ABSTRACT
Multiple gestations have a significantly increased incidence of preterm labor and
preterm rupture of membranes. This leads to an increase in neonatal morbidity and
mortality due to prematurity. In this case, a 30-year-old woman achieved a triplet
pregnancy by ovulation induction and intrauterine inseminations. Preterm premature
rupture of membranes occurred at 21 6/7 weeks' gestation. At 24 weeks' gestation,
preterm labor ensued and a vaginal delivery of the presenting triplet followed. Magnesium
sulfate tocolysis was started after delivery. The patient was placed on bed rest,
magnesium sulfate tocolysis, and weekly steroid injections. The second and third triplet
delivered vaginally after a 46-day delay due to preterm labor. This is the first reported
case of delayed delivery of the two remaining fetuses of a triplet pregnancy, after
spontaneous preterm delivery of the presenting triplet, without surgical intervention.
Although the first fetus expired 48 hours after delivery secondary to complications
of prematurity, the other fetuses were subjected to tocolysis, bed rest, and steroids.
This case illustrates that conservative management of a triplet pregnancy after preterm
delivery of the presenting triplet may have a good outcome.
Keywords
Triplet pregnancy - delayed delivery
