Successfully delayed delivery of second twin after early second trimester rupture of membranes of the first twin: a case report

Twin pregnancies are high-risk pregnancies accompanied with multiple complications, such as: spontaneous abortion, preterm rupture of the membranes, preterm delivery, intrauterine death of one or both twins etc. There is no consensus about the management of twin pregnancies complicated with preterm rupture of the membranes of one twin and risk of preterm delivery. These cases are rarely found in the literature. We present a case of a 35 years old patient, hospitalized in a tertiary level institution, because of a diamniotic dichorionic twin pregnancy complicated with preterm rupture of the membranes of the first twin at 19 weeks of gestation. She had one delivery with Caesarean section 16 years ago. In consultation with the patient induction of labor was done with delivery of the first twin, a death male fetus. After that, antibiotics and tocolytic therapy were administrated and the patient remained in the hospital about one week. The patient was discharged at home with regular control of her condition and condition of the fetus. The patient was again hospitalized at 33 weeks of gestation with uterine contractions on cardiotocography. After administration of corticosteroid therapy for fetal lung maturation she delivered spontaneously the second twin in a good condition and she was discharged from hospital after 16 days. In twin pregnancies clinicians must think about delayed interval delivery of the second twin, after delivery of the first twin, with an aim to increase chances for survival, especially for pregnancies less than 30 weeks of gestation.

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Obstetrical Profile of Twin Pregnancies: A Retrospective Review of 11 Years (1969–1979) at Hôpital Notre-Dame, Montréal, Canada

Acta geneticae medicae et gemellologiae twin research ◽

10.1017/s0001566000008230 ◽

1982 ◽

Vol 31 (3-4) ◽

pp. 149-155 ◽

Cited By ~ 8

Author(s):

Xavier De Muylder ◽

Jean-Marie Moutquin ◽

Marie Françoise Desgranges ◽

Bernard Leduc ◽

Francisco Lazaro-Lopez

Keyword(s):

Mortality Rate ◽

Preterm Delivery ◽

Perinatal Care ◽

Fetal Mortality ◽

Neonatal Deaths ◽

Complete Extraction ◽

Before And After ◽

Twin Pregnancies ◽

Second Twin ◽

Spontaneous Delivery

Four hundred and thirty-four twins delivered from 220 women at Notre-Dame Hospital were studied during a period of 11 years (1969–1979). The maternal, fetal, and neonatal outcome was compared before and after 1974, the year ultrasonography and other changes in perinatal care were introduced in our institution. Early diagnosis occurred more frequently after 1974, together with increased antenatal hospitalization. Preeclampsia and hepatic cholestasis occurred in 19.5% and 9.5% of women, respectively. Preterm delivery occurred in 42.2% of the cases. The corrected fetal mortality rate was 30.2/1,000 and corrected perinatal mortality rate was 74.9/1,000. About 90% of the neonatal deaths occurred in infants born before 36 weeks. Internal version and complete extraction of the second twin increased the neonatal mortality sixfold compared to spontaneous delivery. Availability of ultrasound examination significantly reduced preterm delivery.

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Efficacy and Safety of Corticosteroids’ Administration for Pulmonary Immaturity in Anticipated Preterm Delivery

Current Pharmaceutical Design ◽

10.2174/1381612826666201207102910 ◽

2020 ◽

Vol 26 ◽

Author(s):

Themistoklis Dagklis ◽

Ioannis Tsakiridis ◽

Georgios Papazisis ◽

Apostolos Athanasiadis

Keyword(s):

Preterm Delivery ◽

Neonatal Morbidity ◽

Fetal Lung ◽

Respiratory Morbidity ◽

Efficacy And Safety ◽

Antenatal Corticosteroids ◽

Lung Maturation ◽

Early Neonatal Mortality ◽

Elective Cesarean ◽

Fetal Lung Maturation

: Preterm delivery represents the major cause of neonatal morbidity and mortality. Respiratory morbidity is the primary cause of early neonatal mortality and disability. The administration of antenatal corticosteroids, in cases of imminent preterm delivery, can enhance fetal lung maturation and reduce the incidence of respiratory distress syndrome, leading to improved neonatal outcomes. Hence, for those cases, a single course of antenatal corticosteroids from 24 up to 34 gestational weeks should be offered. Betamethasone and dexamethasone are the most widely used drugs, with similar effectiveness and a recommended dosage of 24mg in divided doses, over a 24-hour period. However, there is an ongoing debate regarding the gestational age of administration. Some obstetric societies recommend their administration even at 22 weeks of gestation. Conflicting is also their usefulness in late preterm cases (between 34 and 37 weeks) or in cases of elective cesarean delivery at term. The use of repeated courses of corticosteroids may be considered in specific cases, however, concerns on the long-term outcomes of repeated courses beyond 34 gestational weeks have been raised. The scope of this narrative review was to synthesize available evidence on efficacy and safety of corticosteroids administration during the antenatal period for pulmonary immaturity in cases of anticipated preterm delivery.

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Comparison of Fetal Lung Maturation in Preterm Singleton and Twin Pregnancies

American Journal of Perinatology ◽

10.1055/s-2007-999256 ◽

1992 ◽

Vol 9 (05/06) ◽

pp. 326-328 ◽

Cited By ~ 14

Author(s):

Hung Winn ◽

Roberto Romero ◽

Andreas Roberts ◽

Haitang Liu ◽

John Hobbins

Keyword(s):

Fetal Lung ◽

Lung Maturation ◽

Fetal Lung Maturation ◽

Twin Pregnancies

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Management of Twin Labor

Acta geneticae medicae et gemellologiae ◽

10.1017/s1120962300024380 ◽

1972 ◽

Vol 22 (S1) ◽

pp. 70-72

Author(s):

Z. Sternadel ◽

A. Lysikiewicz

Keyword(s):

Maternal Mortality ◽

Perinatal Mortality ◽

Apgar Score ◽

Optimum Time ◽

Neonatal Deaths ◽

Uterine Contractions ◽

The Mean ◽

Twin Pregnancies ◽

Second Twin ◽

Stimulation Of

Investigations were carried out on 68 labors in twin pregnancies. It was observed that, upon stimulation of uterine contractions by means of oxytocic agents, mainly oxytocin (90%), the mean duration of labor was significantly reduced to about 7 hours, and prolonged labors (over 20 hours) were completely eliminated. The time between delivery of the first and the second baby is now below 30 minutes in all cases, and this is regarded as the optimum time. No neonatal deaths were observed in labors taking place at term. The condition of the newborns at birth was estimated in accordance with the Apgar score and it was found that the second newborn scored worse than the first one; a fact definitely related to the higher proportion of operative procedures during delivery of the second twin (48%) as compared to the first one (10%).The authors stress that, owing to the introduction of the method of conducting twin labors, maternal mortality has been completely eliminated and twin perinatal mortality has been markedly reduced: from about 28% in 1923-1962 to about 10% in recent years.

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Prediction of intrauterine death and severe preterm delivery in twin pregnancies discordant for major fetal abnormality

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2014.01.003 ◽

2014 ◽

Vol 175 ◽

pp. 115-118 ◽

Cited By ~ 2

Author(s):

Helenice J. Kang ◽

Adolfo W. Liao ◽

Maria L. Brizot ◽

Rossana P.V. Francisco ◽

Vera L.J. Krebs ◽

...

Keyword(s):

Preterm Delivery ◽

Intrauterine Death ◽

Fetal Abnormality ◽

Twin Pregnancies

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Fetal lung maturation in diabetic pregnancy

Acta Endocrinologica ◽

10.1530/acta.0.111s0101 ◽

1986 ◽

Vol 113 (3_Suppl) ◽

pp. S101-S106 ◽

Cited By ~ 7

Author(s):

Olof Tydén ◽

Ulf J. Eriksson ◽

Christian Berne

Keyword(s):

Amniotic Fluid ◽

Metabolic Control ◽

Preterm Delivery ◽

Experimental Studies ◽

Fetal Lung ◽

Diabetic Pregnancy ◽

Phosphatidyl Glycerol ◽

Lung Maturation ◽

Metabolic Derangement ◽

Lung Maturity

Abstract. The increased incidence of the idiopathic respiratory distress syndrome (IRDS) in infants of diabetic mothers may be explained by preterm delivery and asphyxia but the metabolic derangement per se may also be responsible for the inadequate production of surfactant. Experimental studies of the underlying mechanisms in the lungs of fetuses of pregnant diabetic rats have shown a decreased formation of the two major surfactant phospholipids disaturated phosphatidyl choline and phosphatidyl glycerol. In addition, the activities of key enzymes responsible for the production of these phospholipids are decreased in the fetal lung tissue. Inadequate utilization of pulmonary glycogen for surfactant biosynthesis has also been observed. Furthermore, experimental studies support that other changes than fetal hyperinsulinaemia are needed to produce a state of disturbed surfactant production. In human diabetic pregnancy strict metabolic control allows the fetal lungs to mature in a near-normal fashion. The presence of phosphatidyl glycerol in the amniotic fluid seems to be the best available predictor of lung maturity in diabetic pregnancy, in which both the lecithin/sphingomyelin ratio and amniotic fluid cytology may result in false-positive and false-negative values. The trend towards extension of delivery to term will undoubtedly diminish the need for estimation of fetal lung maturity by amniocentesis. Avoiding preterm delivery and adhering to strict metabolic control of the maternal diabetes would be expected to decrease the neonatal respiratory problems in diabetic pregnancy.

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Nicardipin Associated Pulmonary Edema : A Severe Complication of Tocolysis - A Case Report

International Journal of Medicine and Surgery ◽

10.15342/ijms.v5ir.200 ◽

2018 ◽

Vol 5 ◽

Author(s):

Youssef Motiaa ◽

Wafae El Otmani ◽

Nezha El Oudghiri ◽

Anas Saoud Tazi

Keyword(s):

Pulmonary Edema ◽

Preterm Labor ◽

Channel Blocker ◽

Fetal Lung ◽

Pulmonary Angiography ◽

Acute Pulmonary Edema ◽

Lung Maturation ◽

Computed Tomography Pulmonary Angiography ◽

Uterine Contractions ◽

Fetal Lung Maturation

In preterm labor, tocolytics are used to stop uterine contractions and to allow the administration of corticosteroids for fetal lung maturation, nicardipine is a calcium channel blocker increasingly used for this indication. Several adverse effects have been reported during tocolysis using nicardipine, one of the most serious complications is Acute Pulmonary Edema. We report a case of a parturient who was admitted at 28 weeks pregnancy for preterm labor and developed a respiratory failure two days following tocolysis with nicardipine. Echocardiography and Computed Tomography Pulmonary Angiography (CTPA) ruled out a pulmonary embolism and a decompensated heart disease. The patient received oxygen therapy and diuresis for Acute Pulmonary Edema with favorable outcome.The purpose of this paper is to discuss the risk factors for occurrence of pulmonary edema after tocolysis, importance of etiologic investigation to exclude differential diagnoses and therapeutic options for management of this complication.

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Intra-amniotic LPS and antenatal betamethasone: inflammation and maturation in preterm lamb lungs

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00338.2011 ◽

2012 ◽

Vol 302 (4) ◽

pp. L380-L389 ◽

Cited By ~ 53

Author(s):

Elke Kuypers ◽

Jennifer J. P. Collins ◽

Boris W. Kramer ◽

Gaston Ofman ◽

Ilias Nitsos ◽

...

Keyword(s):

Bronchoalveolar Lavage ◽

Preterm Delivery ◽

Gestational Age ◽

Lung Inflammation ◽

Fetal Lung ◽

Inflammatory Cells ◽

Toll Like Receptor ◽

Lung Maturation ◽

Toll Like Receptor 2 ◽

Combined Exposures

The proinflammatory stimulus of chorioamnionitis is commonly associated with preterm delivery. Women at risk of preterm delivery receive antenatal glucocorticoids to functionally mature the fetal lung. However, the effects of the combined exposures of chorioamnionitis and antenatal glucocorticoids on the fetus are poorly understood. Time-mated ewes with singleton fetuses received an intra-amniotic injection of lipopolysaccharide (LPS) either preceding or following maternal intramuscular betamethasone 7 or 14 days before delivery, and the fetuses were delivered at 120 days gestational age (GA) (term = 150 days GA). Gestation matched controls received intra-amniotic and maternal intramuscular saline. Compared with saline controls, intra-amniotic LPS increased inflammatory cells in the bronchoalveolar lavage and myeloperoxidase, Toll-like receptor 2 and 4 mRNA, PU.1, CD3, and Foxp3-positive cells in the fetal lung. LPS-induced lung maturation measured as increased airway surfactant and improved lung gas volumes. Intra-amniotic LPS-induced inflammation persisted until 14 days after exposure. Betamethasone treatment alone induced modest lung maturation but, when administered before intra-amniotic LPS, suppressed lung inflammation. Interestingly, betamethasone treatment after LPS did not counteract inflammation but enhanced lung maturation. We conclude that the order of exposures of intra-amniotic LPS or maternal betamethasone had large effects on fetal lung inflammation and maturation.

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The risk of neonatal respiratory morbidity according to the etiology of late preterm delivery

Journal of Perinatal Medicine ◽

10.1515/jpm-2015-0191 ◽

2017 ◽

Vol 45 (1) ◽

Author(s):

Sung Ae Kim ◽

Seung Mi Lee ◽

Byoung Jae Kim ◽

Chan-Wook Park ◽

Joong Shin Park ◽

...

Keyword(s):

Preterm Birth ◽

Preterm Delivery ◽

Fetal Lung ◽

Late Preterm ◽

Respiratory Morbidity ◽

Preterm Neonates ◽

Lung Maturation ◽

Study Population ◽

Fetal Lung Maturation ◽

Fetal Compromise

AbstractObjective:The risk of neonatal respiratory morbidity between indicated deliveries vs. spontaneous deliveries has not been consistent in previous studies, in spite of the traditional belief that chronic intrauterine stress might have protective effect on fetal lung maturation. We hypothesized that the heterogeneous etiology of indicated preterm delivery may obscure the relationship between the etiologies of preterm birth and neonatal respiratory morbidity. To address this issue, we divided the indicated preterm birth (PTB) into medically-indicated (without fetal compromise) PTB and maternal/fetal-indicated PTB, and compared the neonatal respiratory morbidity according to the etiology of late PTB.Study design:Neonatal respiratory morbidities were examined in neonates who were delivered between 34+0 and 36+6 weeks of gestation according to the etiology of PTB: 1) medically-indicated PTB (but without fetal compromise), 2) maternal/fetal-indicated PTB, or 3) spontaneous PTB such as preterm labor or preterm premature rupture of membranes.Results:A total of 710 late preterm neonates were included in the study population, including 31 cases of medically-indicated PTB, 202 cases of maternal/fetal-indicated PTB, and 477 cases of spontaneous PTB. The rate of composite respiratory morbidity in cases of medically-indicated PTB is higher than both maternal/fetal-indicated PTB and spontaneous PTB (19% in medically-indicated PTB, 6% in maternal/fetal-indicated PTB, and 7% in spontaneous PTB). This difference between medically-indicated PTB and maternal/fetal-indicated PTB remained significant after adjustment for confounding variables.Conclusion:The medically-indicated PTB is associated with highest risk of neonatal respiratory morbidity in late PTB.

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