Vaginal delivery of healthy twins at 38 weeks of gestation after preterm premature rupture of membranes in a triplet pregnancy at 18 weeks of gestation, extraction of the first dead fetus and subsequent cervical cerclage

Preterm premature rupture of membranes (PPROM) often complicates multifetal pregnancies and may lead to pregnancy loss or premature delivery. We repor t the longest so far known prolongation of a multifetal pregnancy after pre term premature rupture of membranes in the second trimester, A 32-year-old primigravida who had undergone IVf-treatment presented at 18+2 weeks of ges tation with preterm premature rupture of membranes and umbilical cord prola pse, After intrauterine death of the first fetus extraction of the first tr iplet and cervical cerclage were performed. The mother was treated with bed rest, antibiotics and tocolysis, After 89 days of i.v. tocolysis and subseq uent oral tocolysis, the mother was discharged from the hospital at 34 week s of gestation. After removal of the cervical cerclage at 37 weeks of gesta tion two healthy fetuses were delivered vaginally at 38 weeks of gestation. The pregnancy was prolonged for 144 days after PPROM and 141 days after de livery of the first fetus. This is the longest continuation of pregnancy af ter PPROM described in the literature so far.