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CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(01): 061-064
DOI: 10.1055/s-0040-1701468
Case Report
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

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

Parto diferido em gravidez gemelar bicoriônica: Um caso com 154 dias de latência
Catarina Alexandra Soares de Frias 
1   Department of Obstetrics and Gynecology, Hospital do Divino Espírito Santo, Ponta Delgada, São Miguel, Açores, Portugal
,
Alexandra Sofia Puga Alvarez de Faria Queirós 
2   Department of Obstetrics and Gynecology, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
,
Helena Teresinha Fernandes Simões 
2   Department of Obstetrics and Gynecology, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
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Weitere Informationen

Publikationsverlauf

21. August 2019

25. November 2019

Publikationsdatum:
27. Februar 2020 (online)

   Lizenzen und Reprints

Abstract

Premature delivery often complicates multifetal pregnancies, placing neonates at risk of serious morbidity and mortality. In select cases, preterm birth of one sibling may not require delivery of the remaining fetus(es), which may remain in utero for a delayed-interval delivery, consequently improving neonatal morbidity and mortality. Currently, there is no consensus on the best protocol for the optimal management of these cases. We report one case of delayed-interval delivery of a dichorionic pregnancy assisted in our center. In this case, prophylactic cerclage, tocolytic therapy and administration of broad-spectrum prophylactic antibiotics enabled delivery at 37 weeks, corresponding to 154 days of latency, which is, to our knowledge, the longest interval described in the literature. The attempt to defer the delivery of the second fetus in peri-viability is an option that should be offered to parents after counseling, providing that the clinical criteria of eligibility are fulfilled. The correct selection of candidates, combined with the correct performance of procedures, as well as fetal and maternal monitoring and early identification of complications increase the probability of success of this type of delivery.

Resumo

O parto pré-termo espontâneo complica frequentemente as gestações multifetais, condicionando elevada morbimortalidade perinatal. Em determinados casos, o nascimento prematuro do primeiro feto pode não requerer o nascimento do(s) feto(s) restante(s), que podem permanecer in utero, com o objetivo de diminuir a morbidade e mortalidade neonatal. Atualmente, não existe consenso quanto à melhor atitude clínica nas situações de parto diferido. Descrevemos um caso de parto diferido de gravidez bicoriônica vigiado no nosso centro. Neste caso, a realização de cerclagem, a terapêutica tocolítica e a administração de antibioticoterapia de largo espectro permitiu o parto às 37 semanas do segundo gêmeo, o que corresponde a 154 dias de latência, que, segundo o nosso conhecimento, é o intervalo de diferimento mais longo descrito na literatura. A tentativa de diferir o parto do segundo feto na periviabilidade é uma opção que deve ser oferecida aos progenitores, após aconselhamento e desde que se cumpram os critérios clínicos de elegibilidade. A seleção correta das candidatas, em conjunto com a realização de corretos procedimentos, monitorização fetal e materna e identificação precoce de complicações aumentam a possibilidade de sucesso deste tipo de parto.

Keywords

delayed-interval delivery - twin pregnancy - preterm birth - maternal morbidity - neonatal morbidity

Palavras-chave

Parto diferido - Gravidez gemelar - Parto pré-termo - Morbidade materna - Morbidade neonatal
 

  • References

  • 1 Galvão A, Gonçalves D, Rocha A, Rodrigues A, Buchner IG, Cunha A, Braga J. Delayed interval delivery of a second twin resulting in septic shock in the mother. Nascer Crescer 2016; 25 (04) 241-243
    PubMedSuche in Google Scholar
  • 2 Aydin Y, Celiloglu M. Delayed interval delivery of a second twin after the preterm labor of the first one in twin pregnancies: delayed delivery in twin pregnancies. Case Rep Obstet Gynecol 2012; 2012: 573824 . doi: 10.1155/2012/573824
    PubMedSuche in Google Scholar
  • 3 Arabin B, van Eyck J. Delayed-interval delivery in twin and triplet pregnancies: 17 years of experience in 1 perinatal center. Am J Obstet Gynecol 2009; 200 (02) 154.e1-154.e8 . doi: 10.1016/j.ajog.2008.08.046
    CrossrefPubMedSuche in Google Scholar
  • 4 Văduva CC, Constantinescu C, Ţenovici M, Văduva AR, Niculescu M, DiŢescu D. , et al. Delayed interval delivery in twin pregnancy - case reports. Rom J Morphol Embryol 2016; 57 (03) 1089-1098
    PubMedSuche in Google Scholar
  • 5 The Royal Women's Hospital. Multiple pregnancy - interval birth delivery: clinical guideline. Melbourne: The Royal Women's Hospital; 2019
    Suche in Google Scholar
  • 6 Roman AS, Fishman S, Fox N, Klauser C, Saltzman D, Rebarber A. Maternal and neonatal outcomes after delayed-interval delivery of multifetal pregnancies. Am J Perinatol 2011; 28 (02) 91-96 . doi: 10.1055/s-0030-1262513
    Thieme ConnectPubMedSuche in Google Scholar
  • 7 Raposo MI, Cardoso M, Ormonde M, Stokreef S, Correia L, Pereira A. Obstetric management of delayed-interval delivery. Case Rep Womens Health 2017; 16: 11-13 . doi: 10.1016/j.crwh.2017.09.002
    CrossrefPubMedSuche in Google Scholar
  • 8 Zorilă GL, Marinaş MC, Florea M, Pătru CL, Drăguşin RC, Căpitănescu RG. , et al. Stillbirth in dichorionic twins discordant for major and minor anomaly, followed by asynchronous delivery - a rare occurrence. Case presentation. Rom J Morphol Embryol 2016; 57 (03) 1117-1123
    PubMedSuche in Google Scholar
  • 9 Yodoshi T, Tipton E, Rouse CA. A case of delayed interval delivery with a successful hospital move. Case Rep Pediatr 2015; 2015: 802097 . doi: 10.1155/2015/802097
    PubMedSuche in Google Scholar
  • 10 Benito Vielba M, De Bonrostro Torralba C, Pallares Arnal V, Herrero Serrano R, Tejero Cabrejas EL, Campillos Maza JM. Delayed-interval delivery in twin pregnancies: report of three cases and literature review. J Matern Fetal Neonatal Med 2019; 32 (02) 351-355 . doi: 10.1080/14767058.2017.1378336
    CrossrefPubMedSuche in Google Scholar
  • 11 Rodrigues F, Pereira J, Rodrigues T, Montenegro N. [The clinical challenge of delayed interval delivery in multiple pregnancies]. Acta Obstet Ginecol Port 2015; 9 (02) 148-153 . Portuguese
    PubMedSuche in Google Scholar
  • 12 Van der Straeten FMA, De Ketelaere K, Temmerman M. Delayed interval delivery in multiple pregnancies. Eur J Obstet Gynecol Reprod Biol 2001; 99 (01) 85-89 . doi: 10.1016/S0301-2115(01)00376-1
    CrossrefPubMedSuche in Google Scholar
  • 13 Udealor PC, Ezeome IV, Emegoakor FC, Okeke DO, Okere PC. Delayed interval delivery following early loss of the leading twin, case report. Case Rep Obstet Gynecol 2015; 2015: 213852 . doi: 10.1155/2015/213852
    PubMedSuche in Google Scholar
  • 14 Centeno M, Clode N, Tuna M, Graça LM. [Delayed delivery – perinatal and maternal outcomes]. Acta Obstet Ginecol Port 2009; 3 (03) 128-133 . Portuguese
    PubMedSuche in Google Scholar
  • 15 Zhang J, Johnson CD, Hoffman M. Cervical cerclage in delayed interval delivery in a multifetal pregnancy: a review of seven case series. Eur J Obstet Gynecol Reprod Biol 2003; 108 (02) 126-130 . doi: 10.1016/S0301-2115(02)00479-7
    CrossrefPubMedSuche in Google Scholar
  • 16 Eleje GU, Ikechebelu JI, Eke AC, Okam PC, Ezebialu IU, Ilika CP. Cervical cerclage in combination with other treatments for preventing preterm birth in singleton pregnancies. Cochrane Database Syst Rev 2017; ; (11) CD012871 . doi: 10.1002/14651858.CD012871
    PubMedSuche in Google Scholar
  • 17 Cozzolino M, Seravalli V, Masini G, Pasquini L, Di Tommaso M. Delayed-interval delivery in dichorionic twin pregnancies: a single-center experience. Ochsner J 2015; 15 (03) 248-250
    PubMedSuche in Google Scholar
  • 18 Doger E, Cakiroglu Y, Ceylan Y, Kole E, Ozkan S, Caliskan E. Obstetric and neonatal outcomes of delayed interval delivery in cerclage and non-cerclage cases: an analysis of 20 multiple pregnancies. J Obstet Gynaecol Res 2014; 40 (07) 1853-1861 . doi: 10.1111/jog.12435
    CrossrefPubMedSuche in Google Scholar
  • 19 Rosbergen M, Vogt HP, Baerts W. , et al. Long-term and short-term outcome after delayed-interval delivery in multi-fetal pregnancies. Eur J Obstet Gynecol Reprod Biol 2005; 122 (01) 66-72 . doi: 10.1016/j.ejogrb.2004.11.036
    CrossrefPubMedSuche in Google Scholar
  • 20 Graça LM. Medicina materno-fetal. 5. ed. Lisboa: Lidel; 2017
    Suche in Google Scholar
  • 21 Tran PL, Desveaux C, Barau G, Iacobelli S, Boukerrou M. Delayed-interval delivery in multifetal pregnancy: a review and guidelines for management. Gynecol Obstet (Sunnyvale) 2015; 5: 333 . doi: 10.4172/2161-0932.1000333
    PubMedSuche in Google Scholar