Delayed interval delivery in a triplet gestation

Background. Although there are numerous studies on delayed interval delivery in twins, this study is one of few reporting on preterm premature rupture of membranes in triplets and even fewer on dichorionic triamniotic triplet twins. The case presented here highlights the important interplay between informed consent and patient autonomy. Case Presentation. A 37-year-old woman gravida 1, para 0 with a dichorionic triamniotic triplet pregnancy experienced preterm premature rupture of membranes of the singleton triplet at 15 weeks and six days of gestation. Delayed interval delivery was offered to the parents, who chose to continue the pregnancy while acknowledging the risks for maternal and foetal health. The patient was treated with prophylactic intravenous antibiotics and discharged on oral antibiotics after an eight-day admission. Two days after being discharged, she was readmitted with clinical signs of chorioamnionitis. Within six hours, the preterm premature rupture of membranes singleton was delivered. Three days later, she again presented to the hospital with preterm premature rupture of membranes of one of the dichorionic twins. After discussion with the maternal foetal medicine team, the parents chose to terminate the pregnancy. Delayed interval delivery was not successful in this patient, and it is unclear at which gestational age it is too early to offer expectant management. Conclusions. The case affirmed the very poor foetal survival rate when the first delivery occurs at under 20 weeks’ gestation. A standardised management of delayed interval delivery should be established to assist with consistent parental counselling.

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“…The babies were in good condition but required ventilatory support for 72 hours. There were no specific maternal complications [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Delayed Interval Delivery in Preterm Premature Rupture of Membranes in Dichorionic Triamniotic Triplets: Ethical Considerations for Maternal Health Case Report

Hosiani

Brown

Alahakoon

2022

Case Reports in Obstetrics and Gynecology

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“…Bernasko et al [25] 2006;95 Triplet Triplet PTVC (55) and no PTVC (40) NA PTVC was not associated with a significant prolongation of triplet pregnancy. Moragianni et al [26] 2009;24 Triplet Ultrasound-indicated cervical shortening TVC (11) were reviewed regarding emergency transvaginal cerclage, and 12 observational analyses involving 1021 patients [15] showed that emergency cerclage in pregnant women with painless cervical dilatation seems to decrease preterm births, prolong pregnancy, and decrease neonatal deaths and fetal losses, but does not increase the risk of chorioamnionitis or premature rupture of membranes. Nevertheless, these favorable results were associated with low-quality statistical analyses, [15] and the study included only singleton pregnancies.…”

Section: Vd (38 Ga)mentioning

confidence: 99%

“…[2] Only a few cases of gestation in triplets have been successfully prolonged by emergency cerclage. [9][10][11][12] This paper reports a case of vaginal delivery after emergency cerclage of triplets and prolonged gestation for 20/21 days. After a 1-year follow-up, all 3 newborns were now in well-being.…”

Section: Introductionmentioning

confidence: 99%

Vaginal delivery of triplets after emergency transvaginal cerclage: A case report and literature review

Zou,

Wu,

Yao

2024

Medicine

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Rationale: To report a peculiar case of vaginal delivery of a triplet after emergency transvaginal cerclage and to find a way to optimize some extreme situations encountered in clinical practice after evaluating feasibility. Patient concerns: A 33-year-old gravida 6, para 0050 woman at 21 + 6 weeks of gestation was referred to the obstetric department for opening of the cervical canal. An emergency McDonald cerclage was performed at 22 weeks of gestation after a comprehensive assessment, and the pregnancy ended with vaginal delivery at 24 + 6 weeks of gestation. The postpartum period was normal, and the newborns were discharged to home care after treatment in the neonatal intensive care unit. Interventions: After discussing the risks, the patient requested emergency transvaginal McDonald cerclage at 22 weeks of gestation. Outcomes: Emergency McDonald cerclage was performed at 22 weeks of gestation, and the pregnancy ended with vaginal delivery at 24 + 6/25 weeks of gestation, successfully prolonging gestation by 20/21 days. The postpartum period had no exceptional circumstances, and newborns were discharged to home care after treatment in the neonatal intensive care unit for 104/98/104 days. Lessons: Emergency cerclage seems to be impossible in multiple pregnancies. However, in this case, after a comprehensive assessment, it was feasible to extend the gestational age by emergency cerclage, and prompt and accurate evaluation is important to avoid complications and individualize the following management. In this case, we may find a way to optimize some extreme situations encountered in clinical practice and offer a glimmer of hope for families challenged with multiple pregnancies at risk of preterm delivery. However, more high-quality studies are needed to prove the effectiveness and safety of emergency cerclages in triplets.

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“…Bis heute ist das Management der verzögerten sequenziellen Entbindung von Drillingen eine Herausforderung. Die mangelnde Evidenz hinsichtlich der Effizienz eingesetzter Methoden sowie fehlende Richtlinien sind Gründe dafür [4]. Darüber hinaus beschreiben die meisten Fallberichte primär Intervallgeburten von Ge-…”

Section: Einführungunclassified