Delayed interval delivery in a quintuplet pregnancy

Abstract

We present a case report of delayed delivery of a quintuplet pregnancy. The pregnancy resulted from intrauterine insemination following hormonal treatment. This case may represent the first report of quintuplets delivered using the technique of delayed interval delivery. Three separate spontaneous labours and one Caesarean section for two fetuses took place between the 24th and 32nd weeks of pregnancy. The delay between the first and the last delivery was 61 days. Only a boy, born fourth, survived.

Successful Obstetrical Management of Over 100-day Interval between the First and Second Twin Delivery in an Infertility-Treated Patient: Counseling and Management Approach to Extreme Asynchronous Twin

“…It is not known how many times attempt at delay has been met with failure therefore the incidence of success of the procedure is not known but already a clearer picture of efficacy of this approach can be seen, and tried, specially where neonatal units have yet to show good survival rates in cases of extreme prematurity. 12 Tocolytics, antibiotics and 14-117 days progesterone therapy Zhang J 2003 13 Same as above 9 days Labib M Ghulmiyyah et al 2004 5 Same as above 110 days Zhang J 2004 14 Same as above 6 days (ranging from 2-107 days) Oyelese Y 2005 15 Same as above 1-4 weeks Arabin B van Eyck J 2009 16 Same as above Mean delay was 19 days (1-107 days)…”

“…This delay was seen on expectant management only. 12 Eiecher in 1970 was the first to try purposeful prolongation of gestation by 72 days after the first birth, with treatment, for which he used progesterone, diazepam and 'spasmolytics'. In this case the birth of the first twin occurred at 25 weeks and the birth weight difference was 1,680 gm between the two neonates.…”

“…Maternal complications, which occurred in his study, were manual removal of placenta and abruption of placenta with disseminated intravascular coagulation (DIC). 12 Tocolysis alone were used first by Woolfson et al in 1983 in a case of twin gestation. In his case he could prolong the delivery of second twin by 54 days after the birth of the first twin.…”

“…In his case he could prolong the delivery of second twin by 54 days after the birth of the first twin. 12 Thomson applied the first cerclage in 1978 in a twin pregnancy at 27 weeks. Delay of 24 days was achieved.…”

Quadruplets and Quintuplets

“…The most challenging cases of quadruplet and quintuplet pregnancies are the cases where preterm labor of at least one fetus has occurred and delayed interval delivery is considered an option in order to improve the chances of survival for the remaining fetuses. Such cases with at least one newborn surviving have been published, both for quadruplet [140,141] and for quintuplet pregnancies [142]. For twin and triplet gestations, some authors consider delayed internal delivery a viable option [143,144], while for quadruplet and quintuplet pregnancies, there are still not enough data.…”