Beating the Record: 157 Days of Delayed Delivery of The Second Fetus in a Twin Pregnancy

Abstract

Case Report: We present the case of a diamniotic-dichorionic twin pregnancy of 14+4 weeks with obstetric history of cervical incompetence. The premature delivery of the first twin took place, with unfortunate outcome. The second twin was left in utero. The management, at first, included combination of expectant attitude with a close monitoring of maternal constants and analysis, and administration of antibiotics; in a second step, after discarding intraamniotic infection, a McDonald cerclage was performed with success. At 37 weeks the cerclage was removed and after Oxytocin induction, a healthy baby was born. Conclusion: Delayed delivery of the second fetus in a twin pregnancy is an effective management choice. The use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. The behaviour in these unusual cases should be assessed individually, due to the scarce literature on the matter and the lack of unanimous protocols. But, always considering the maternal and fetal status, trying to improve perinatal results with a strict maternal surveillance to discard the appearance of a possible intraamniotic infection.