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Ghulmiyyah LM, Wehbe SA, Schwartz SA, et al. Successful obstetrical management of 110-day intertwin delivery interval without cerclage: counseling and conservative management approach to extreme asynchronous twin birth. BMC Pregnancy Childbirth. 2004;4(1):23doi: 10.1186/1471-2393-4-23.
Ghulmiyyah, L. M., Wehbe, S. A., Schwartz, S. A., & Sills, E. S. (2004). Successful obstetrical management of 110-day intertwin delivery interval without cerclage: counseling and conservative management approach to extreme asynchronous twin birth. BMC pregnancy and childbirth, 4(1), 23. https://doi.org/10.1186/1471-2393-4-23
Ghulmiyyah, Labib M, et al. "Successful obstetrical management of 110-day intertwin delivery interval without cerclage: counseling and conservative management approach to extreme asynchronous twin birth." BMC pregnancy and childbirth vol. 4,1 (2004): 23. doi: https://doi.org/10.1186/1471-2393-4-23
Ghulmiyyah LM, Wehbe SA, Schwartz SA, Sills ES. Successful obstetrical management of 110-day intertwin delivery interval without cerclage: counseling and conservative management approach to extreme asynchronous twin birth. BMC Pregnancy Childbirth. 2004 Dec 06;4(1):23. doi: 10.1186/1471-2393-4-23. PMID: 15581427; PMCID: PMC539248.
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BMC Pregnancy Childbirth. 2004 Dec 06;4(1):23. doi: 10.1186/1471-2393-4-23.

Successful obstetrical management of 110-day intertwin delivery interval without cerclage: counseling and conservative management approach to extreme asynchronous twin birth.

BMC pregnancy and childbirth

Labib M Ghulmiyyah, Salim A Wehbe, Seth A Schwartz, Eric Scott Sills

Affiliations

  1. Department of Obstetrics and Gynecology, Atlanta Medical Center; Atlanta GA 30321 USA. [email protected].

PMID: 15581427 PMCID: PMC539248 DOI: 10.1186/1471-2393-4-23

Abstract

BACKGROUND: This report describes a patient counseling approach and non-surgical management of a dichorionic-diamniotic twin pregnancy where delivery of the second twin followed the delivery of the first by 110 days. CASE PRESENTATION: An early transvaginal sonogram at 19 1/2 weeks suggested cervical dilation with protruding amniotic membranes. Tocolytic and antibiotic therapy was initiated; no cerclage was placed. Spontaneous rupture of membranes and cord prolapse occurred 48 h later, resulting in delivery of a stillborn female infant. Conservative management was offered after counseling for possible risks associated with maternal sepsis, need for extended hospitalization, potential for hysterectomy and death. The cervix appeared closed after delivery and the umbilical cord was ligated, with subsequent spontaneous cord retraction in utero. Reassuring fetal status was observed for twin B without evidence of contractions or chorioamnionitis. A viable male infant (2894 g) was delivered vaginally at 35 1/2 weeks. CONCLUSIONS: This report outlines a counseling approach useful for patients with premature delivery of one twin, and presents application of conservative obstetrical management principles for the aftercoming twin even when delivery interval is extreme.

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