Abstract

We discuss the case of two sets of twins, with extreme premature delivery of 1^st twin prolonging the gestation of the 2^nd twin using close surveillance and a cervical suture.

A 36 year old Primip, IVF conception with a previous large loop excision of the transformation zone (LLETZ) attended with blood stained discharge. Vaginal examination revealed bulging membranes (cervix 3 cm dilated). Shortly after she had spontaneous ruptured membranes and delivered a 19 + 5 a SB infant. Viability of second twin was confirmed leading to a rescue Mcdonnalds suture. Cyclogest pessaries and clinidamycin PV were commenced. At 21 weeks she was re-admitted feeling generally unwell with a low grade fever. Steroids were given at 24 weeks gestation. At 30/40 she went into pre term labour. The suture was removed and she progressed rapidly to full dilatation and delivered. The baby made good progress on neonatal unit.

A 31 year old primip, IVF twins, presented with bleeding and SRM at 17 weeks gestation. She proceeded to deliver Twin 1. A rescue suture was inserted. Ante natal course was uneventful and the suture was removed at 36/40. She progressed into spontaneous labour and had a LSCS due to persistence of a pathological CTG.

Although evidence limited the cases have highlight that in some circumstances insertion of a rescue cervical suture is beneficial to prolong the gestation and viability of the second twin. Both of these sets of twins had oligohydramnios after suture insertion which then normalised throughout the rest of the antenatal course.