fourth quadruplets were delivered (27 2/7 weeks). The patient had no postoperative complications, and all four infants were treated in the neonatal intensive care unit and discharged successfully. CONCLUSION This case emphasizes that comprehensive management of delayed interval delivery can improve perinatal outcomes in multiple pregnancies, including anti-infection, tocolytic therapy, practice to promote fetal lung, and cervical cerclage.
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Affiliation(s)
- Yanan Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong Province, China
| | - Ran Chu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong Province, China
| | - Yarong Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong Province, China
| | - Meiling Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong Province, China
| | - Yuyan Ma
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong Province, China.
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4
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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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Nohuz E, Albaut M, Szymanowski M, Brunel A, Lemery D, Vendittelli F. Response to IA Abdelazim's et al. letter about the article of E. Nohuz et al. [Combined Endoloop® ligation and pessary cerclage devices for delayed interval delivery: A first case report, Taiwan J Obstet Gynecol. 2019; 58:579-580]. Taiwan J Obstet Gynecol 2021; 59:631. [PMID: 32653150 DOI: 10.1016/j.tjog.2020.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Erdogan Nohuz
- Hospices Civils de Lyon, Department of Obstetrics and Gynecology, Femme Mere Enfant Hospital, University Hospital Center, 59 boulevard Pinel, 69500, Lyon, France.
| | - Maël Albaut
- Department of Obstetrics and Gynecology, General Hospital, Thiers, France
| | - Marie Szymanowski
- Department of Obstetrics and Gynecology, General Hospital, Thiers, France
| | - Angelique Brunel
- Department of Obstetrics and Gynecology, General Hospital, Thiers, France
| | - Didier Lemery
- Department of Obstetrics and Gynecology, University Hospital, Clermont-Ferrand, France
| | - Françoise Vendittelli
- Department of Obstetrics and Gynecology, University Hospital, Clermont-Ferrand, France; University Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
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6
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McDonnell BP, Martin A. Delayed interval delivery of preterm multiples: experience from a large specialized twin center. J Matern Fetal Neonatal Med 2020; 35:2227-2233. [PMID: 32586161 DOI: 10.1080/14767058.2020.1782375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Preterm delivery is a recognized complication of twins and higher order multiple pregnancies. Delayed interval delivery is a rarely used management option for pre- or peri-viable preterm labor in these pregnancies. We describe the management and outcomes of 7 delayed interval deliveries over an 8-year period in a large specialized twin center.Study design: A retrospective cohort study of all delayed interval deliveries of preterm multiples from 2009 to 2016, defined as >24 h between deliveries of twins 1 and 2.Results: During the study period there were 68,845 deliveries with 1377 multiple pregnancies comprising 1331 sets of twins and 46 sets of higher-order multiples. 7 of these were identified as being delayed interval deliveries - 6 twin pregnancies and 1 triplet pregnancy. The mean gestation of delivery of the first infant was 23 + 4 weeks (range 22 + 3 to 30 + 0 weeks) with a mean interval of 10 days (range 1.5-39 days). Outcomes for the first infant delivered were poor, with 5 out of 7 (71%) dying from extreme prematurity. However, out of the remaining twins or triplets, 5/8 (62%) survived. The mean gestation of delivery of the remaining infant (or infants in the triplets) was 25 + 0 weeks (range 23 + 0 to 30 + 2 weeks). Only one mother (16%) developed clinical chorioamnionitis requiring iatrogenic delivery of the remaining infant with subsequent neonatal death due to extreme prematurity. There were no cases of severe maternal morbidity - however, there was one maternal death in the cohort due to an amniotic fluid embolism. The neonatal follow up of the surviving infants to date is mostly normal.Conclusion: Delayed interval deliveries can offer hope for survival for the remaining infant(s) with an acceptable risk profile to the mother. Close clinical and laboratory monitoring is essential to reduce the risk of severe maternal morbidity.
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Affiliation(s)
| | - Aisling Martin
- Coombe Women and Infants University Hospital, Dublin, Ireland
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7
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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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8
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Nan Y, Wenyuan H, Beejadhursing R, Qingling K, Wanjiang Z, Dongrui D, Suhua C, Ling F, Fuyuan Q, Xun G. Obstetric and neonatal outcomes of delayed interval delivery in cerclage: A retrospective study. Eur J Obstet Gynecol Reprod Biol 2019; 246:45-49. [PMID: 31945710 DOI: 10.1016/j.ejogrb.2019.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/22/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Delayed delivery is sometimes selectively performed in twin pregnancy when the first birth occurs inevitably in order to improve the prognosis and decrease the morbidity and mortality of the second twin. The aim of this study is to explore the maternal and fetal outcomes of pregnancies in which cerclage is carried out following the loss of first fetus in twin gestation for delayed interval delivery. METHODS Three cases of delayed-interval delivery of dichorionic-diamniotic twin pregnancies were reported in our center between 2017 and 2018 and were retrospectively analyzed. Once the first twin was delivered, the second twin was left in utero and the patient underwent in utero percutaneous umbilical cord ligation, antibiotics, tocolytic therapy and cervical cerclage. RESULTS Mean gestational age at delivery of the first fetuses was 21.6 ± 2.9 weeks and 24.8 ± 4.0 weeks for the remaining fetuses, respectively. The mean interval of the delay was 22 days (4-50 days). Mortality of the first fetus was 66.7%, and the retained one was 33.3%. In general, maternal outcome was good, one patient experienced postpartum hemorrhage and placenta accreta. However neonatal aftermath was generally not favorable, probably due to extreme prematurity. CONCLUSIONS Cervical cerclage after the first delivery could prolong the pregnancy until an adequate gestational age at which an enhanced prognosis and better perinatal outcome for the second twin can be achieved.
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Affiliation(s)
- Yu Nan
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Hu Wenyuan
- Department of Obstetrics and Gynecology, Taikang Tongji (Wuhan) Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Rajluxmee Beejadhursing
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Kang Qingling
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Zeng Wanjiang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Deng Dongrui
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Chen Suhua
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Feng Ling
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Qiao Fuyuan
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
| | - Gong Xun
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China.
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9
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Nohuz E, Albaut M, Szymanowski M, Brunel A, Lemery D, Vendittelli F. Combined Endoloop ® ligation and pessary cerclage devices for delayed interval delivery: A first case report. Taiwan J Obstet Gynecol 2019; 58:579-580. [PMID: 31307757 DOI: 10.1016/j.tjog.2019.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Erdogan Nohuz
- Hospices Civils de Lyon, Department of Obstetrics and Gynecology, Femme Mère Enfant Hospital, University Hospital Center, 59 boulevard Pinel, 69500, Lyon-Bron, France; Department of Obstetrics and Gynecology, General Hospital, Thiers, France.
| | - Maël Albaut
- Department of Obstetrics and Gynecology, General Hospital, Thiers, France
| | - Marie Szymanowski
- Department of Obstetrics and Gynecology, General Hospital, Thiers, France
| | - Angélique Brunel
- Department of Obstetrics and Gynecology, General Hospital, Thiers, France
| | - Didier Lemery
- Department of Obstetrics and Gynecology, University Hospital, Clermont-Ferrand, France
| | - Françoise Vendittelli
- Department of Obstetrics and Gynecology, University Hospital, Clermont-Ferrand, France; University Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
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10
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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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11
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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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12
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Daskalakis G, Fotinopoulos P, Pergialiotis V, Theodora M, Antsaklis P, Sindos M, Papantoniou N, Loutradis D. Delayed interval delivery of the second twin in a woman with altered markers of inflammation. BMC Pregnancy Childbirth 2018; 18:206. [PMID: 29866067 PMCID: PMC5987477 DOI: 10.1186/s12884-018-1848-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 05/23/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Delayed interval intertwin delivery rates are expected to rise during the next years as potent and targeted tocolytic agents are employed and antenatal surveillance methods become more sophisticated and specific in predicting the critical delivery timepoint of optimal perinatal outcome. CASE PRESENTATION We present a case of delayed intertwin delivery after delivery of the first twin due to premature prelabor rupture of the membranes. Maternal serum White Blood Cells and C-Reactive Protein levels remained high until delivery of the second twin (34 days after the first was delivered), although maternal temperature remained constant. The mother underwent close antenatal surveillance and she was hospitalized. She had an uncomplicated delivery of the second twin at 29+ 2 weeks by cesarean section due to an abnormal Non-Stress Test. CONCLUSION We strongly suggest future evaluation of maternal serum inflammatory markers among these rare cases as these could predict intraamniotic infection.
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Affiliation(s)
- George Daskalakis
- 1st Department of Obstetrics and Gynecology, Athens Medical School , Alexandra General Hospital, 9 Aristeidou Street , 17563 P. Faliro, Athens, Greece
| | - Panagiotis Fotinopoulos
- 1st Department of Obstetrics and Gynecology, Athens Medical School , Alexandra General Hospital, 9 Aristeidou Street , 17563 P. Faliro, Athens, Greece
| | - Vasilios Pergialiotis
- 3rd Department of Obstetrics and Gynecology, Athens Medical School, Attikon General Hospital, Athens, Greece
| | - Mariana Theodora
- 1st Department of Obstetrics and Gynecology, Athens Medical School , Alexandra General Hospital, 9 Aristeidou Street , 17563 P. Faliro, Athens, Greece
| | - Panagiotis Antsaklis
- 1st Department of Obstetrics and Gynecology, Athens Medical School , Alexandra General Hospital, 9 Aristeidou Street , 17563 P. Faliro, Athens, Greece
| | - Michail Sindos
- 1st Department of Obstetrics and Gynecology, Athens Medical School , Alexandra General Hospital, 9 Aristeidou Street , 17563 P. Faliro, Athens, Greece
| | - Nikolaos Papantoniou
- 3rd Department of Obstetrics and Gynecology, Athens Medical School, Attikon General Hospital, Athens, Greece
| | - Dimitrios Loutradis
- 1st Department of Obstetrics and Gynecology, Athens Medical School , Alexandra General Hospital, 9 Aristeidou Street , 17563 P. Faliro, Athens, Greece
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13
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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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14
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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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Raposo MI, Cardoso M, Ormonde M, Stokreef S, Correia L, Pereira A. Obstetric Management of Delayed-Interval Delivery. Case Rep Womens Health 2017; 16:11-13. [PMID: 29594002 PMCID: PMC5842964 DOI: 10.1016/j.crwh.2017.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 09/29/2017] [Indexed: 11/16/2022] Open
Abstract
The delayed-interval delivery is a rare, flexible and complex procedure. In light of these facts, there is no consensus on the best approach to achieve it successfully. This case report is of an asynchronous delivery, in a twin pregnancy, with a 32-day interval between births of siblings. Our obstetric management at a critical gestational age improved the outcome of the second newborn. The probability of success of delayed-interval delivery depends on the proper selection of the candidates, the appropriate active management and the continuous monitoring for early detection of complications. Asynchronous delivery may be lifesaving for the second twin. The proper selection of candidates for delayed-interval delivery is crucial. The success depends on the individualized management. Continuous monitoring is essential for early detection of complications.
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Affiliation(s)
- Maria Inês Raposo
- Department of Obstetrics and Gynecology, Hospital of Divino Espírito Santo of Ponta Delgada, EPER, São Miguel, Azores, Portugal
| | - Mariana Cardoso
- Department of Obstetrics and Gynecology, Hospital of Divino Espírito Santo of Ponta Delgada, EPER, São Miguel, Azores, Portugal
| | - Mariana Ormonde
- Department of Obstetrics and Gynecology, Hospital of Divino Espírito Santo of Ponta Delgada, EPER, São Miguel, Azores, Portugal
| | - Sarah Stokreef
- Department of Pediatrics, Hospital of Divino Espírito Santo of Ponta Delgada, EPER, São Miguel, Azores, Portugal
| | - Laura Correia
- Department of Obstetrics and Gynecology, Hospital of Divino Espírito Santo of Ponta Delgada, EPER, São Miguel, Azores, Portugal
| | - Andrea Pereira
- Department of Obstetrics and Gynecology, Hospital of Divino Espírito Santo of Ponta Delgada, EPER, São Miguel, Azores, Portugal
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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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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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Ndoua CCN, Fattouh M, Mirdat S, Kemfang JD, Kasia JM, Di Pace C. [Deferred twin birth: report of two cases observed at the maternity of Creil Hospital Centre]. Pan Afr Med J 2014; 19:104. [PMID: 25722777 PMCID: PMC4337348 DOI: 10.11604/pamj.2014.19.104.4617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 09/06/2014] [Indexed: 11/11/2022] Open
Abstract
L'accouchement gémellaire différé définit un accouchement en deux ou plusieurs temps, avec l'expulsion spontanée d'un premier fœtus au deuxième ou au troisième trimestre, et un prolongement de la grossesse pour obtenir un accouchement du ou des fœtus restants en gestation le plus proche possible du terme. Cette technique est mise en œuvre, en cas de grossesse gémellaire pour prévenir la prématurité du fœtus restant après l'expulsion très prématurée d'un premier fœtus. Nous rapportons deux cas observés à la maternité du Centre Hospitalier de Creil avec des latences respectives de 3 et 52 jours pour lesquels nous discutons la prise en charge.
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Affiliation(s)
- Claude Cyrille Noa Ndoua
- Centre Hospitalier de Creil, Creil, France ; Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé I, Yaoundé, Cameroun ; Centre Hospitalier de Recherche et d'Application de la Chirurgie Endoscopique et de la Reproduction Humaine, Cameroun
| | | | | | - Jean Dupont Kemfang
- Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé I, Yaoundé, Cameroun ; Centre Hospitalier de Recherche et d'Application de la Chirurgie Endoscopique et de la Reproduction Humaine, Cameroun
| | - Jean Marie Kasia
- Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé I, Yaoundé, Cameroun ; Centre Hospitalier de Recherche et d'Application de la Chirurgie Endoscopique et de la Reproduction Humaine, Cameroun
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20
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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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21
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Zimmer M, Fuchs T, Pomorski M, Geneja R, Krolak-Olejnik B, Lachowska M, Paluszynska D. Extremely delayed delivery of second and third fetus in spontaneous triplet pregnancy. J OBSTET GYNAECOL 2013; 33:524. [PMID: 23815214 DOI: 10.3109/01443615.2013.783005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M Zimmer
- Department of Gynecology and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
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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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23
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Abstract
We describe two cases of delayed delivery in dichorionic, diamniotic pregnancies, where we used an Endoloop ligature to clamp the umbilical cord with excellent maternal and fetal long-term outcome.
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24
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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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25
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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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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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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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28
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Salim R, Shalev E. Endoloop ligation of the umbilical cord of an aborted fetus in a twin gestation. Int J Gynaecol Obstet 2009; 105:270. [PMID: 19272599 DOI: 10.1016/j.ijgo.2009.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 01/05/2009] [Accepted: 01/27/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Raed Salim
- Obstetrics and Gynecology, HaEmek Medical Center, Afula and Rappaport Faculty of Medicine, Technion, Haifa, Israel
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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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30
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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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Viswanathan M. Tailoring systematic reviews to meet critical priorities in maternal health in the intrapartum period. Paediatr Perinat Epidemiol 2008; 22 Suppl 1:10-7. [PMID: 18237347 DOI: 10.1111/j.1365-3016.2007.00907.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Health care practitioners and researchers commonly call for greater reliance on evidence as a means to achieve improvement in quality of care. Systematic reviews provide a means to accelerate the use of evidence-based clinical interventions and public health practices. The extent to which these time- and resource-intensive systematic reviews currently address critical maternal health priorities in the intrapartum period is unclear. This analysis summarises key maternal health and research priorities, maps these priorities to existing reviews, identifies gaps in the literature that can be addressed with systematic reviews, and highlights key methodological concerns in conducting systematic reviews. The analysis draws on published data on maternal morbidities and an overview of 108 systematic reviews in Medline in the past 5 years using the MeSH terms 'Delivery, Obstetric,' to draw the links between health priorities, research priorities, existing evidence and missing evidence. Key causes of morbidity during labour and delivery in the United States include haemorrhage, pre-eclampsia and eclampsia, obstetric trauma and infection. Analyses of maternal morbidity and mortality suggest that key concerns include racial and ethnic disparities in health outcomes and the prevention of adverse events. Systematic reviews, however, generally tend to focus on the reduction of harms associated with interventions, are frequently limited to randomised designs, and do not address issues of health disparities. The results suggest that advances in evidence-based care in maternal health require that systematic reviews address issues of prevention of adverse events, include a larger variety of study designs when necessary and pay closer attention to health disparities.
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Affiliation(s)
- Meera Viswanathan
- Research Triangle Institute International, Research Triangle Park, NC 27709-2194, USA.
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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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Sébahoun V, Helmlinger C, Vayssière C, Boudier E, Langer B, Nisand I. Twin pregnancies and delayed-interval delivery: Report of two cases with delivery after 35 weeks’ gestation. Eur J Obstet Gynecol Reprod Biol 2005; 122:248-50. [PMID: 16054289 DOI: 10.1016/j.ejogrb.2005.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Revised: 05/04/2005] [Accepted: 05/17/2005] [Indexed: 11/16/2022]
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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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35
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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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Abstract
Preventing preterm delivery remains a major challenge for the 21st century. The cervix plays a fundamental role in supporting a pregnancy and preventing ascending infection from the lower genital tract. Infection is associated with early preterm delivery in about half of cases. Whatever the aetiology of preterm delivery, dilation of the cervix is a common endpoint, and transvaginal scanning of the cervix now provides a good predictor of early preterm delivery in both high- and low-risk women. Changes in the cervix are related to the detection of fetal fibronectin in the vagina, which is also an accurate predictor of delivery. However, the role of intervention in at-risk women is unclear. Elective cerclage is only effective in a minority of women, and the evidence to support its use is limited. It is currently being evaluated whether indicated cerclage, dictated by ultrasound findings, is beneficial.
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Affiliation(s)
- Andrew Shennan
- Maternal and Fetal Research Unit, GKT School of Medicine, King's College, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
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37
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Zhang J, Hamilton B, Martin J, Trumble A. Delayed interval delivery and infant survival: a population-based study. Am J Obstet Gynecol 2004; 191:470-6. [PMID: 15343223 DOI: 10.1016/j.ajog.2004.03.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Delaying delivery of the remaining fetus(es) in a multifetal pregnancy is feasible in some cases. However, the impact of this procedure on infant survival is unclear. STUDY DESIGN We used the US 1995-1998 Matched Multiple Birth File. We identified 200 twin pregnancies in which the first twin was delivered between 17 and 29 weeks of gestation and the second twin was delivered 2 or more days later. We individually matched the delayed deliveries with 374 twin pregnancies in which the second twin was delivered on the same or next calendar day. Perinatal outcomes and infant survival were compared between the delayed and nondelayed twins. RESULTS Among the 200 pregnancies with delayed delivery, the mean gestational age at first delivery was 23 weeks and the median duration of delay was 6 days (ranging from 2-107 days). One week of delay in delivery was associated with an increase in infant birth weight of 131 g on average (95% CI: 115-147 g). Moreover, 56% of the delayed second twins survived to 1 year of age, whereas only 24% of the nondelayed second twins survived to 1 year of age (P <.001). However, 11% of the second twin in delayed delivery (95% CI: 6%-16%) experienced fetal death before 24 weeks. CONCLUSION Delayed delivery of the remaining fetus(es) before 30 weeks of gestation for 2 or more days was associated with improved infant survival.
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Affiliation(s)
- Jun Zhang
- Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health/DHHS, Bethesda, MD, USA
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38
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Current awareness in prenatal diagnosis. Prenat Diagn 2003; 23:772-8. [PMID: 14533646 DOI: 10.1002/pd.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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