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Previable Premature Rupture of Membranes in Dichorionic Diamniotic Twin Gestation, Loss of Leading Twin, Emergency Cervical Cerclage and Ceaserean Delivery at Term

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Case Reports in Clinical Medicine 2023年第1期12卷 14-21页

作者： Darlington-Peter Chibuzor Ugoji Ugochukwu sunday Julius Ezenyirioha Ifeanyichukwu Jude Ofor Chukwuemeka Joseph Nwoye god’s miracle david banso sunday Emmanuel Ucha Ugochi Chimerem Ugoji Julius Ezenyirioha Memorial Hospital and Maternity Abakpa Nike Enugu State Nigeria Department of Obstetrics and Gynaecology Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State Nigeria Department of Obstetrics and Gynaecology Enugu State University College of Medicine Parklane Enugu State Nigeria school of Nursing Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State Nigeria

Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: she was a case of a 29 years old, Gsub>6sub>Psub>1sub>sup>+4sup> with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. she subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. she then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.

关键词： Previable Premature Rupture of Membrane Cervical Cerclage Twin Gestation Multiple Gestation Multiple Pregnancy Twin Preterm Delivery Cervical Incompetence Cerclage Interval Delivery

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