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Very prolonged membrane rupture and delayed delivery of the second twin
O Bakos1, M Cederholm, H Kieler
1Department of Obstetrics and Gynaecology, University Hospital, Uppsala, Sweden.
Objectives:
To present the complications of twin pregnancies with delayed delivery of the second twin, 32 days after expulsion of the first twin.
Case:
A 29-year-old woman with a twin pregnancy at gestational age 13 weeks and 5 days presenting with a rupture of the membranes of the first twin. At 21 completed weeks the umbilical cord prolapsed and at 23 weeks the first twin was stillborn with the placenta in the uterus. After maternal septicemia the second twin was delivered by caesarian section, at 28 complete weeks, liveborn. The mother and child were discharged from hospital 10 weeks later, corresponding to 38 completed weeks of pregnancy.
Conclusions:
A very early premature rupture of membrane (PROM) occurs more often in twin pregnancies. The delivery of one twin most often results in expulsion of the second twin. With PROM there is a great risk of chorioamnionitis, as in our case, which resulted in an acute cesarean section. In this case, conservative management achieved a viable fetus in spite of very early and serious complications.