CHENNAI: In a rare medical feat, doctors at Motherhood Hospital in the city have successfully prolonged a high-risk twin pregnancy by seven weeks after the mother’s water broke at just 23 weeks, a stage considered medically pre-viable, leading to the safe birth of twin boys.
The case involved a 24-year-old first-time mother carrying dichorionic–diamniotic twins, where each baby has a separate placenta and amniotic sac.
The pregnancy took a critical turn at 23 weeks when she developed pre-term pre-labour rupture of membranes (PPROM), a complication seen in less than 0.5% of pregnancies before 24 weeks and associated with a high risk of infection, foetal loss and long-term disability. Compounding the risk, the rupture was confined to one sac and was accompanied by a large placental haematoma.
Standard medical outcomes at this stage often involve rapid labour or pregnancy loss. However, a multidisciplinary team at Motherhood Hospital adopted an aggressive expectant-management strategy aimed at prolonging the pregnancy safely.
Statistically, pregnancies with PPROM this early rarely continue for long. Our goal was to safely extend the gestation, as every additional week significantly improves survival and long-term outcomesDr Kavya Krishnakumar, consultant obstetrician and gynaecologist, at the hospital.
The patient was hospitalised for over six weeks under 24/7 monitoring, infection surveillance and preventive antibiotic therapy. Strict bed rest and supportive care helped maintain adequate amniotic fluid for the affected twin, allowing the pregnancy to progress to 30 weeks.
When the mother returned with signs of labour, antenatal steroids were administered to aid lung maturity, followed by an emergency delivery. The twin boys, weighing about 1.5 kg each, required neonatal intensive care for respiratory support and were discharged in stable condition after three weeks.
Managing extremely premature twins demands constant vigilance. Early respiratory support and stringent infection control were crucial,Dr Madhuri, consultant paediatrician and neonatologist.