Spontaneous fetal reduction in triplets and prolongation of twin pregnancy for 111 days as an\xa0outpatient: a case report

Davis Rubagumya,Ernie Mdachi,Munawar Kaguta,Muzdalfat Abeid,Hussein Kidanto

doi:10.1186/s13256-021-02952-w

Abstract

BackgroundMultiple gestation has been on the rise because of advancement in assisted reproductive technology. Triplet pregnancy is associated with fetal loss and preterm birth as its major complications. Spontaneous triplet pregnancy is rare. In the case of fetal loss, delayed interval delivery has been used to achieve delivery of the retained fetuses. There is no common approach to delayed interval delivery.CaseA 31-year-old East African lady with spontaneous triplet pregnancy presented to our institution at gestation age of 19 weeks with features of threatened miscarriage. One fetus was miscarried, and delayed interval delivery was done as an outpatient. At gestation age of 35 weeks, she delivered healthy twins by cesarean section.ConclusionDelayed interval delivery improves neonatal outcomes of high-order pregnancy after fetal loss even in a resource-limited setting.

Highlights

Multiple gestation has been on the rise because of the advancement in assisted reproductive technology
Case We report a case of successful spontaneous reduction of triplets to twins
Chorionicity does have a significant role in the outcome of multifetal pregnancy with reports suggesting that monochorionic and dichorionic triplet pregnancies have higher rates of poor perinatal and neonatal outcomes as compared with trichorionic pregnancy [15, 16]

Summary

Background

Multiple gestation means conceiving more than one fetus. Of late, multiple gestation has been on the rise because of the advancement in assisted reproductive technology. Obstetric ultrasound revealed triplet dichorionic triamniotic live pregnancy corresponding to gestational age of 18+2, 18+6, and 17+6 weeks, respectively, without fetal anomaly, and her cervix was short and open at the internal os. She was prescribed a complete bed rest, intravenous ampicillin 500 mg every 6 hours for 5 days, and oral nifedipine retard 20 mg every 12 hours. Obstetric ultrasound on day 4 postadmission revealed dichorionic diamniotic viable twin pregnancy corresponding to gestational age of 19+2 and 1 8+3 weeks, respectively, and the cervix was 4.1 cm long with funneling at the internal os measuring 1.58 cm.

Discussion

Conclusion