West China Second Hospital of Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu, China.
Medicine (Baltimore). 2024 Mar 15;103(11):e37262. doi: 10.1097/MD.0000000000037262.
To report a peculiar case of vaginal delivery of a triplet after emergency transvaginal cerclage and to find a way to optimize some extreme situations encountered in clinical practice after evaluating feasibility.
A 33-year-old gravida 6, para 0050 woman at 21 + 6 weeks of gestation was referred to the obstetric department for opening of the cervical canal. An emergency McDonald cerclage was performed at 22 weeks of gestation after a comprehensive assessment, and the pregnancy ended with vaginal delivery at 24 + 6 weeks of gestation. The postpartum period was normal, and the newborns were discharged to home care after treatment in the neonatal intensive care unit.
After discussing the risks, the patient requested emergency transvaginal McDonald cerclage at 22 weeks of gestation.
Emergency McDonald cerclage was performed at 22 weeks of gestation, and the pregnancy ended with vaginal delivery at 24 + 6/25 weeks of gestation, successfully prolonging gestation by 20/21 days. The postpartum period had no exceptional circumstances, and newborns were discharged to home care after treatment in the neonatal intensive care unit for 104/98/104 days.
Emergency cerclage seems to be impossible in multiple pregnancies. However, in this case, after a comprehensive assessment, it was feasible to extend the gestational age by emergency cerclage, and prompt and accurate evaluation is important to avoid complications and individualize the following management. In this case, we may find a way to optimize some extreme situations encountered in clinical practice and offer a glimmer of hope for families challenged with multiple pregnancies at risk of preterm delivery. However, more high-quality studies are needed to prove the effectiveness and safety of emergency cerclages in triplets.
报道一例经阴道分娩三胞胎的特殊病例，评估可行性后寻找优化某些临床实践中极端情况的方法。
一位 33 岁的孕妇，孕 6 产 0，妊娠 21+6 周，因宫颈管扩张就诊于产科。经全面评估后，于妊娠 22 周行紧急 McDonald 宫颈环扎术，妊娠于 24+6 周经阴道分娩结束。产后情况正常，新生儿经新生儿重症监护室治疗后出院回家护理。
讨论风险后，患者要求行紧急经阴道 McDonald 宫颈环扎术。
妊娠 22 周行紧急 McDonald 宫颈环扎术，妊娠于 24+6/25 周经阴道分娩结束，成功延长妊娠 20/21 天。产后无特殊情况，新生儿经新生儿重症监护室治疗 104/98/104 天后出院回家护理。
紧急宫颈环扎术似乎不适用于多胎妊娠。然而，在本例中，经全面评估后，紧急宫颈环扎术延长妊娠时间是可行的，及时准确的评估对于避免并发症和个体化后续管理非常重要。在这种情况下，我们可能会找到优化某些临床实践中极端情况的方法，为面临早产风险的多胎妊娠家庭带来一线希望。然而，需要更多高质量的研究来证明紧急宫颈环扎术在三胞胎妊娠中的有效性和安全性。
