Emergency cervical cerclage in delayed-interval delivery of twin pregnancies: a scoping review.

BACKGROUND: The protocol for delayed-interval delivery of the second twin in twin pregnancies has not been standardized. Cervical cerclage is often performed, but its use is debated. To conduct a scoping review on cervical cerclage for prolonging the intertwin delivery interval and improving second twin survival and maternal outcomes after preterm delivery or spontaneous abortion of the first twin in twin pregnancies. METHODS: Seven Chinese and English language databases were searched from inception to March 1, 2023, including PubMed, The Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP Chinese Science Journal Database, and Sinomed. Relevant observational studies that assessed the effectiveness of the use of cervical cerclage in delayed-interval delivery of twins were screened and selected, and raw data were extracted, and descriptive statistics and chi-square analysis were performed. RESULTS: A total of 102 articles were retrieved. After screening and exclusion of duplicate and irrelevant articles, 22 articles meeting the inclusion criteria were obtained. Studies in which cerclage was performed reported longer intertwin delivery intervals than those that did not perform cerclage, and the difference was statistically significant. The cerclage group also tended to have lower rates of chorioamnionitis and maternal complications, but the difference between the two groups was not statistically significant. CONCLUSION: After excluding patients with contraindications, emergency cervical cerclage can be considered in cases of spontaneous abortion of the first twin in twin pregnancies to prolong the gestation and improve the prognosis of the remaining fetus until it becomes viable and increases its birth weight.

Delayed interval delivery in a quadruplet pregnancy: a case report and literature review.

BACKGROUND: As the rate of multiple pregnancies increases, delayed interval delivery (DID) is increasingly being implemented to improve perinatal outcomes. But there are no international guidelines for DID in multiple pregnancies. We report a case of DID in a quadruplet pregnancy and review the relevant literature to summarize the management of DID in multiple pregnancies. CASE PRESENTATION: A 22-year-old woman, 22 2/7 weeks' gestation, with quadruplets, was admitted to the hospital for a first cervical cerclage due to cervical dilation. Twenty-five days later, it was found that the cervix was dilated again, so after removing the cervical cerclage, the first quadruplet was delivered vaginally (25 6/7 weeks), and a second cervical cerclage was performed. Four days later, due to re-dilation of the cervix, after removal of the cervical cerclage, the second quadruplet was delivered vaginally (26 3/7 weeks), followed by a third cervical cerclage. Six days later, the pregnancy was terminated by cesarean section due to fetal distress, and the third and fourth quadruplets were delivered (27 2/7 weeks). The patient had no postoperative complications, and all four infants were treated in the neonatal intensive care unit and discharged successfully. CONCLUSION: This case emphasizes that comprehensive management of delayed interval delivery can improve perinatal outcomes in multiple pregnancies, including anti-infection, tocolytic therapy, practice to promote fetal lung, and cervical cerclage.

Obstetric and fetal short- and long-term outcomes of delayed-interval delivery in multiple pregnancies.

INTRODUCTION: Multiple pregnancies are at higher risk of preterm birth. However, both children do not necessarily have to be born and exposed to the morbidity of prematurity. One option is a delayed-interval delivery with reduction of morbidity and mortality for the second twin. The present case series demonstrates the feasibility and safety of this procedure including the long-term outcome of the surviving children compared to the overall outcome of premature born children at the same perinatal center. MATERIAL: Retrospective evaluation of all cases of delayed-interval deliveries in multiple pregnancies from 2003 to 2020 at the Women's and Children's Hospital of the University Hospital Ulm. RESULTS: In 17 cases, the delivery of the second twin could be delayed, on average by 36 days. Pregnancies with delivery of the first twin before 22 weeks of gestation had a longer prolongation than pregnancies with delivery of the first twin after 22 weeks (53 vs. 22 days). If a cerclage was placed after the delivery of the first twin a longer prolongation interval could be achieved (45 vs. 19 days). No severe maternal morbidity occurred, and the short- and long-term outcome of the second twin did not differ from age-matched controls. CONCLUSIONS: In multiple pregnancies with extremely preterm birth of the first twin, delivery of the second twin can in some cases be successfully postponed without serious maternal morbidity or additional fetal complications. Delivery of the first twin before 22 weeks of gestation and placement of a cerclage is associated with a longer prolongation interval.

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.

Delayed interval delivery of preterm multiples: experience from a large specialized twin center.

OBJECTIVE: Preterm delivery is a recognized complication of twins and higher order multiple pregnancies. Delayed interval delivery is a rarely used management option for pre- or peri-viable preterm labor in these pregnancies. We describe the management and outcomes of 7 delayed interval deliveries over an 8-year period in a large specialized twin center. STUDY DESIGN: A retrospective cohort study of all delayed interval deliveries of preterm multiples from 2009 to 2016, defined as >24 h between deliveries of twins 1 and 2. RESULTS: During the study period there were 68,845 deliveries with 1377 multiple pregnancies comprising 1331 sets of twins and 46 sets of higher-order multiples. 7 of these were identified as being delayed interval deliveries - 6 twin pregnancies and 1 triplet pregnancy. The mean gestation of delivery of the first infant was 23 + 4 weeks (range 22 + 3 to 30 + 0 weeks) with a mean interval of 10 days (range 1.5-39 days). Outcomes for the first infant delivered were poor, with 5 out of 7 (71%) dying from extreme prematurity. However, out of the remaining twins or triplets, 5/8 (62%) survived. The mean gestation of delivery of the remaining infant (or infants in the triplets) was 25 + 0 weeks (range 23 + 0 to 30 + 2 weeks). Only one mother (16%) developed clinical chorioamnionitis requiring iatrogenic delivery of the remaining infant with subsequent neonatal death due to extreme prematurity. There were no cases of severe maternal morbidity - however, there was one maternal death in the cohort due to an amniotic fluid embolism. The neonatal follow up of the surviving infants to date is mostly normal. CONCLUSION: Delayed interval deliveries can offer hope for survival for the remaining infant(s) with an acceptable risk profile to the mother. Close clinical and laboratory monitoring is essential to reduce the risk of severe maternal morbidity.

Spontaneous fetal reduction in triplets and prolongation of twin pregnancy for 111 days as an outpatient: a case report.

BACKGROUND: Multiple gestation has been on the rise because of advancement in assisted reproductive technology. Triplet pregnancy is associated with fetal loss and preterm birth as its major complications. Spontaneous triplet pregnancy is rare. In the case of fetal loss, delayed interval delivery has been used to achieve delivery of the retained fetuses. There is no common approach to delayed interval delivery. CASE: A 31-year-old East African lady with spontaneous triplet pregnancy presented to our institution at gestation age of 19 weeks with features of threatened miscarriage. One fetus was miscarried, and delayed interval delivery was done as an outpatient. At gestation age of 35 weeks, she delivered healthy twins by cesarean section. CONCLUSION: Delayed interval delivery improves neonatal outcomes of high-order pregnancy after fetal loss even in a resource-limited setting.

Delayed-Iinterval delivery in dichorionic twin pregnancies: A case report of 154 latency days / Parto diferido emg ravidez gemelar bicoriônica: Um caso com 154 dias de latência

Abstract Premature delivery often complicates multifetal pregnancies, placing neonates at risk of seriousmorbidity andmortality. In select cases, pretermbirth of one sibling may not require delivery of the remaining fetus(es), which may remain in utero for a delayedinterval delivery, consequently improving neonatalmorbidity andmortality. Currently, there is no consensus on the best protocol for the optimalmanagement 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.

Delayed-interval delivery of twins in 13 pregnancies.

BACKGROUND: Delayed interval delivery is a rare practice aiming at prolonging gestation for the second twin in case of pre-viable birth of twin one. Our objective was to identify factors related to successful delayed delivery of the second twin, among cases in which the interval after delivery of the first twin was above 24h. METHOD: A descriptive, retrospective and multicenter study of all delayed interval deliveries in dichorionic twins in 4 perinatal centers in Paris over a 14-year period. RESULTS: In 13 cases of delayed interval delivery, delivery of twin 1 was at a median of 18 weeks' gestation (range 14WG+2days to 24WG), and none survived. Delivery of the second twin occurred at a median of 25 weeks' gestation +3 days, 51 days after twin 1 (range 13-138 days). Seven of the 13s twins (54 %) survived. There were 5 cases of chorioamnionitis and 1 case of maternal disseminated intravascular coagulation. Poor outcome was not significantly associated with the gestational age, presentation for PPROM or inflammatory markers (C-reactive protein and white blood cell count) at the time of delivery of twin 1. CONCLUSION: Delayed-interval delivery of the second twin may prolong pregnancy and lead the second twin child to a viable term of birth; but carries a risk of maternal complications.

Successful delayed-interval delivery in monochorionic diamniotic twin pregnancy: A case report.

Delayed-interval delivery in twin pregnancy is a rare occurrence. It is sometimes performed in twin pregnancies when the first twin is born at the limit of viabililty, to improve outcome for the second twin. It has been suggested that monochorionicity is a contraindication to delayed-interval delivery in multifetal pregnancy. The literature describes only a dozen cases over the last 20 years and only a handful of these reports specify success. We describe a case of a successful delayed-interval delivery of monochorionic diamniotic twins following prelabour rupture of membranes at 20 weeks of gestation. The first twin was previable, delivered at 23 weeks and 2 days of gestation, but the second twin was delivered at 24 weeks and 1 day of gestation and survived. Practitioners could consider delayed-interval delivery in monochorionic diamniotic twin pregnancy in a closely monitored environment if the first twin is born peri-viable, to obtain an improved outcome for the remaining fetus.

Delayed-interval delivery in twin pregnancies: report of three cases and literature review.

INTRODUCTION: Delayed delivery is sometimes performed in selected multifetal pregnancies when the first twin birth occurs inevitably. The aim of this procedure is to improve the prognosis and decrease the morbidity and mortality of the second twin. We report three cases of delayed-interval delivery of dichorionic-diamniotic twin pregnancies assisted in our center between 2015 and 2017. After the first twin delivery, the second twin was left in utero and the patient received tocolytic therapy and antibiotics. Cervical cerclage was not performed. RESULTS: Our patients were admitted between 21 + 3 and 23 + 6 weeks of gestation. We achieved an average interval delivery of 6.33 d. Four out of six twins did not survive the delayed interval procedure. The average stay of the first and second twins that were admitted to the neonatal intensive care unit (NICU) was of 72 d (28-116) and 39.5 d (12-67), respectively. The first twin birth was vaginal in all cases, while the second twin delivery was performed by cesarean section in two out of our three patients. Our neonatal results are not favorable, probably due to the extreme prematurity. CONCLUSIONS: Delayed delivery of the second twin before 28 weeks of gestation can be an alternative for the obstetrician since it could prolong the pregnancy until a gestational age which confers a better prognosis and a better perinatal outcome for the second twin.

Delayed interval delivery in multiple gestations: the Munich experience.

OBJECTIVE: To evaluate delayed interval deliveries in multiple gestations in regard of delayed interval and neonatal survival and to provide a protocol. METHODS: Data of multiple pregnancies with delayed interval delivery at a tertiary maternity unit between 2002 and 2017 were collected. Contraindications for evaluation of a delay of the delivery of the remaining child were: severe maternal blood loss, poor maternal general condition, preeclampsia, placental abruption, fetal distress, serious congenital malformations of the remaining child, chorioamnionitis, and premature rupture of membranes of the second fetus. A total of 14 cases was included in this retrospective monocentric analysis. RESULTS: The cohort comprised nine twin and five triplet pregnancies. Mean gestational age at delivery of the first fetus was 21 + 6 and 26 + 0 of the retained fetus, respectively. The earliest delivery of the first fetus was at 15 + 2 weeks. The mean interval of the delay was 29.3 days (2-82 days). Mortality of the first fetuses was 53.3%, while it was 17.6% for the retained fetuses. Maternal outcome was good in general: two cases of major blood loss occurred with the necessity of a blood transfusion. CONCLUSION: Delayed interval delivery is a reasonable approach in cases of an imminent preterm birth in multiple gestations which can be performed with a good fetal outcome and limited maternal risks. The situation when this procedure may be an option always comes unexpected. Therefore, the team of perinatologists should keep it in mind as one potential therapeutic approach. In addition, a standard protocol for the procedure should be established in the perinatal center.

Parto diferido o asincrónico del segundo gemelo: un caso clínico con buen desenlace neonatal / Delayed interval delivery or asynchronous birth of the second twin: a case report with a good outcome neonatal

Resumen ANTECEDENTES: El parto diferido o asincrónico ocurre cuando los fetos de un embarazo múltiple nacen con una diferencia de días o semanas. La finalidad es incrementar la edad gestacional del segundo gemelo y aumentar la tasa de supervivencia. CASO CLÍNICO: Paciente primigesta de 39 años, con embarazo gemelar bicorial, biamniótico logrado mediante fertilización in vitro. En la semana 23 + 2 acudió a urgencias por sangrado vaginal y dolor abdominal. En la especuloscopia se observó líquido amniótico claro y dilatación cervical de 4-5 cm. El registro cardiotocográfico reportó dinámica uterina franca. En la ecografía se visualizaron dos fetos: el primero en presentación podálica sin latido cardiaco y el segundo en transversa con latido cardiaco. Después del nacimiento del primer gemelo se observó la retracción del cuello uterino y desaparición de la dinámica uterina. El estudio ecográfico mostró la bolsa amniótica íntegra, sin signos de desprendimiento placentario ni pérdida del bienestar fetal. Se propuso a la pareja la posibilidad de realizar un cerclaje cervical y diferir el parto del segundo gemelo, hecho que fue aceptado. Se consiguió prolongar la gestación del segundo gemelo 77 días, que nació mediante parto, sin morbilidad materna ni fetal. CONCLUSIONES: El parto diferido es una práctica adecuada para incrementar la tasa de supervivencia del feto o fetos retenidos. Los protocolos asociados con este tipo de partos son variados. Se requieren estudios adicionales para establecer los criterios de tratamiento de este tipo de partos.

Abstract BACKGROUND: Delayed Interval delivery or asynchronous birth is when a multiple pregnancy`s fetuses are not born simultaneously, and with several day´s difference between their births. This practice´s objective is to increase the second twin´s gestational age and, as such, improve its survival rate. CLINICAL CASE: A 39 years-old patient with bicorial biamniotic twin pregnancy achieved by in vitro fertilization. At 23 + 2 weeks of pregnancy assisted to Emergency service for vaginal bleeding and abdominal pain. In the speculoscopy a clear amniotic fluid and cervical dilation of 4-5 cm was observed. The cardiotocographic record reported frank uterine dynamics. In the ultrasound, two files are displayed: the first in the syntax presentation in the heartbeat and the second in the transversal with heartbeat. After the birth of the first twin, retraction of the cervix and the disappearance of uterine dynamics were observed. The ecological study showed the amniotic bag intact, without signs of placental detachment or loss of fetal well-being. It was proposed to the couple the possibility of performing the cervical fence and the other part of the second day, which was accepted. It was possible to prolong the gestation of the second year to 77 days, which was born through childbirth, without registering maternal or fetal morbidity. CONCLUSIONS: Delayed Interval delivery is a good practice to increase the survival rate of a retained fetus or retained fetuses. The protocols associated with this type of births are varied. Additional studies are required to establish treatment criteria for this type of births.

Successful delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a twin pregnancy.

There has been a significant increase in the number of multiple pregnancies that are associated with a high risk of preterm delivery among Korean women. However, to date, delayed-interval delivery in women with multiple pregnancy is rare. We report a case of delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a dichorionic diamniotic twin pregnancy. The patient presented with vaginal leakage of amniotic fluid at 16 weeks of gestation and was diagnosed with a preterm premature rupture of membranes. Three days later, the first twin was delivered, but the neonate died soon after. The second twin remained in utero, and we decided to retain the fetus in utero to reduce the morbidity and mortality associated with a preterm birth. The patient was managed with antibiotics and tocolytics. Cervical cerclage was not performed. The second twin was delivered vaginally at 34 weeks and 5 days of gestation, 128 days after the delivery of the first-born fetus. This neonate was healthy and showed normal development during the 1-year follow-up period. Based on our experience with this case, we propose that delayed-interval delivery may improve perinatal survival and decrease morbidity in the second neonate in highly selected cases.

Successful delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a twin pregnancy / 영남의대학술지

There has been a significant increase in the number of multiple pregnancies that are associated with a high risk of preterm delivery among Korean women. However, to date, delayed-interval delivery in women with multiple pregnancy is rare. We report a case of delayed-interval delivery performed 128 days after the vaginal delivery of the first fetus in a dichorionic diamniotic twin pregnancy. The patient presented with vaginal leakage of amniotic fluid at 16 weeks of gestation and was diagnosed with a preterm premature rupture of membranes. Three days later, the first twin was delivered, but the neonate died soon after. The second twin remained in utero, and we decided to retain the fetus in utero to reduce the morbidity and mortality associated with a preterm birth. The patient was managed with antibiotics and tocolytics. Cervical cerclage was not performed. The second twin was delivered vaginally at 34 weeks and 5 days of gestation, 128 days after the delivery of the first-born fetus. This neonate was healthy and showed normal development during the 1-year follow-up period. Based on our experience with this case, we propose that delayed-interval delivery may improve perinatal survival and decrease morbidity in the second neonate in highly selected cases.

Obstetric Management of Delayed-Interval Delivery.

The delayed-interval delivery is a rare, flexible and complex procedure. In light of these facts, there is no consensus on the best approach to achieve it successfully. This case report is of an asynchronous delivery, in a twin pregnancy, with a 32-day interval between births of siblings. Our obstetric management at a critical gestational age improved the outcome of the second newborn. The probability of success of delayed-interval delivery depends on the proper selection of the candidates, the appropriate active management and the continuous monitoring for early detection of complications.

Delayed interval delivery of the second twin: obstetric management, neonatal outcomes, and 2-year follow-up.

OBJECTIVES: To evaluate the obstetric management and neonatal outcomes in twin pregnancies with delayed delivery of the second twin, including follow-up. METHODS: This study is a review of four cases of delayed delivery of the second twin in our hospital from 2009 to 2012. The obstetric management of the cases from the expulsion of the first twin to the delivery of the second twin is analyzed. The neonatal outcomes including follow-up for 2 years were reviewed. RESULTS: The first twins were delivered between 15 and 25 weeks (average 21 weeks) and the second twins were delivered between 25 and 31 weeks (average 27 weeks). One first twin (25 %) survived, while three (75 %) second twins survived. Two out of the three second twins delivered after 28 weeks were in satisfactory condition. CONCLUSIONS: The delayed delivery of the second twins which occurred in the third trimester is associated with favorable outcome, however, the risks should not be ignored.

The Impact of Delayed Interval Delivery on Neonatal Mortality and Morbidity

PURPOSE: To evaluate the impact of delayed interval delivery on neonatal outcomes. METHODS: This was a retrospective study of infants who were born at Seoul National University Hospital by delayed interval delivery from June 2005 to July 2010. Outcomes (neonatal mortality and morbidity) of later babies were compared to those of the first babies and the control group whose gestational ages and birth weights were similar to them. RESULTS: There were 4 twin and 5 triplet pregnancies. The first babies (group 1, n=9) were delivered at 22(+6) to 27(+5) weeks of gestational age, and the later babies (group 2, n=14) were born at 24(+6) to 28(+0) weeks. The mean interval between the first and later deliveries was 10 days, and there was no delay between the second and third deliveries in all triplet pregnancies. There were more small for gestational age (SGA) infants in group 1 than group 2 (66.7% and 21.4% respectively, P=0.03). Two of three babies who died in group 1 were born before 24 weeks of gestational age and expired within a week after birth. The mortality rate of group 2 (7.1%) was lower than group 1 (33.3%), but not significantly (P=0.106). The control group matched to group 2 consisted of 28 infants. There were no significant differences in neonatal mortality and morbidity between the two groups. CONCLUSION: Although there is a limitation to the number of infants in this study, it suggested that delayed delivery in a multiple pregnancy could decrease the incidence of SGA of the remaining fetuses and that prolonged gestation would not be harmful to those fetuses after birth.

A Successful Delayed-Interval Delivery without Cerclage Operation after One Fetal Delivery in a Case of Twin Pregnancy / 대한주산의학회잡지

The incidence of multifetal pregnancies has significantly increased because of progress of assisted reproductive technologies. Preterm delivery is the most common and significant obstetrical problem in multifetal pregnancies. When the first twin of mutifetal pregnancy is prematurely delivered at previable gestational age, the success of delayed interval delivery of the second twin can improve the neonatal outcome for the remaining fetus. The optimal management of delayed interval delivery is not defined. Tocolysis, prophylactic antibiotics, and cervical cerclage are generally used. I present a case of delayed interval delivery in twin pregnancy with an interval of 89 days. The first twin was delivered at 21.3 weeks of gestation and delayed delivery of the second twin was succeeded by conservative treatment without cervical cerclage. This case is the longest interval case in Korea.

Delayed Interval Delivery after Emergency Cerclage of Cervical Incompetency in Twin Pregnancy by in vitro Fertilization / 대한주산의학회잡지

Twin pregnancies are at substantially higher risks for premature delivery than singleton pregnancies. This further increases their risk of perinatal and infant mortality. Recently there has been a marked increase in multiple pregnancies as a direct result of assisted reproductive technology. Cervical incompetency is a condition in which a pregnant woman's cervix begins to dilate and efface before her pregnancy has reached term. And multiple pregnancies and pregnancies by in vitro fertilization (IVF) have been increasing the risk of cervical incompetency. In twin pregnancy during preterm delivery, successful delayed-interval deliveries may improve the neonatal outcomes of the second fetus. We report a case of a delayed interval delivery in twin pregnancy of incompetent of cervix with an interval of 28 days after 3rd emergency cerclage.

Delayed Interval Delivery after Emergency Cerclage of Cervical Incompetency in Twin Pregnancy by in vitro Fertilization / 대한주산의학회잡지

Twin pregnancies are at substantially higher risks for premature delivery than singleton pregnancies. This further increases their risk of perinatal and infant mortality. Recently there has been a marked increase in multiple pregnancies as a direct result of assisted reproductive technology. Cervical incompetency is a condition in which a pregnant woman's cervix begins to dilate and efface before her pregnancy has reached term. And multiple pregnancies and pregnancies by in vitro fertilization (IVF) have been increasing the risk of cervical incompetency. In twin pregnancy during preterm delivery, successful delayed-interval deliveries may improve the neonatal outcomes of the second fetus. We report a case of a delayed interval delivery in twin pregnancy of incompetent of cervix with an interval of 28 days after 3rd emergency cerclage.