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Management of delayed-interval delivery in multiple gestations
Stéphane Cristinelli1, Jeanne Fresson, Monique André
1Materno-Fetal Medicine Department and Neonatal Intensive Care, Maternity Hospital, Nancy, France.
Fetal Diagnosis and Therapy
|June 28, 2005
Summary
Delayed delivery can reduce risks for newborns. This study suggests an interventionist approach, using cerclage, tocolysis, and antibiotics for managing delayed delivery cases, balancing maternal and fetal safety.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Neonatal Care
Background:
- Delayed delivery, while not standard, presents potential benefits for neonatal outcomes.
- Management strategies for delayed delivery lack universal consensus.
- Precise conditions are crucial to mitigate maternal and fetal risks.
Purpose of the Study:
- To demonstrate the feasibility of delayed delivery.
- To explore and debate the modalities of managing delayed delivery.
- To propose guidelines for the management of delayed delivery.
Main Methods:
- A case series of six delayed delivery instances treated between 1979 and 2001.
- Comparison with a literature review of 148 cases identified via Medline database.
- Analysis of interventions including cerclage, prophylactic tocolysis, and antibiotics.
Main Results:
- Delayed delivery was associated with reduced neonatal mortality and morbidity.
- Delivery intervals ranged from 2-93 days (median 7) in the case series and 2-153 days (median 31) in the literature.
- Interventions included cerclage (60%), prophylactic tocolysis (79%), and antibiotics (71%) after initial expulsion.
Conclusions:
- An interventionist approach is supported, incorporating cerclage, prophylactic tocolysis, and antibiotics.
- Management requires specific conditions to minimize risks to both mother and fetus.
- Further consensus on optimal management strategies is needed.