Surhud Patki¹, Shriswaroop Kulkarni², Vijay Mali³, Pallavi Patil⁴ and Satish Patki⁵*

¹Consultant Obstetrician and Gynaecologist and IVF Consultant, India
²Consultant Anaesthesiologist and Intensivist, India
³Consultant Neonatologist, India
⁴Fetal Medicine Consultant, India
⁵I.V.F. Consultant, India

*Corresponding Author: Satish Patki, I.V.F. Consultant, India.

Received: October 27, 2022; Published: November 23, 2022

Abstract

In twin pregnancies, usually the delivery of both the babies occur together with a difference of few minutes. However, in very rare situations the first fetus gets aborted during second trimester and the cervix gets reformed. In such rare situations after the abortion (vaginal expulsion) of the first fetus, prolonging pregnancy is a real challenge. The risks of haemorrhage, chorioamnionitis, coagulopathies and immediate abortion of the second fetus are very high. In such event, if the pregnancy is prolonged, preterm delivery of the second twin within next few weeks is very common.

We report a case of diamniotic, dichorionic pregnancy achieved through In Vitro Fertilisation (I.V.F.) in a 43 years old woman who also had diabetes mellitus. This patient had spontaneous onset of uterine contractions and leaking which resulted into expulsion of the first fetus at 17 weeks of gestation. The placenta of the first fetus and intact gestational sac of the other twin, were left in utero. The management included vigilant maternal monitoring, use of tocolytics antibiotics and delayed cervical cerclage. The pregnancy was prolonged for 115 days. The patient required caesarean section at 34 weeks for the development of severe pre-eclampsia and delivered a healthy male baby of 2.1 kg who required a brief stay of twelve days in NICU. Placentas of both the fetuses were removed during caesarean section.

This case is exceptional and there are no validated medical protocols for the management; the scientific evidence is still controversial.

Our care supports the prolongation of the pregnancy of the second twin with high medical vigilance.

Keywords: Assisted Reproductive Technology (A.R.T.); Twin; Pregnancy

References

1. B Blondel., et al. “The impact of the increasing number of multiple birth son the rates of preterm birth and low birthweight: an international study”. American Journal of Public Health 8 (2002): 1323-1330.
2. A Roman., et al. “Maternal and neonatal outcomes after delayed-interval delivery of multifetal pregnancies”. American Journal of Perinatology 28 (2011)91-96.
3. JA Martin., et al. “Births: final data for 2013”. National Vital Statistics Reports 1 (2015): 1-65.
4. A Gezer., et al. “Perinatal mortality and morbidity in twin pregnancies: the relation between chorionicity and gestational age at birth”. Archives of Gynecology and Obstetrics 2 (2012): 353-360.
5. Y Oyelese., et al. “Delayed interval delivery in twin pregnancies in the United States: impact on pernatal mortality and morbidity”. American Journal of Obstetrics and Gynecology 2 (2005): 439-444.
6. C Vaduva., et al. “Delayed interval delivery in twin pregnancy case reports”. Romanian Journal of Morphology and Embryology 3 (2016): 1089-1098.
7. L Temur. “A twin pregnancy provided with ICSI, an abortion of the first fetus at the 18^th week and live birth of the second fetus at the end of 36^th week: a case report and literature review”. Journal of Maternal-Fetal and Neonatal Medicine 13 (2013): 1355-1358.
8. M Kaneko., et al. “Case report and review of delayed-interval delivery for dichorionic, diamniotic twins with normal development”. Journal of Obstetrics and Gynaecology Research 4 (2012) 741-744.
9. Tzafettas JM., et al. “Asynchronous delivery of twins and triplets with a delivery interval ranging form 48 hours to 19 weeks”. Clinical and Experimental Obstetrics and Gynecology 31 (2004): 53-55.

Citation

Citation: Satish Patki., et al. “Delivery of the Second Twin, 115 Days After the Birth of the First: Case Report of a Rare Event". Acta Scientific Women's Health 4.12 (2022): 40-43.

Copyright

Copyright: © 2022 Satish Patki., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.