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[Delayed birth of the second child in multiple gestation]
M Weemhoff1, C A van Meir, F J Walther
1Medisch Centrum Haaglanden, locatie Antoniushove, afd. Gynaecologie en Obstetrie, Leidschendam.
Nederlands Tijdschrift Voor Geneeskunde
|August 10, 2001
Summary
Delayed interval delivery can improve outcomes for the second twin in multiple gestations facing very preterm birth. While challenging, interventions like tocolysis and steroids may enhance neonatal condition.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Neonatology
Background:
- Delayed interval delivery involves prolonging pregnancy for the second fetus after the birth of the first.
- This management strategy is considered in cases of multiple gestation with imminent very preterm birth.
Observation:
- Case histories demonstrate varied outcomes, including successful prolonged pregnancies and instances where attempts to delay delivery failed.
- Significant differences in neonatal course were observed between twins, influenced by gestational age at birth and interventions.
- Maternal complications, such as placental abruption, can occur during delayed delivery attempts.
Findings:
- Early tocolytic and antibiotic therapy, alongside antenatal glucocorticoids, may delay delivery and improve lung maturation for the second twin.
- Publication bias exists due to under-reporting of failed delayed delivery attempts.
Implications:
- Delayed interval delivery is a feasible option for improving neonatal outcomes in select cases of multiple gestation.
- Further research is needed to clarify the role of interventions like cervical cerclage and to address reporting biases.