Delayed-interval-delivery of twins in didelphys uterus complicated with chorioamnionitis: a case report and a brief review of literature.

Delayed-Interval-Delivery (DID) of multiple gestations has been attempted with variable degrees of success in normal, as well as, in anomalous uteri. We describe a delayed interval delivery procedure in a dichorionic diamniotic twin pregnancy after removal of both, placenta and fetus from one horn by cesarean delivery at 25 weeks followed by spontaneous delivery of the remaining twin at 35 weeks. This was followed by a review of similar cases reported to the literature. The importance of this case resides in the success of DID in spite of chorioamnionitis. Furthermore, this was the second DID attempt where delivery of the first twin was accomplished by cesarean while that of the second one was done by vaginal route.

How safe is high-order repeat cesarean delivery? An 8-year single-center experience in Lebanon.

AIM: To quantify the impact of the number of prior cesarean deliveries (CD) on operative complications and preterm birth. Then to investigate the presence of a threshold, beyond which complications tend to be disproportionately dangerous. METHODS: This was a retrospective cohort observational study, where data corresponding to all CD done at our service, during an 8-year period, were collected and analyzed. In total, 1840 CD were performed. Patients were divided into five categories that corresponded to the number of CD. Primary outcome was the composite adverse maternal outcome, while preterm birth and individual complications were secondary outcomes. RESULTS: The composite adverse maternal outcome, preterm birth, as well as all individual complications related to CD, except for placental abruption, showed a significant rise in frequency that paralleled the increase in the number of CD. Furthermore, this increase tended to be continuous as the number of CD increased, with an evident surge after the fourth. CONCLUSION: In our population, increasing number of prior CD was a risk factor for a parallel increase in the rate of composite adverse maternal outcome, preterm birth and almost all intraoperative complications attributable to CD. Decreasing exposure to such surgeries by limiting family size to four offspring should be considered seriously in patient counseling.