Delayed-Interval Delivery with Timely Cord Ligation
Dr Zahrah Ali
A 43-year-old gravida 6 para woman with dichorionic diamniotic (DCDA) twins presented at 18+6 weeks gestation with extreme Preterm Premature Rupture of Membranes (PPROM) of twin 2. 23 days later at gestation 22+1 the patient had cord prolapse of twin 1 with an absent fetal heart. The cord of twin 1 was ligated under general anaesthetic with subsequent spontaneous vaginal delivery of twin 1. The patient was kept as an inpatient and monitored for signs of chorioamnionitis and was continued on an antibiotic regimen and steroid loaded. At 31+4 twin 2 was delivered by emergency caesarean section in good condition, giving an interval delivery of 63 days. In this case we believe that the counselling and management of the cord prolapse with high ligation along with close monitoring reduced the risk of infection and resulted in delaying the delivery of twin 2, resulting in an excellent outcome for both mother and baby.
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