Obstetric and Neonatal Outcomes of Delayed Interval Delivery in a Twin Pregnancy: A Case Report

  • Sule Yildiz Oguz Department of Obstetrics and Gynecology, Koc University Hospital, Istanbul, Turkey
  • Esra Bilir Koc University, School of Medicine, Istanbul, Turkey
  • Merve Ozturk Dr. Zekai Tahir Burak Women’s Health Education and Research Hospital, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey
  • Onur Karabacak Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey
Keywords: Multiple pregnancy, preterm labor, cervical cerclage, magnesium sulfate, delayed interval delivery


Patients with multiple pregnancies are at greater risk of preterm labor and delivery which is associated with increased risk of perinatal morbidity and mortality. We report a case of delayed-interval delivery of a twin pregnancy with the survival of the second fetus. The patient was hospitalized at 24 weeks and 3 days gestational age (GA) due to premature rupture of the membrane of the first amniotic sac. At 26 weeks of GA, the first fetus was born vaginally and died due to prematurity. To keep the second fetus in utero and minimize the complications, emergency McDonald cerclage was performed, and tocolysis, magnesium sulfate, betamethasone, and antibiotics were administrated. Despite our treatment at 28 weeks and 2 days gestational age, the second fetus was born via cesarean section due to breech presentation. At 10 months of corrected age, she exhibited normal development. She is now 6 years old and does not have sequel.


Carson JL. Twins born with an interval of 44 days. Br Med J 1880;1:242.

Guinn DA1, Atkinson MW, Sullivan L, Lee M, MacGregor S, Parilla BV, Davies J, Hanlon-Lundberg K, Simpson L, Stone J, Wing D, Ogasawara K, Muraskas J. Single vs weekly courses of antenatal corticosteroids for women at risk of preterm delivery: A randomized controlled trial. JAMA. 2001;286:1581-7.

ACOG Committee Opinion No.713, Antenatal Corticosteroid Therapy for Fetal Maturation. August 2017

Australian Research Centre for Health of Women and Babies. Antenatal Magnesium Sulphate Prior to Preterm Birth for Neuroprotection of the Fetus, Infant and Child – National Clinical Practice Guidelines. Adelaide. ARCH; 2010

ACOG Committee Opinion No. 652, Magnesium Sulfate Use in Obstetrics, January 2016

Alfirevic Z, Milan SJ, Livio S. Caesarean section versus vaginal delivery for preterm birth in singletons. Cochrane Database Syst Rev. 2012; 6: CD000078.

Feys S, Jacquemyn Y. Delayed-interval delivery can save the second twin: evidence from a systematic review. Facts Views Vis Obgyn. 2016 ;8:223-31.

Kolben T, Fischer D, Ruehl I, Franz M, Hester A, Kolben TM, Deppe C, Delius M, Friese K, Mahner S, Hasbargen U, Hübener C. Delayed interval delivery in multiple gestations: the Munich experience. Arch Gynecol Obstet. 2018 Nov 1. doi: 10.1007/s00404-018-4959-2

Roman AS, Fishman S, Fox N, et al. Maternal and neonatal outcomes after delayed-interval delivery of multifetal pregnancies. Am J Perinatol 2011; 28:91.

Uludağ S, Gezer A, Koşcağız Cansever İ, Duru Suiçmez B. Delayed interval delivary in multiple gestation. Cerrahpasa J Med 2007; 38: 62 - 4