ABSTRACT
INTRODUCCIÓN: Se presenta el caso de un parto diferido en una gestación gemelar en la que se consigue retrasar el parto del segundo gemelo 45 días con manejo conservador. CASO CLÍNICO: Mujer de 25 años, gestación gemelar bicorial biamniótica, con diagnóstico de muerte fetal del primer gemelo en semana 24+3 y parto del mismo tras una semana de evolución. Se decide la opción de tratamiento conservador expectante, con reposo absoluto, manteniendo tocolisis intravenosa, controles analíticos seriados, controles cardiotocográficos diarios, profilaxis antibiótica y antitrombótica. Con ello se consigue diferir el parto un total de 45 días. CONCLUSIÓN: El parto diferido en gestaciones gemelares es una práctica poco habitual, por lo que se carece de protocolos y actuaciones específicas. La bibliografía disponible difiere en cuanto al manejo de dichos casos y en el total de días que se consigue diferir el parto, pero en todos los estudios se reporta el beneficio en términos de resultados perinatales al conseguir aumentar la edad gestacional del segundo gemelo. En nuestro caso se consiguió una mejora sustancial del resultado perinatal asociado a la prematuridad sin importantes efectos adversos maternos y tras el periodo de latencia indicado.
INTRODUCTION: We report a delayed delivery of a dichorionic diamniotic twin pregnancy, in which the birth of the second twin was postponed 45 days. CASE REPORT: At 24+3 weeks of gestation, a 25-year-old woman with dichorionic diamniotic twin pregnancy presented with preterm premature rupture of membranes and intrauterine dead of the first fetus. Spontaneous delivery of the first death twin, occurred al 25+2 weeks. Tocolysis, antibiotic, antithrombotic prophylaxis, absolute rest, serial blood tests and fetal cardiotocography controls, were performed. The second twin was delivered at 31+5 weeks, after a the preterm premature rupture of membranes triggered the labor. The interval between the first and second birth was 45 days. CONCLUSION: Delayed delivery in twin pregnancies, is an uncommon clinical situation, so there are not validated medical protocols. Available bibliography offers different practices related to its management. Most studies confirm the better survival rate and perinatal outcomes of the postponed birth twin.
Subject(s)
Humans , Female , Pregnancy , Adult , Obstetric Labor, Premature/therapy , Pregnancy, Multiple , Time Factors , Tocolysis , Fetal Death , Watchful Waiting , Conservative TreatmentABSTRACT
We describe a case of diamniotic dichorionic pregnancy at 23 weeks and 6 days of gestation with threatened preterm labor with rupture of membrane of twin one. After 10 days we delivered the first twin. We decided to retain the other one to allow improvement in the outcome for the second twin. The patient was treated with tocolytics, antibiotics, cervical cerclage, steroid and continously monitored. After 58 daysthere was increasing uterine contractility and we delivered the second twin.
Subject(s)
Female , Humans , Pregnancy , Anti-Bacterial Agents , Cerclage, Cervical , Membranes , Obstetric Labor, Premature , Pregnancy, Multiple , Rupture , Tocolytic Agents , TwinsABSTRACT
With the introduction of assisted reproductive technologies, the incidence of multifetal pregnancies has significantly increased. In vaginal delivery for multifetal pregnancy, the delivery of the second fetus usually follows the first in few minutes. However in rare circumstances, the delivery is delayed for days due to disappearance of uterine contraction after delivery of the first fetus. Successful prolongation of the interdelivery time may improve the neonatal outcomes of the remaining fetus (es), particularly in the cases of extremely premature gestation. We present a case of a delayed delivery of second twin with an interval of 48 days.