Delayed-Interval Delivery in Multifetal In Vitro Fertilization (IVF) Pregnancies: Two Case Reports

TL;DR

This paper presents two cases where the second twin was delivered days after the first to improve neonatal outcomes in IVF pregnancies.

Contribution

The paper contributes two case reports on delayed-interval delivery in IVF twin pregnancies with extended latency periods.

Findings

A 5-day delay allowed the second twin to reach 28 weeks with better neurodevelopmental outcomes.

A 30-day delay was attempted, but the second twin developed posthemorrhagic hydrocephalus.

Prolonged latency may reduce neonatal morbidity if managed with strict maternal monitoring and infection control.

Abstract

Delayed-interval delivery in twin pregnancies is a rare but increasingly recognized obstetric intervention aimed at improving neonatal outcomes, particularly in cases of preterm labor. The rise in multiple gestations associated with in-vitro fertilization (IVF) has contributed to the need for optimized management strategies in such cases. However, there remains no consensus on standardized protocols for delayed twin delivery.

We present two cases of dichorionic-diamniotic twin pregnancies obtained via IVF, where the birth of the second twin was delayed by 5 and 30 days. In the first case, a 31-year-old nulliparous woman presented at 24 weeks of gestation with preterm labor. Despite initial tocolysis and antibiotic prophylaxis, the first twin was delivered at 24 weeks, while the second twin was successfully retained until 28 weeks. The first neonate developed severe retinopathy of prematurity, while the second twin exhibited normal neurodevelopmental outcomes. In the second case, a 52-year-old multiparous woman with an IVF pregnancy and donor oocytes experienced premature rupture of membranes at 25 weeks, leading to immediate vaginal delivery of the first twin. Conservative management, including tocolysis and antibiotics, enabled the extension of the pregnancy for five additional days. The first neonate had a favorable postnatal course, while the second twin developed posthemorrhagic hydrocephalus requiring ventriculoperitoneal shunting.

The decision to delay twin delivery is contingent upon multiple factors, including maternal stability, absence of chorioamnionitis, and the viability of the remaining fetus. Current literature suggests that prolonged latency between twin deliveries is associated with reduced neonatal morbidity when managed with strict maternal monitoring, tocolysis, and infection control. However, the benefits must be weighed against maternal and fetal risks, particularly the potential for intrauterine infection and placental dysfunction.

Asynchronous twin delivery remains a complex but potentially beneficial intervention for improving neonatal outcomes in cases of preterm labor, especially in IVF pregnancies. These cases highlight the importance of individualized management, vigilant maternal-fetal surveillance, and further research to establish standardized protocols for optimizing perinatal outcomes.

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