[Delayed birth of the second child in multiple gestation]

Abstract

Five case histories illustrate the issue of delayed interval deliveries. In the first two cases, the first child was born at a gestational age of 20 and 18 weeks, respectively. The first woman (40 years old) gave birth to the second child after successful prolongation of pregnancy to a gestational age of 38 weeks. In the second case (28 years old), the attempt to delay delivery failed and the second child was born at 19 weeks of gestation. The third case (32 years old), illustrates the enormous differences in neonatal course between a child born at 26 weeks of gestation, who had to be treated at length for respiratory distress syndrome, hypotension and patent ductus arteriosus, and his twin brother born two weeks later and who recovered more quickly. The fourth case (24 years old) describes delayed delivery to allow administration of antenatal glucocorticoids. The last case (32 years old) deals with a serious maternal complication of placental abruption during an attempt to delay the birth of the second twin. Early tocolytic and antibiotic therapy may delay delivery and, in combination with antenatal glucocorticoids to stimulate lung maturation, may thereby improve the condition of the second twin. The role of cervical cerclage remains controversial. There is an important publication bias in the literature due to under-reporting of the failed attempts of delayed deliveries. In multiple gestation with imminent very preterm birth, delayed delivery of the second child is a feasible management option.