Delayed Interval Delivery

Question 0

Porreco technique

Answer 0

Amnio for retained twin either before delivery or immed after cerclage, w/i 24 hrs
High ligation of cord
Placenta left in situ
Irrigation of LUS w/ bacitracin 50,000U/L
IV Gent/Clinda x 48 hrs, then PO cephalosporin + flagyl until d/c
Tocolytics - IV nitro 100-200 immed after 1st fetus, mag 6 then 2-4/hr, indocin 50 PR then 25 PO q 4 hrs x 48
McDonald cerclage - monofilament
Inpt x 7d

Question 1

Exclusion criteria

Answer 1

Monochorionic
Severe pree
Abruption
Hysterotomy
Breech, viable twin A

Question 2

Mean latency interval

Answer 2

34 days, range 3-76

Question 3

GA range in 1998 Porreco paper:

Answer 3

Mean 23+6, range 19+3 to 27+6

Question 4

Porreco 1998 outcomes

Answer 4

9 survivors of 11 retained infants

Main reason for failure = infection

Question 5

Porreco 2000 outcome

Answer 5

Max GA where pts were offered delayed interval 28w 4d
Retained fetus perinatal mortality rate = 37%
Most common reason for completed delivery - PPROM