Breech in sac. Today primi pt delivered spontaneously twins at 24 wks,h/o pain since 3 days with leaking since 18 hrs reported today morning at 7_30am. She was supported with nat progesterone. A case of PCOS ,conceived after Tt but poor lady delivered 2 premature babies. Let's discuss the about the causes of prom & labour. @



Dear Dr. Nanavaty , Thank you very much for posting a good case for discussion. Agree with Dr. Nisha Bhargava, Dr. M. A. Parveen , Dr. U. S. Sodha and you. Most of the possible causes are discussed already. Just to add few words : - Spontaneous (unprovoked) preterm labor may result from several causes including 1 ) Infection, 2 ) Inflammation, 3 ) Vascular disease (poor blood supply to the uterus and placenta) , 4 ) An overstretched uterus, and 5 ) Abnormalities of the cervix . 6 ) The cause of many preterm births is never found . Prevention of Preterm Labor :- Bedrest, intramuscular and long term use of oral medications to stop contractions (tocolytics) are not recommended for the prevention of preterm labor in multiple pregnancies because these treatments are either ineffective and/or may cause harm. Cervical cerclage is also not recommended in multiple pregnancies except in specific circumstances. However, vaginal progesterone may be effective in reducing bad outcomes in women with a twin pregnancy and a cervical length of 25 mm or less. Cervical pessaries, small ring-shaped devices which are inserted around the cervix, may also be effective in reducing bad outcomes in women with a twin pregnancy and a cervical length of less than 38mm. If there is enough time the babies could be given corticosteroid to help the lungs mature and reduce other complications of being born prematurely. A shortened cervix is a strong predictor of preterm delivery in twin pregnancies . Lastly, with due respect , I hope you won't mind, perhaps you have forgotten to edit the 3rd picture to prevent disclosure of the identity of the mother. And while delivering the breech, I don't understand why the 1st twin is still there , when cord is separated, without wrap, instead of in the hands of a Neonatologist / Paediatrician. What was the Apgar score of 1st and 2nd twin? Are anyone alive still ?

Totally agree with you.

Preterm delivery is common in twins . Timely cervical encirclage should be done. Uti and gest diabetes to be ruled out. Rest and progesterone help to prevent preterm del.

In twin pregnancy preterm delivery is common.Cervical cerclage after doing TIFFA scan at 18wks nd progesterone support up to 36wks will help in twin pregnancy.Cervical incompetence,uncontrolled hypothyroidism,Gest.diabetes, chorioamnionitis are other causes which can cause for early preterm delivery.If the babies wt is more than 500gms can be saved with good NICU facilities .

Both 500+ wt ,both alive. Mother non DM,non hypothyroidism/hyper,no UTI,oncx length was 4.1,no other complaints except she reported late.

As common causes of preterm r ruled out, then it PROM due to infection , chorioamnitis leading to preterm delivery.

Use of tocolytic agents n bed rest should also be advised along with other mentioned treatment.

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Thanks for sharing mam

USG report If cx less than 2.5 cmcx tighten Tab isoxsuprin start

Thanx for sharing of a v. much informative and interesting case.

Thanks for sharing's helpful

Thanks mam fr sharing this case

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