A Multidisciplinary Approach To The Care Of The Patient Encountering Delayed Interval Delivery In Twin Pregnancy
Title: A Multidisciplinary Approach To The Care Of The Patient Encountering Delayed Interval Delivery In Twin Pregnancy
- Identify and describe the risk to the pregnant mother when choosing delayed interval delivery vs elective termination of pregnancy.
- Identify different forms of support that are utilized based on family needs when the diagnosis is the same.
- Identify and explore the various coping mechanisms that families use in similar situations.
Multiple gestation occurs in approximately 32/1000 births. This number has increased over the past 30 years primarily due to assisted reproduction technology and advanced maternal age. One in eight twins are born before 32 weeks gestation. Typically fetuses of multiple gestation deliver within a short interval of time, however, if membranes rupture, or an intrauterine demise occurs previability, there may be benefit in attempting to delay delivery of the second twin in order to achieve viability. Caring for these patients is challenging and will be best served by a multidisciplinary team approach.
Case:
- A 31 yo G1 P0 conceived by IVF presented at 19 weeks 5 days with preterm premature rupture of membranes (PPROM) of twin A. She and her husband chose to attempt to maintain pregnancy for the benefit of twin B. Twin A was delivered at 19 weeks 6 days. Twin B was born at 28 weeks 3 days and went home from the NICU 9 weeks later. During her hospitalization, the parents met with Maternal Fetal Medicine (MFM), neonatology, supportive care and spiritual care. This very private couple supported each other well and acknowledged the bittersweet experience of grieving for one child and being happy for the positive outcome for the other.
- A 41 yo G9 P5034 presented at 22 weeks 1 day with PPROM of twin A and delivered shortly after admission. She desired to continue the pregnancy for benefit of twin B. She ultimately delivered at 26 weeks 1 day. Her baby died at 16 days of life in the NICU. Her hospitalization was challenging for all involved. She had a strong psychiatric and substance dependence diagnosis. During her hospitalization, she met with MFM, neonatology, supportive care and psychiatry. She continues to struggle with her grief.
- A 29 yo G1 P0 conceived by IUI was admitted for PPROM of twin A at 20 weeks 0 day. She delivered twin A one day later. They also desired to maintain pregnancy. 24 hours later, she developed chorioamnionitis, and labor was augmented for twin B. During her hospitalization, she met with MFM, Supportive Care and Spiritual Care. They thrived with involvement of the entire team and wanted to share their children with everyone. They spent time making memories and building legacy projects.
Conclusion:
When delayed interval delivery is chosen, families and caregivers must be education about risks of infection and potential poor outcome of the remaining fetus. Identifying and providing supportive care is vital for both family and staff .
Keywords: twins, bereavement, perinatal loss