ABSTRACT
Multiple pregnancy is frequently complicated by preterm delivery, a major cause of perinatal mortality and morbidity1,2. The number of multiple pregnancies has increased rapidly in recent decades, primarily due to the use of assisted reproductive technologies (ART) and increased maternal age (see below). Arrest of labor often occurs after the premature delivery of one member of a multiple pregnancy. Traditionally, only a few attempts were undertaken to postpone delivery of the remaining fetus(es). In 1880, Carson reported an interval of 44 days between the birth of two babies from a woman with uterus didelphis and ‘twin’ pregnancy3. In 1957, Abrams reported an interval of 35 days between the deliveries of two babies, both alive at the time of birth4. At 23.3 weeks of gestation, the mother delivered a girl of 396 g, who died 3h after birth at home. Five weeks later, she delivered a living boy weighing 1033g. Unfortunately, neonatal outcome and further development were not stated. Over recent decades, several additional case reports and series have reported delayed-interval delivery in multiple pregnancies. Review of these studies, despite a large variation in treatment protocols, shows a very high success rate (93%), suggesting that mainly cases with successful outcomes are reported5. As a result of this selection bias, both prognosis and recommendations concerning treatment protocols based on these early studies are speculative. Recently, however, three larger studies have been published demonstrating a success rate of about 50%5-7. The objective of this chapter is to report techniques and the results of our attempts using a fixed protocol.
