Delivery and Survival of Triplet Infants at 26 Weeks of Gestational Age after Emergency Cerclage in Woman with Dilated Cervix and Bulging Fetal Membranes

Songyi Song; Yung Zu Park; Eun-Ae Kim; Heejin Ham; Gahyun Son; Keun-Young Lee; Tae-Jung Sung

doi:10.14734/PN.2019.30.4.244

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Song, Park, Kim, Ham, Son, Lee, and Sung: Delivery and Survival of Triplet Infants at 26 Weeks of Gestational Age after Emergency Cerclage in Woman with Dilated Cervix and Bulging Fetal Membranes

Original Article

Perinatology 2019;30(4):244-248.

Published online: 20 September 2019

DOI: https://doi.org/10.14734/PN.2019.30.4.244

Delivery and Survival of Triplet Infants at 26 Weeks of Gestational Age after Emergency Cerclage in Woman with Dilated Cervix and Bulging Fetal Membranes

Songyi Song, MD, Yung Zu Park, MD, Eun-Ae Kim, MD, Heejin Ham, MD, Gahyun Son, MD, Keun-Young Lee, MD, PhD, Tae-Jung Sung, MD, PhD

¹Department of Pediatrics, Hallym University Medical Center, Kangnam Sacred Heart Hospital, Seoul, Korea

²Department of Obstetrics and Gynecology, Hallym University Medical Center, Kangnam Sacred Heart Hospital, Seoul, Korea

Correspondence to Tae-Jung Sung, MD, PhD Department of Pediatrics, Hallym University Medical Center, Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In triplet pregnancy, preterm delivery is a major cause of neonatal morbidity and mortality. If mother was suffering from cervical insufficiency, the effectiveness and safety of cervical cerclage remains controversial. The authors experienced the case of a 29-year-old patient with triplet pregnancy who had dilated cervix and bulging fetal membranes at 20+4 weeks of gestation. The patient underwent emergency cervical cerclage and carried pregnancy until 26th weeks of gestation. The babies were delivered by cesarean section in the 26th week of gestation and they were discharged home at the 40 weeks of corrected age. In triplet gestation as well as single or twin gestation, cervical cerclage in the patients with cervical dilatation and bulging fetal membrane could be successful if obstetricians and neonatologists collaborate.

Keywords: Uterine cervical incompetence, Cervical cerclage, Pregnancy, triplet

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Table 1.

The Neonatal Morbidities of Babies during Admission at Neonatal Intensive Care Unit

	1st baby	2nd baby	3rd baby
Birth weight	900 g	830 g	950 g
APGAR score at 1, 5, 10 minutes	2, 5, 6	3, 5, 7	1, 4, 6
Number of surfactants used	1 (prophylactic)	1 (prophylactic)	2 (prophylactic and rescue)
Duration of invasive ventilation (day)	16	4	6
Duration of noninvasive ventilation (day	y) 33	49	45
BPD severity	Mild	Mild	Mild
PDA
Medical treatment (IV ibuprofen)	3 cycles	None	1 cycle
Surgical treatment (ligation)	Yes	None	None
Culture proven sepsis	None	None	None
NEC	None	None	None
ROP	State 1	Stage 1	Stage 1
PVL	None	None	None

Abbreviations: BPD, bronchopulmonary dysplasia; PDA, patent ductus arteriosus; NEC, necrotizing enterocolitis; ROP, retinopathy of prematurity; PVL, periventricular leukomalacia.

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