Department of Obstetrics and Gynecology, Hospital do Divino Espírito Santo, Ponta Delgada, São Miguel, Açores, Portugal.
Department of Obstetrics and Gynecology, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal.
Rev Bras Ginecol Obstet. 2020 Jan;42(1):61-64. doi: 10.1055/s-0040-1701468. Epub 2020 Feb 27.
Premature delivery often complicates multifetal pregnancies, placing neonates at risk of serious morbidity and mortality. In select cases, preterm birth of one sibling may not require delivery of the remaining fetus(es), which may remain for a delayed-interval delivery, consequently improving neonatal morbidity and mortality. Currently, there is no consensus on the best protocol for the optimal management of these cases. We report one case of delayed-interval delivery of a dichorionic pregnancy assisted in our center. In this case, prophylactic cerclage, tocolytic therapy and administration of broad-spectrum prophylactic antibiotics enabled delivery at 37 weeks, corresponding to 154 days of latency, which is, to our knowledge, the longest interval described in the literature. The attempt to defer the delivery of the second fetus in peri-viability is an option that should be offered to parents after counseling, providing that the clinical criteria of eligibility are fulfilled. The correct selection of candidates, combined with the correct performance of procedures, as well as fetal and maternal monitoring and early identification of complications increase the probability of success of this type of delivery.
早产常使多胎妊娠复杂化，使新生儿面临严重发病率和死亡率的风险。在某些情况下，一个胎儿的早产可能不需要分娩其余的胎儿，这些胎儿可以延迟分娩，从而降低新生儿的发病率和死亡率。目前，对于这些病例的最佳管理方案尚无共识。我们报告了一例在我们中心辅助的双绒毛膜妊娠的延迟间隔分娩。在这种情况下，预防性宫颈环扎术、宫缩抑制剂治疗和广谱预防性抗生素的使用使分娩得以在 37 周时进行，对应于 154 天的潜伏期，据我们所知，这是文献中描述的最长间隔。在接近生存能力时推迟第二胎儿分娩的尝试是在咨询后应向父母提供的一种选择，前提是符合资格的临床标准。正确选择候选人，结合正确的手术操作，以及对胎儿和母体的监测和早期识别并发症，可提高这种分娩方式的成功率。
