Delayed delivery of a triplet pregnancy without surgical intervention: a case report

Multiple gestations have a significantly increased incidence of preterm labor and preterm rupture of membranes. This leads to an increase in neonatal morbidity and mortality due to prematurity. In this case, a 30-year-old woman achieved a triplet pregnancy by ovulation induction and intrauterine inseminations. Preterm premature rupture of membranes occurred at 21 6/7 weeks' gestation. At 24 weeks' gestation, preterm labor ensued and a vaginal delivery of the presenting triplet followed. Magnesium sulfate tocolysis was started after delivery. The patient was placed on bed rest, magnesium sulfate tocolysis, and weekly steroid injections. The second and third triplet delivered vaginally after a 46-day delay due to preterm labor. This is the first reported case of delayed delivery of the two remaining fetuses of a triplet pregnancy, after spontaneous preterm delivery of the presenting triplet, without surgical intervention. Although the first fetus expired 48 hours after delivery secondary to complications of prematurity, the other fetuses were subjected to tocolysis, bed rest, and steroids. This case illustrates that conservative management of a triplet pregnancy after preterm delivery of the presenting triplet may have a good outcome.