Multiple Pregnancy: Interval Birth/Delivery

Premature birth/delivery in multiple gestation is common. Both infertility and in vitro fertilisation are independent risk factors for preterm delivery. There are exceptional circumstances in which the birth/delivery of a second twin can be delayed after the preterm birth/delivery of the first. This also may apply to triplets and quadruplets under exceptional circumstances.

Indications for interval birth/delivery

• The placenta(e) of the remaining fetus(es) must be separate from the delivered fetus(es)

• Contractions must cease after the delivery of the fetus(es)

• Absence of infection

• Absence of bleeding

• Absence of fetal distress in the retained fetus(es)

• Prior to 28 weeks gestation only.

Technique of interval birth/delivery

• Adequate analgesia/anaesthesia

• High ligation of the umbilical cord with 1 CCG

• Postoperative vaginal douche with antiseptic solution

• Broadspectrum antibiotic coverage until results of cervical microbiology are available

• Corticosteroids to be administered at fetal viability

• Maternal and fetal monitoring for evidence of infection

• No evidence for the use of:

References