zugewiesene Abstracts

Preterm birth is a significant cause of perinatal morbidity and mortality, especially in multiple pregnancies. Delayed interval delivery can prolong the pregnancy for the remaining fetus(es) in an imminent stillbirth or extremely preterm birth of the first fetus, improving the lastborns outcomes.

We present a case of delayed interval delivery of a triplet pregnancy following preterm premature rupture of membranes (pPROM) and progressive cervical insufficiency. The patient was admitted with a trichorionic triplet pregnancy at 23+2 gestational weeks, pPROM of the first fetus had occurred eleven days before.

At the time of her admittance the patient had a cervical pessary in situ. After completion of the lung maturation the cervical pessary was removed, as it was considered to increase the risk for amnion infection. At the subsequent speculum examination, the feet of the leading fetus were already protruding through the cervical canal. Following vaginal delivery of the first fetus at 24+1 gestational weeks, the patient received antibiotics and tocolysis. Cerclage was not conducted as the mother had a vaginal infection. A 15-day delivery interval for the second and third fetus was achieved. Magnesium sulphate for neuroprotection was applied immediately before both deliveries. The firstborn required mechanical ventilation and inotropic support and was diagnosed with a Staphylococcus hemolyticus sepsis on day eight, while the others only required continuous positive airway pressure. All three newborns were discharged at 41+0 weeks corrected age without severe complications.

There is no consensus on the best way to perform delayed interval delivery. We achieved a complications-free interval of 15 days with conservative management in a triplet pregnancy.