Abstract

We present a very unusual case of a set of twins delivering 87 days apart and with a birth weight difference of 1990 g with survival of both.

A 33 year old woman with 2 previous full term vaginal deliveries presented to the EPAU of out department at 6 weeks gestation with light PV bleeding. Ultrasound confirmed DCDA twin pregnancy. Follow-up ultrasound 10 days later confirmed an ongoing pregnancy. She had formal booking appointment at 12 weeks and an uncomplicated pregnancy with regular review until 23 + 5 gestation when she presented with brown PV watery loss. PPROM of Twin 1 was confirmed. She was afebrile with normal BP and HR. HVS was taken, oral erythromycin commenced and bethamethasone administered. She was retained for inpatient monitoring and counselled about the associated risks of preterm delivery.

24 hours following admission she began contracting and had a quick spontaneous breech vaginal delivery of twin 1, a female, at 24 + 0 weeks weighing 550 g. Twin 2 was Cephalic with normal liquor volume on ultrasound. A trial of conservative management was agreed. She was retained in hospital for 4 hourly temperature, HR and BP cheques as well as weekly HVS, CRP and FBC monitoring and ultrasound surveillance.

Her inpatient management period was uneventful and she was induced at 36 + 3 gestation with 1 mg of Prostaglandin PV and went on a few hours later to have a spontaneous vaginal delivery of Twin 2, a female, weighing 2.54 Kg as well as the retained placenta of Twin 1.