Generally speaking, twin were mostly born on the same day of the same year, the same month, but Ningbo Ms. Jin (pseudonym)'s twin daughters were born a whole month apart. My sister was forced to give birth naturally at 24 weeks of pregnancy, but unfortunately she did not survive due to dysplasia; my sister waited until she was 28 weeks of pregnancy to give birth to a caesarean section, and after living in incubator for more than a month, she was lucky to be discharged from the hospital.
Chief physician Yu Ying of the Department of Obstetrics and Gynecology of Zhejiang University Women and Women's Hospital said that this pregnancy method that retains the second child to continue pregnancy after the first miscarriage or premature birth is called delayed delivery of twin pregnancy. The longer the time interval, the greater the risk, which is a huge test for both the mother and the newborn.
Age-aged mother has difficulty getting pregnant
However, premature rupture of the membrane
Ms. Jin is 35 years old this year. After marriage, habitual miscarriage of several times, and finally got pregnant with twins through artificial insemination . She and her family cherish these two hard-won babies. But around 17 weeks of pregnancy, she began to experience repeated vaginal bleeding, and amniotic fluid and gradually decreased. The local hospital did not have good results after treatment, so they were recommended to transfer to Zhejiang University Women's Hospital. Ultrasound from Zhejiang University Women's Hospital showed that the twins were in upper and lower fetal positions, with the maximum depth of A-fetal amniotic fluid located below only 1.3cm, and the amount of amniotic fluid was seriously insufficient; the maximum depth of B-fetal amniotic fluid located above was 3.5cm, and the situation was quite good. Yu Ying said that a series of symptoms and manifestations pointed to premature rupture of the membrane, but the local hospital had previously tested amniotic fluid crystals and the result was negative. In order to check for false negatives, they used a more accurate test strip , which found IGFBP-1 (insulin growth factor binding protein-1) unique to amniotic fluid, and clarified the diagnosis of premature rupture of fetal membrane A. "The premature rupture of the fetal membrane occurred in 17 weeks of pregnancy. Our routine operation was to induce labor and terminate the pregnancy. But after we told the mother this plan, she completely collapsed. She cried sadly in the ward and refused to give up the child." Faced with the mother's persistence, Yu Ying organized a multi-disciplinary discussion (MDT) across the hospital, and finally decided to take over this hot potato and do everything possible to protect her. However, Yu Ying also told that insufficient amniotic fluid may affect the growth and development of fetal lungs and limbs of fetal A, and may also easily lead to intrauterine infections in the fetus. After fully understanding the risks, Ms. Jin still expressed her willingness to bear all the consequences and accept this test with her baby.
Kidney stone pain induces uterine contraction
Sister was forced to be born early
Ms. Jin has a 5-year history of kidney stone . She usually has no symptoms. Unexpectedly, she actually attacked during the critical period of pregnancy protection and had strong renal colic , which then induces uterine contraction. At 24 weeks of pregnancy, she gave birth to a fetus A naturally. As the doctor expected, due to too little amniotic fluid, the baby had poor lung development and limb deformities. He weighed only 650g and the newborn score was only 1 point, but he failed to survive in the end. At this time, fetus B is still in the mother's belly, the amniotic membrane is intact, there are no signs of chorionic amniotic inflammation, and the small heart is still beating tenaciously... Yu Ying said that when the fetus and mother have no other signs of delivery, the second fetus delays delivery after the first fetus abortion or premature delivery can improve the survival rate of the second child and improve the prognosis of the newborn. Combined with the situation of B and Ms. Jin, they decided to implement delayed delivery. The team immediately used drugs to inhibit uterine contractions, fully disinfected the vagina, and ligated the A-fat umbilical cord at a high position, and continued anti-infection treatment. Over the next month, they gave the mother an ultrasound every week to evaluate the growth status and cervical length of fetus B. Although the mother and fetus are still stable, Yu Ying still has a lingering doubt in her heart: What exactly causes the premature rupture of fetal membranes in fetus A? The biggest possibility is bacterial infection, but several previous reports of bacterial cultures have shown no bacterial growth. She once again found the laboratory department for a final attempt. This time, she used the most advanced sequencing technology (NGS) pathogenic microbial detection, and finally found three bacteria that may lead to premature rupture of the fetal membrane. Pharmacy adjusted the type and dosage of antibiotics according to the test results, further improved the anti-infection treatment plan, greatly reducing the risk of fetal infection in B, and allowing the little guy to grow in his mother's belly with more peace of mind.
A month later, my sister was born safely.
Twins can be up to 154 days
Up to 28 weeks of pregnancy, Ms. Jin suffered regular uterine contractions and vaginal bleeding. Ultrasound prompted that the placenta of fetal A covers the inner cervix, and the placenta of fetal B is close to the inner cervix, and the time has finally come! Yu Ying's team gave birth to a 1270g baby girl in an acute cesarean section. The neonatal score was 9 points and 10 points for 1 minute and 5 minutes respectively, and then transferred to the neonatal intensive care unit for treatment. Ms. Jin recovered well after cesarean section and was discharged from the hospital five days later. The baby is in good condition. During the more than a month of staying in the incubator, he did not experience serious complications of premature babies, and his weight has also increased steadily. He also returned home safely not long ago. Yu Ying said that with the development of assisted reproductive technology, the incidence of multiple pregnancy has increased significantly, and the subsequent increase is maternal and infant complications related to multiple pregnancy, the most common of which is twin miscarriage or premature birth, and delayed delivery of twins (DID) can increase the chance of survival of the second twin. She introduced that DID was first reported in 1880, and the individuals with delay intervals vary greatly, up to 154 days. However, there is currently a lack of unified consensus on DID, and clinical treatment is not standardized.
A pair of twins abroad, the first child born in 26 weeks, the second child born in 34 weeks, the two child is 53 days apart. The smaller one on the left is the first child, which obviously does not develop well without the second child, which means that the intrauterine environment is more suitable for the growth and development of the fetus. Currently, it is believed that the most suitable population for DID is those who are born naturally through the vagina due to premature delivery, cervical insufficiency, premature rupture of the fetus or intrauterine death. The prerequisite for DID is that the cervical canal retraction and uterine contraction disappears after the first fetus is delivered, and the following conditions must be excluded: fetal distress , fatal malformation, premature rupture of the fetus, chorionic amnioticitis, severe vaginal bleeding, suspicious placental abruption , etc. Yu Ying said that DID is a complex clinical decision that requires balancing the risk between perinatal survival rate and maternal complications. "This process requires the technology and experience of doctors, and it is also inseparable from the support from the family. We are lucky to have completed a successful attempt with the mother and fulfilled her mother's dream."
Qianjiang Evening News·Hours News Reporter Zhang Bingqing Correspondent Sun Meiyan
