Delayed-interval Delivery in Multiple Pregnancies: Short- and Long-term Outcome

Purpose Multiple pregnancies are at higher risk of preterm birth due to premature labor, cervical insufficiency, or premature rupture of membranes. However, both children do not necessarily have to be born and exposed to the morbidity of prematurity depending on the age of gestation. One option is a delayed-interval delivery with reduction of morbidity and mortality for the second twin, considering maternal morbidity. Methods Retrospective study of delayed-interval deliveries in multiple pregnancies with evaluation of short-and long-term outcome from 2003 to 2020 at the Women’s and Children’s Hospital of the University Hospital < blinded>. Results In 17 cases, the delivery of the second twin could be prolonged, on average for 36 days. Pregnancies with delivery of the first twin before 22 weeks of gestation had a longer prolongation than pregnancies with delivery of the first twin after 22 weeks (53 vs. 22 days). In cases where a cerclage was placed, on average a longer prolongation interval (45 vs. 19 days) was observed. The short- and long-term follow-up of the second twin is comparable to the usual complication rate of premature birth. Conclusion Multiple pregnancies endangered by premature birth can be successfully prolonged for the second twin without serious maternal morbidity. If the first twin is born before 22 weeks of gestation and a cerclage is performed afterwards, a longer prolongation interval appears.

Spontaneous fetal reduction in triplets and prolongation of twin pregnancy for 111 days as an outpatient: a case report

Background Multiple gestation has been on the rise because of advancement in assisted reproductive technology. Triplet pregnancy is associated with fetal loss and preterm birth as its major complications. Spontaneous triplet pregnancy is rare. In the case of fetal loss, delayed interval delivery has been used to achieve delivery of the retained fetuses. There is no common approach to delayed interval delivery. Case A 31-year-old East African lady with spontaneous triplet pregnancy presented to our institution at gestation age of 19 weeks with features of threatened miscarriage. One fetus was miscarried, and delayed interval delivery was done as an outpatient. At gestation age of 35 weeks, she delivered healthy twins by cesarean section. Conclusion Delayed interval delivery improves neonatal outcomes of high-order pregnancy after fetal loss even in a resource-limited setting.