A Case of Delayed Interval Delivery with a Successful Hospital Move

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.

Delayed-Interval Delivery in Dichorionic Twin Pregnancies: A Case Report of 154 Latency Days

“…10 The long-term outcome and neurological development seems to be comparable to those of children with the same gestational age. 9,19 In the case reported here, the fetal short-term outcomes were optimal, with no neonatal morbidity.…”

“…Cerclage, tocolysis, hospitalization, and antibiotic therapy are all still controversial procedures. 1,2,[7][8][9]13 The use of prophylactic cerclage is the most controversial issue among the recommended procedures. 7,8,11,13,14 For some authors, it is a routine procedure, while for others it is recommended only if the etiology of the spontaneous delivery is cervical insuffiency.…”

Obstetric Management of Delayed-Interval Delivery

“…For each day of delaying the delivery between the 23 rd and 26 th WG there is an improvement of 3% in infant survival [12] , which justifies the pertinence of deferring delivery in this patient. Moreover, in multiple pregnancies the mortality rate was 32% between the 23 rd and 25 th WG [5] , which highlights the interest of reporting this case as successful.…”

“…In twin pregnancies, the birth of the first fetus is usually followed by the birth of the second twin in a short-time interval [2] , [3] , [4] , [5] , [6] , [7] , on average 1,1 days [7] . However, in selected cases, preterm delivery of one fetus may not require the immediate birth of the remaining fetus.…”

“…This improves survival and reduces morbidity [1] , [8] , [9] , [10] . Despite the interest for this subject since its first publication by Abrams in 1957 [3] , [5] , [11] , the rarity of this condition and the absence of large-scale studies confronts the obstetrician with a difficult problem about the optimal management of delayed-interval delivery [1] .…”