Neonatal and maternal outcomes after intentional delayed delivery for the second twin in dyzigotic pregnancy. Case report and literature review
M. Russu, D. DobriĊ£oiu, S. Svasta, A. Tudor, A. Craciun
Rezumat: Intentional delayed delivery of second twin in
dizygotic pregnancy is rare. There are analyzed the
peculiarities regarding maternal, short-term neonatal
outcomes in a 41-year-old mother, admitted in a
tertiary university maternity, diagnosed with: IVG IIP
24 weeks + 3 days dizygotic pregnancy, alive fetuses
(A. breech presentation, 690 g, palpable amniotic sac;
B. cephalic presentation, intact membranes, EFWs of
690/700 g - ultrasound). At 26 weeks of gestation, after
PROM, short positive trial of labor for planned vaginal
delivery, under continuous CTG, Bracht maneuver for
breech presentation which records the birth of female
fetus A, 920 g, Apgar score 5/6. Sectioned umbilical
cord is introduced in the vagina. At 50 days of close
monitoring and treatment for both mother and fetus
B, it is done caesarean section for female fetus B, 1870
g (34 weeks of gestation), Apgar score 8, placentae
A/B: 200/450g. Maternal postoperative evolution is
normal. Baby A is admitted at Neonatal Intensive Care
Unit (NICU) for moderate hypoxia at birth, repeated
apnea crisis, without functional respiratory syndrome,
anemia being corrected with blood derivates, 70
days, with gastric-tube nutrition, antibiotics, stage
I retinopathy, bilateral hip risk; the weight of fetus
B was 1550 g at the cesarean section and 2250
when discharged. Baby B had a favorable evolution
(breastfeeding plus formula milk). Conclusions.
Vaginal delivery at a multipara can be assumed in
breech presentation, after a precise protocol, followed
by experienced obstetrical/neonatological teams,
and an intentional delayed CS delivery is feasible.
Fetus B is larger at delivery than fetua A at the same
moment (1870 g vs. 1550 g), and at discharge (2250
g vs. 2975 g), with a very short admission in NICU/
preterm wards. No maternal complication appeared. Cuvinte cheie: intentional delayed delivery, dizygotic
pregnancy, preterm delivery, outcome.