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Prolonged-interval delivery between the first and second twin. A case report.

BACKGROUND
Prolonged-interval delivery between twins can improve neonatal outcome and, under careful monitoring, poses minimal maternal risk.


CASE
A 27-year-old, nulliparous woman conceived after in vitro fertilization and was found to have diamniotic-dichorionic twins. At 17 weeks she presented with premature preterm rupture of the membranes of twin A. She was offered delivery or expectant management. She chose expectant management and was discharged. At 18 weeks she delivered twin A and decided to expectantly manage the second twin. Amniocentesis was performed to evaluate for intraamniotic infections. There was no evidence of them, and a McDonald cerclage was placed. At 32 weeks, spontaneous rupture of the membranes occurred for twin B. The patient delivered vaginally a male infant (2,070 g) who did not need mechanical ventilation and was discharged from neonatal intensive care on the 7th day of life, with no complications.


CONCLUSION
Expectant management of a second twin after delivery of the first in selected patients can improve neonatal outcome.