BACKGROUND:

Asynchronous twin birth consists in deferring the birth of the second twin, when the first one inevitably occurs in early stages of gestation.

CLINICAL CASE:

A 39-year-old patient with bicorial twin pregnancy, achieved after in vitro fertilization treatment. Served at the Miguel Servet University Hospital due to the threat of premature delivery. Upon admission the death of the first twin was verified and it was decided to perform the delivery at week 23 + 2 weeks. Subsequently, cervical retraction was observed, with 2-3 cm dilation and cessation of uterine dynamics. The amniotic bag of the second twin remained intact, with no signs of loss of fetal well-being, so it was decided to perform the asynchronous delivery attempt. During the interval between the two twins, four cycles of tocolytic drugs with atosiban and fetal pulmonary maturation with corticosteroids were administered due to the threat of premature delivery. Finally, the cerclage was removed at 34 + 2 weeks of pregnancy, due to regular uterine dynamics, even with the administration of tocolytics, giving birth to the second twin. The newborn weighed 1810 g, had Apgar of 9 per minute and 10 at 5 minutes, and cord pH of 7.39. Its evolution was favorable and remained in the neonatal intermediate care unit for 13 days, to discharge it with 2070 g. The postmortem study of the first twin did not report morphological expression of the cause of death, nor were there signs of infection. The result of the array was normal and the karyotype was 46 XY. The microbiological study of the placenta showed no signs of chorioamnionitis. The patient was discharged three days after delivery, with satisfactory evolution and without registering incidents during the puerperium.

CONCLUSIONS:

Deferred delivery of the second twin is an alternative for well-selected twin pregnancies in which the birth of the first twin occurs in weeks corresponding to extreme prematurity since it could prolong pregnancy to a gestational age that improves the prognosis of the second twin .

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