Prolongation of pregnancy and survival of remaining fetuses after operative evacuation of one triplet at 18 weeks' gestation.

BACKGROUND

Successful delay of aftercoming siblings is an infrequent event in obstetrics. No case of second-trimester operative vaginal evacuation of a fetus followed by delayed delivery of the remaining siblings has been described previously.

CASE

A triplet pregnancy was complicated by preterm rupture of membranes at 17 weeks' gestation, followed by cord prolapse and subsequent fetal arm prolapse at 18 weeks' gestation. Operative evacuation of triplet A was performed under ultrasound guidance, with the placenta left undisturbed. Antibiotics and tocolytics were used perioperatively and the pregnancy was prolonged for another 16 weeks. Onset of active labor at 34 weeks' gestation resulted in the vaginal delivery of viable twin males weighing 2810 and 2680 g.

CONCLUSION

In cases of multiple gestations with second-trimester rupture of the lower sac, selective fetal evacuation can be performed safely and may allow successful continuation of the remaining pregnancy.