[Delayed delivery in a triplet pregnancy--a case report]

Area of Science:

• Perinatology
• Reproductive Medicine
• Maternal-Fetal Medicine

Background:

• Multiple pregnancies, particularly those resulting from in vitro fertilization (IVF), present unique challenges in managing delivery timing.
• Strategies to delay delivery in multiple gestations include bed rest, antibiotics, tocolytics, and steroids, alongside careful maternal and fetal monitoring.
• Preventing intra-amniotic infection is crucial during delayed delivery attempts in multiple pregnancies.

Observation:

• This report details a rare case of a trichorionic, triamniotic triplet pregnancy conceived via IVF.
• The initial two fetuses were delivered spontaneously at 23 and 26 weeks' gestation.
• The third fetus was delivered via cesarean section at 26 weeks, resulting in an 18-day interval between the first and subsequent deliveries.

Findings:

• Despite the significant delay between births, only the second infant survived.
• The surviving infant, delivered at 26 weeks gestation, exhibits normal psychomotor development at present.
• The case demonstrates the potential for delayed delivery in extreme preterm multiple gestations, albeit with significant risks.

Implications:

• This case underscores the complex decision-making involved in managing extremely preterm multiple births and the potential, though limited, for inter-delivery interval extension.
• Further research is warranted to optimize interventions for delaying delivery in multifetal gestations and improving neonatal outcomes.
• Careful monitoring of clinical and laboratory parameters is essential to mitigate complications such as intra-amniotic infection during delayed delivery scenarios.