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Delayed interval delivery in twin pregnancy A case report Author names have to be listed here
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Introduction
Materials and Methods
The incidence of multiple-fetus pregnancies has dramatically increased due to assisted reproductive technology. As a result, second-trimester preterm labor, PPROM, and fetal losses are commonly encountered by Obstetricians. Despite advances in prenatal care, preterm delivery is associated with a high risk of neonatal mortality and morbidity.1 Gestational age is the most important predictor of neonatal survival in extremely low birth weight babies.2 At these extremely premature gestational ages, even small increases in gestational age have tremendous impact on neonatal survival.2 Thus, a goal of pregnancy management is to prolong gestation and maximize fetal maturity.
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Aims and Objectives
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3. Delayed interval delivery in twin pregnancy A case report Author names have to be listed here
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Observation and Results (Case Details for Case Study)
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Mrs. XXX, aged 40 and a known case of primary infertility had undergone successful IVF with a twin pregnancy. She had a history of 3 failed prior IVF and heterotopic pregnancy in last IVF cycle, which ended in laparoscopic segmental salpingectomy of the right Fallopian tube. She developed severe hypertension & the intra-uterine pregnancy ended as an IUD at 26 weeks of gestation. Patient conceived with IVF again (donor embryo transfer) and was diagnosed as twin live intrauterine pregnancies. Growth and viability of both the fetuses were followed up on the USG. Patient had history of spotting at 7 weeks of gestation hence started on Inj. Susten. Patient was also given vaginal progesterones. Patient was started on LMWH (low molecular weight heparin) once spotting resolved completely in view of previous history of sudden hypertension and IUD. There was a small retroplacental clot on sonography at 9 weeks of gestation. There was a left uterine artery notching at 12 weeks of gestation. Anomaly scan at 18 weeks of gestation showed concordance in growth with no gross anomaly. Patient came with the complaints of leaking PV after 5 days with frank leaking per vagina with one fetus in vagina. Sonography showed one fetus in vagina with absent liquor in the lower sac but intact membranes and adequate liquor in the upper sac.

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Delayed interval delivery in twin pregnancy A case report Author names have to be listed here
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Discussion
Conclusions
In 1957, Abrams published the first reported case of delayed interval delivery in a patient with normally shaped uterus. 3 Since then, several case reports and case series have been published. 4-7 Although these have clearly demonstrated that delayed interval delivery can be successfully achieved, no standard protocol for management exists because of its very rare occurrence. The use of prolonged bed rest, cervical cerclage, tocolytics, antibiotics, and corticosteroids composes complex, frequently debated issues. 8 In all cases, the umbilical cord of the first-born twin is cut as high as possible inside the cervix. 9 It is remarkable that the remaining placenta and umbilical cord of the expelled fetus do not seem to initiate intrauterine infection Infection is often implicated with preterm labor and preterm birth. All possibilities of infections must be ruled out before attempting delayed interval delivery. In particular, clinical chorio-amnionitis must be absent as this can lead to uterine contractions and subsequent delivery.
-Generally obstetricians land up removing second fetus also in this kind of situation due to ongoing bleeding, uterine contractions and chance of infection.
-Careful management of the pregnancy may yield success for delaying delivery of second fetus for those having precious pregnancy.
-Delayed interval pregnancy appears to be safe for the mother and salvageable for the fetuses.
References