A Case of Delayed Interval Delivery with a Successful Hospital Move

Area of Science:

• Maternal-Fetal Medicine
• Perinatology
• Obstetrics

Background:

• Delayed interval delivery involves delivering twins asynchronously, with a significant time gap between births.
• Such cases are rare, especially when involving maternal transport and aiming for optimal neonatal outcomes.
• Managing twin pregnancies with preterm labor requires careful consideration of maternal and fetal well-being.

Purpose of the Study:

• To report the first case of delayed interval twin delivery with successful maternal and infant survival following inter-facility transport.
• To document a rare instance of asynchronous delivery where both twins survived without major morbidity.
• To illustrate the management of a dichorionic twin pregnancy presenting with preterm labor and bleeding.

Main Methods:

• A 30-year-old female with a diamniotic/dichorionic twin pregnancy presented at 22+5 weeks gestation with vaginal bleeding.
• Twin A was delivered at 23+2 weeks; Placenta A was intentionally left in utero with umbilical cord ligation.
• The mother and Twin A were transported to another facility, where Twin B was delivered at 26+4 weeks.

Main Results:

• Both mother and Twin A survived without major morbidity following transport.
• Twin B was delivered three weeks after Twin A, with both infants surviving.
• Neither twin experienced significant complications such as intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), retinopathy of prematurity (ROP), or chronic lung disease (CLD).

Conclusions:

• Delayed interval delivery is a viable option in select cases of dichorionic twin pregnancies, even with maternal transport.
• Successful management involves careful planning and transfer to a facility capable of managing preterm neonates.
• This case underscores the possibility of achieving positive outcomes for both mother and twins in complex obstetric scenarios.