DOI: http://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20151502

Prolonged latency period of 70 days in a diamniotic and dichorionic twin pregnancy complicated by early second trimester rupture of membrane in one sac and its outcome

Manisha Sahu, Sasmita Das, Kabita Chananya

Abstract


A patient with diamniotic dichorionic twin (DADC) pregnancy was on regular antenatal checkup from conception, admitted to emergency department at 21 weeks with leaking PV. On per speculum and pervaginal examination it was found that clear liquor was draining from os & cervix was long and os was closed. USG revealed twin A sac having  live fetus of 20 weeks with no liquor and twin B sac having live fetus with plenty of liquor. Considering the emotional aspect of parents we decided for conservative management   which includes combination of antibiotics, micronized progesterone as tocolytic, probiotics, L- arginine and absolute bed rest. Caesarean section was performed at 31 weeks as she entered in labour and had cord prolapse. She delivered two live twin babies after a long latency period of 70 days. Twin ‘A’ baby could not be saved because of lung hypoplasia due to prolonged Oligohydraminous but twin ‘B’ was discharged safely along with mother. Since last decade assisted reproduction technique has increased in numbers of twin pregnancies and its complications. The most important are preterm labour and PPROM. On literature review there is no clear cut guide line for management of PPROM in early second trimester in twin pregnancies. This case is reported because of its long latency period of 70 days from PPROM in early 2nd trimester in a twin pregnancy to delivery by conservative management and can save the baby in intact sac. Also we can add our experience to currently available limited literature regarding management of such patient.

Keywords


Twin, Latency period, Premature rupture of membrane (PPROM)

Full Text:

PDF

References


Wittmann BK, Farguhanson D, Wong JP, Baldwin V, Wadsworth LD, Ellit L. Delayed delivery of second twin: report of four cases and review of the literature. Obstet Gynecol. 1992;79:260–3.

Mercer BM, CrockerLG, PierceWF, Sibai BM. Clinical characteristics and outcome of twin gestation complicated by preterm pre-mature rupture of the membranes. Am J Obstet Gynecol. 1993;168:1467–73.

Bianco AT, Stone J, Lapinski R, Lockwood C, Lynch L, Berkowitz RL. The clinical outcome of preterm premature rupture of membranes in twin versus singleton pregnancies. Am J Perinatol. 1996;13:135–8.

Hsieh YY, Chang CC, Tsai HD, Yang TC, Lee CC, Tsai CH. Twin versus singleton pregnancy. Clinical characteristics and latency periods in pre- term premature rupture of membranes. J Reprod Med. 1999;44:616–20.

van der Heyden JL, van der Ham DP, van Kuijk S, Notten KJ, Janssen T, Nijhuis JG et al. Outcome of pregnancies with preterm premature rupture of membranes before 27 weeks gestation : a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):125-30.

Arias F. Delayed delivery of multifetal pregnancies with premature rupture of membranes in the second trimester. Am J Obstet Gynecol. 1994;170:1233–7.

Clerici G, Cutuli A, Di Renzo GC. Delayed interval delivery of a second twin. Eur J Obstet Gynecol and Reprod Biology. 2001;96:121–2.

Zajicek M, Yagel S, Ben-Ami M, Weisz B, Keselman L, Lipitz S. Outcome of twin pregnancies complicated by early second trimester rupture of membranes in one sac. Twin Res Hum Genet. 2010;13(6):604-8.

Zhang J, Johnson CD, and Hoffman M. “Cervical cerclage in delayed interval delivery in a multifetal pregnancy: a review of seven case series”. European Journal of Obstetrics Gynecology and Reproductive Biology. 2003; 108(2);126–30.

Costeloe K, Hennessy E, Gibson AT, Marlow N, Wilkinson AR. The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics. 2000;106(4):659-71.

Yamasmit W, Chaithongwongwatthana S, Tolosa JE, Limpongsanurak S, Pereira L, Lumbiganon P. Prophylactic oral betamimetics for reducing preterm birth in women with a twin pregnancy. Cochrane Database Syst Rev.2012;9:CD004733.

van Doorn HC, van Wezel-Meijler G, van Geijn HP, Dekker GA. Delayed interval delivery in multiple pregnancies; is optimism justified? Acta Obstet Gynecol Scand. 1999;78:710–5.

Dugoua JJ, Machado M, Zhu X, Chen X, Koren G, Einarson TR. Probiotic safety in pregnancy: A systematic review and metaanalysis of randomized controlled trial of lactobacillus, Bifidobacterium and saccharomyces spp. JOGC. 2009;31(6):542-52.