Yeungnam Univ J Med.  2018 Jun;35(1):135-139. 10.12701/yujm.2018.35.1.135.

Successful delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a twin pregnancy

Affiliations
  • 1Department of Obstetrics and Gynecology, Yeungnam University College of Medicine, Daegu, Korea. yujinkoo@yu.ac.kr

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.

Keyword

Delayed-interval delivery; Multiple pregnancy; Twin pregnancy; Premature birth

MeSH Terms

Amniotic Fluid
Anti-Bacterial Agents
Cerclage, Cervical
Female
Fetus*
Follow-Up Studies
Humans
Infant, Newborn
Membranes
Mortality
Pregnancy
Pregnancy, Multiple
Pregnancy, Twin*
Premature Birth
Rupture
Tocolytic Agents
Twins*
Anti-Bacterial Agents
Tocolytic Agents

Figure

  • Fig. 1. Transvaginal ultrasonographic examination shows images of the cervix. The functional length of the cervix was observed to be 2.7 cm with Y-shape funneling at the time of the patient’s visit to the emergency room at 16 weeks of gestation (A). The cervical length was observed to have normalized to 3.2 cm without funneling 8 days after the delivery of the first-born fetus (B).


Reference

1. Korean Statistical Information Service. Birth and death statistics twin birth [Internet]. Daejeon: KOSIS;2016. [cited 2018 May 5]. http://kosis.kr/index/index.do.
2. Livingston JC, Livingston LW, Ramsey R, Sibai BM. Second-trimester asynchronous multifetal delivery results in poor perinatal outcome. Obstet Gynecol. 2004; 103:77–81.
Article
3. Carson JL. Twins born with an interval of forty-four days. Br Med J. 1880; 1:242.
4. 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.
Article
5. Fayad S, Bongain A, Holhfeld P, Janky E, Durand-Réville M, Ejnes L, et al. Delayed delivery of second twin: a multicentre study of 35 cases. Eur J Obstet Gynecol Reprod Biol. 2003; 109:16–20.
Article
6. Wittmann BK, Farquharson D, Wong GP, Baldwin V, Wadsworth LD, Elit L. Delayed delivery of second twin: report of four cases and review of the literature. Obstet Gynecol. 1992; 79:260–3.
7. Kalchbrenner MA, Weisenborn EJ, Chyu JK, Kaufman HK, Losure TA. Delayed delivery of multiple gestations: maternal and neonatal outcomes. Am J Obstet Gynecol. 1998; 179:1145–9.
Article
8. Oyelese Y, Ananth CV, Smulian JC, Vintzileos AM. Delayed interval delivery in twin pregnancies in the United States: Impact on perinatal mortality and morbidity. Am J Obstet Gynecol. 2005; 192:439–44.
Article
9. Lee EH, Sohn JA, Lee JY, Choi EJ, Lee JA, Choi CW, et al. The impact of delayed interval delivery on neonatal mortality and morbidity. J Korean Soc Neonatol. 2011; 18:111–6. Korean.
Article
10. Rosbergen M, Vogt HP, Baerts W, van Eyck J, Arabin B, van Nimwegen-Hamberg JM, et al. Long-term and short-term outcome after delayed-interval delivery in multi-fetal pregnancies. Eur J Obstet Gynecol Reprod Biol. 2005; 122:66–72.
Article
11. van Doorn HC, van Wezel-Meijler G, van Geijn HP, Dekker GA. Delayed interval delivery in multiple pregnancies. Is optimism justified? Acta Obstet Gynecol Scand. 1999; 78:710–5.
12. 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.
Article
13. 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.
Article
14. 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.
Article
15. Farkou LJ, Sabin ED, Heyborne KD, Lindsay LG, Porreco RP. Delayed-interval delivery: extended series from a single maternal-fetal medicine practice. Am J Obstet Gynecol. 2000; 183:1499–503.
Article
16. Ahn HS. A successful delayed-interval delivery without cerclage operation after one fetal delivery in a case of twin pregnancy. Korean J Perinatol. 2009; 20:395–400.
17. Sosa C, Althabe F, Belizán J, Bergel E. Bed rest in singleton pregnancies for preventing preterm birth. Cochrane Database Syst Rev. 2004; (1):CD003581.
Article
18. Trivedi AN, Gillett WR. The retained twin/triplet following a preterm delivery--an analysis of the literature. Aust N Z J Obstet Gynaecol. 1998; 38:461–5.
Article
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