DELAYED DELIVERY AFTER BIRTH OF AN EXTREM ELY IMMATURE FETUS - REPORTON 3 CASES - OBJECTIVE

Extreme immaturity between 23 and 26 weeks of gestation is associated with high neonatal mortality and morbidity. The prolongation of multif etal gestations after the delivery of the first fetus might achieve a gestational age for the remaining fetus(es) more compatible with neona tal survival. Study design: In three twin and triplet pregnancies the first fetus was born at a gestational age of 23 + 2, 24 + 2 and 24 + 7 weeks. We used cervical cerclage, tocolysis and antibiotic therapy to extend the intrauterine life of the remaining fetus(es). Results: In two pregnancies (triamniotic, trichorionic triplets and biamniotic, mo nochorionic twins) we succeeded in prolonging the gestation of the in utero remaining fetus(es) for 22 and 70 days. Only the first born fetu s with a gestational age of 23 + 2 weeks died, the other four neonates survived. No maternal complications occurred in these two patients. I n the third pregnancy (triamniotic, trichorionic triplets) chorioamnio nitis was the reason for a Caesarean section one day after the spontan eous delivery of the first fetus. The first fetus survived while the o ther two died. The mother developed septicaemia due to a infectious ov arian vein thrombosis. Conclusion: Delayed delivery in multifetal preg nancies with extreme immaturity of the first fetus might be a reasonab le option in some pregnancies to enhance maturity of the in utero rema ining fetuses. This advantage must be weighed up against the risk of s evere chorioamnionitis seen in one patient in our series.