A case of spontaneous conceived twins in uterus didelphys, with induction and delayed delivery between twins

摘要

A 31-year-old primigravida at 21 weeks and 5 days of a spontaneously conceived trichorionic, triamniotic, triplet gestation was admitted with uterine contractions. The cervix was fully dilated, and the amniotic sac containing the first triplet was extruding into the vagina. The patient delivered the first fetus directly after examination. The baby was male, weighing 320 g, and died soon after birth. The umbilical cord was cut and tied as high as possible and the contractions stopped. Speculum examination showed a shortened cervix at 5 cm dilation and the intact amniotic sac of the next triplet. Physical examination and further tests showed no indications of infection. The woman was given the option of attempting to delay the deliveries of the second and third fetuses until both obtained biological maturity. With consent, the woman was placed in the Trendelenburg position and given intravenous fenoterol (60-120 mug/h). After 24 h, this was replaced with oral treatment (fenoterol 5 mg, X 8/day and verapamil 40 mg, X 4/day). To prevent infection, we gave intravenous cefuroxime (500 mg, X 3/day, for 7 days). Cervical canal culture, urinalysis, blood count and C-reactive protein measurement were performed every 7 days to assess the infection risk. At 24 weeks, we gave steroid treatment (betamethasone 24 mg). Because immobilisation presented a higher risk of thromboembolism, low molecular weight heparin (40 mg/0.4 ml) was prescribed. Ultrasound scans were performed every 14 days and confirmed eutrophic growth of both babies. Cardiotocography was done every 48 h from 28 weeks.