Delayed Interval Delivery of a Second Twin: A Case Report and Review of the Literature

Abstract

We report a case of diamniotic, dichorionic pregnancy that presented at 26 weeks with premature rupture of the first amniotic sac. Nine days later, premature labour and delivery of the first male twin took place, with death of the first twin. The second twin was left in utero. The management included combination of tocolytics, antibiotics and cervical cerclage. Caesarean section was performed 48 days later, at 34 weeks due to breech presentation and contractions. We delivered a live male infant with apgar scores 4/1 and 7/5 and 1680 gr weight. The infant was discharged home 29 days later.The implementation of assisted reproduction during the last ten years has increased the incidence of multiple pregnancies. In some cases one or more infants must be born due to intrauterine risks or stillbirth. According to the relevant literature there is an absence of unanimity on the best management for these pregnancies. The aim ofthis report is to add our experience to the currently limited literature.A 31 year-old nullipara woman was admitted to the hospital at the 26th week of a twin dichorionic, diamniotic pregnancy after in vitro fertilisation (IVF), because of premature rupture of the membranes of the first amniotic sac. The ultrasound examination revealed cephalic presentation of the first female fetus, whereas the second male fetus was breech. Both had normal amniotic fluid index and growth. Two independent placentas were also visualized.The patient was treated with bed rest, erythromycin 250 mg three times per day (TID) for 7 days, atociban iv for 48 hours and 24 mg betamethasone in two separate doses. Seven days later, the first infant was born, weighting 780 g, but died seven days later at the Neonatal Intensive Care Unit (NICU) because of severe lung prematurity. The contractions ceased after the delivery of the first fetus. A ligation of the umbilical cord was performed, as high in the cervix as possible, in aseptic conditions, and the placenta was left inside the uterus. A McDonald cervical cerclage was also performed. During the procedure a course ofiv coamoxyclav 1.2 gr was administered. In addition, prophylactic ritrodine iv was administered for 48 hours.The patient was kept in the hospital for close monitoring which involved daily auscultation of the fetal heart and measurement of body temperature, twice weekly full blood count, CRP and clotting screen and ultrasound examination for growth and doppler once weekly. Pregnancy was terminated by caesarean section 48 days later (34th week) due to uterine contractions and breech presentation. A male

Epileptic EEG discharges and short non-convulsive crisis: Influence on cognitive and psychobehavioural functions in youths

“…[18][19][20] Based on the current literature we theorize that the stable cognitive function is changed by illness factors, while mechanistic processes are altered by acute epileptiform discharges. [21][22]…”