NEONATAL AND MATERNAL OUTCOMES AFTER INTENTIONAL DELAYED DELIVERY OF THE SECOND TWIN IN DIZYGOTIC PREGNANCY CASE REPORT

*Manuela Russu, Simona Svasta, Anca Tudor, D Dobritoiu and A. Craciun

ABSTRACT

Intentional delayed delivery of second twin in dizygotic pregnancy is rarely. There are analyzed the peculiarities regarding maternal, short- term neonatal outcomes in a 41 yrs mother, admitted in a tertiary university maternity, diagnosed: IVG IIP 24wks+3days dizygotic pregnancy, alive fetuses, A- breech, B cephalic presentation, intact membranes, EFWs: of 690/700g (ultrasound). At 26 wks gestation, after PROM, short positive trial of labor for planned vaginal delivery, under continuous CTG, Bracht maneuver for breech presentation on records birth of female fetus A, 920g, Apgar 5/6. Sectioned umbilical cord is introduced in the vagina. At 50 days interval of close monitoring/treatment for mother, fetus B, placentae, it is done CS for female fetus B, 1870 g (34 wks gestation), Apgar 8, placentae A/B: 200/450g. Maternal postoperative evolution is normal. Baby A admitted in NICU for moderate hypoxia at birth, repeated apnea crisis, without functional respiratory syndrome, anemia corrected with blood derivates, 70 days with gastric-tube nutrition, antibiotics, stage I retinopathy, bilateral hip risk; weight of 1550g when cesarean section (CS) of fetus B. Baby B has- favorable evolution, breast fed plus milk. Conclusions: Vaginal delivery at a multipara can be assumed in breech presentation, after a precise protocol, followed by experienced obstetrical/neonatological teams, and an intentional delayed CS delivery is feasible. Fetus B is larger at delivery than A at the same moment (1870g vs 1550g) and discharge (2250g vs 2975g), with a very short admission in NICU/preterm wards. No maternal complication.

Keywords: intentional delayed delivery, dizygotic pregnancy, preterm delivery, outcome.