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 eva cuation of a fetus followed by delayed delivery of the remaining sibli ngs has been described previously. Case: A triplet pregnancy was compl icated by preterm rupture of membranes at 17 weeks' gestation, followe d by cord prolapse and subsequent fetal arm prolapse at 18 weeks' gest ation. Operative evacuation of triplet A was performed under ultrasoun d guidance, with the placenta left undisturbed. Antibiotics and tocoly tics were used perioperatively and the pregnancy was prolonged for ano ther 16 weeks. Onset of active labor at 34 weeks' gestation resulted i n the vaginal delivery of viable twin males weighing 2810 and 2680 g. Conclusion: In cases of multiple gestations with second-trimester rupt ure of the lower sac, selective fetal evacuation can be performed safe ly and may allow successful continuation of the remaining pregnancy.