2019, Number 09
PDF size: 258.21 Kb.
ABSTRACTBackground: Asynchronous twin birth consists in deferring the birth of the second twin, when the first one inevitably occurs in early stages of gestation.
Clinical case: A 39-year-old patient with bicorial twin pregnancy, achieved after in vitro fertilization treatment. Served at the Miguel Servet University Hospital due to the threat of premature delivery. Upon admission the death of the first twin was verified and it was decided to perform the delivery at week 23 + 2 weeks. Subsequently, cervical retraction was observed, with 2-3 cm dilation and cessation of uterine dynamics. The amniotic bag of the second twin remained intact, with no signs of loss of fetal well-being, so it was decided to perform the asynchronous delivery attempt. During the interval between the two twins, four cycles of tocolytic drugs with atosiban and fetal pulmonary maturation with corticosteroids were administered due to the threat of premature delivery. Finally, the cerclage was removed at 34 + 2 weeks of pregnancy, due to regular uterine dynamics, even with the administration of tocolytics, giving birth to the second twin. The newborn weighed 1810 g, had Apgar of 9 per minute and 10 at 5 minutes, and cord pH of 7.39. Its evolution was favorable and remained in the neonatal intermediate care unit for 13 days, to discharge it with 2070 g. The postmortem study of the first twin did not report morphological expression of the cause of death, nor were there signs of infection. The result of the array was normal and the karyotype was 46 XY. The microbiological study of the placenta showed no signs of chorioamnionitis. The patient was discharged three days after delivery, with satisfactory evolution and without registering incidents during the puerperium.
Conclusions: Deferred delivery of the second twin is an alternative for well-selected twin pregnancies in which the birth of the first twin occurs in weeks corresponding to extreme prematurity since it could prolong pregnancy to a gestational age that improves the prognosis of the second twin .
Carson J. Twins born with an interval of forty-four days. Br Med J 1880;1:242.
Magdaleno-Dans F, et al. Parto gemelar asincrónico. Presentación de un caso y revisión del tratamiento obstétrico. Ginecol Obstet Mex. 2016;84(1):53-59. https:// ginecologiayobstetricia.org.mx/secciones/casos-clinicos/ parto-gemelar-asincronico-presentacion-de-un-caso-yrevision- del-tratamiento-obstetrico/
Quesnel C, et al. Nacimiento asincrónico en embarazo gemelar. Revisión de la bibliografía y reporte de un caso. Ginecol Obstet Mex 2012;80:91-4. https://ginecologiayobstetricia. org.mx/secciones/casos-clinicos/nacimientoasincronico- en-embarazo-gemelar-revision-de-la-bibliografia- y-reporte-de-un-caso/
Arabin B, et al. Delayed-interval delivery in twin and triplet pregnancies: 17 years of experience in 1 perinatal center. Am J Obstet Gynecol. 2009;200:154.e1-8. DOI: 10.1016/j. ajog.2008.08.046
Livingston JC, et al. Second-trimester asynchronous multifetal delivery results in poor perinatal outcome. Obstet Gynecol 2004;103:77-81. DOI: 10.1097/01. AOG.0000103995.79536.9C
Zhang J, et al. Delayed interval delivery and infant survival: a population-based study. Am J Obstet Gynecol. 2004;191:470-6. DOI: 10.1016/j.ajog.2004.03.002
Benito-Vielba M, et al. Delayed-interval delivery in twin pregnancies: report of three cases and literatura review. J Matern Fetal Neonatal Med 2019;32(2):351-355. DOI: 10.1080/14767058.2017.1378336.
Feys S, Jacquemyn Y. Delayed-interval delivery can save the second twin: evidence from a systematic review. Facts Views Vis Obgyn. 2016;8(4):223-231. https://www.ncbi. nlm.nih.gov/pmc/articles/PMC5303700/
Zhang J, Johnson CD, Hoffman M. Cervical cerclage in delayed interval delivery in multifetal pregnancy: a review of seven case series. Eur J Obstet Gynecol Reprod Biol 2003;108:126-130.
Roman AS, et al. Maternal and neonatal outcomes after delayed-interval delivery of multifetal pregnancies. Am J Perinatol 2011;28(2):91-6. DOI: 10.1055/s-0030-1262513.