Ian and Laia are two twins 10-month-old twins born with nine days apart. The boy was born January 17 of this year. The girl was born January 26. Both were premature: Ian was born at 28 weeks and three days and Laia, at 29 weeks and five days. They weighed just over one kilo.
The children were born in what is called a delayed delivery, a type of baby delivery extreme preterm. This November 17 marks World Premature Infant Day. “Very extreme preterm infants, between the 23rd and 28th week, have a complicated prognosis y high risk of mortality and injury.” explains Silvia Ferrero, head of the prematurity unit of the Sant Joan de Déu Hospital (Esplugues de Llobregat) and assistant physician of the Gynecology and Obstetrics Service of the center. Delayed deliveries are scarce: Sant Joan de Déu made three last year, “something exceptional.” “There are a lot of premature twin deliveries, but very few hospitals where this wait can be applied,” says the gynecologist.
“When there is a twin gestation, if some of the following are met. certain requirements, there is the possibility that one baby will be born but the other will stay inside,” he continues. In this way, doctors try to to lengthen the gestational time of the second baby and that its forecast be better than that of the baby born.
The goal is to keep the second sibling as long as possible in the mother’s uterus, if the conditions are met
Laura Pupo, 35 years old, is the mother of little Ian and Laia. She became pregnant in July 2021. In the 20th week, after an ultrasound, the doctors saw that the cervix by Laura iba decreasing in length. This is something that occurs as the body prepares for childbirth. The uterus finally opens when the mother goes into labor. “That’s when I started doing a weekly follow-up, I was given intravaginal pills and was advised to maintain rest at home, Laura counts.
At 22 weeks, she had to undergo a cerclage (which is the placement of stitches in the cervix to keep it closed). The doctors gave Laura discharge. “But at week 24, it opened up and you could already see a little bit of the amniotic sac of the child. At the Hospital General de Catalunya (Sant Cugat) I was told that I could go into labor at any time, and that. their neonatal unit was not prepared to receive such tiny infants.”
Laura was then transferred to Sant Joan de Déu. This hospital and the Clínic practice delayed deliveries. “Such a delivery has no a priori risks. That said, when you have a twin that has stayed inside you must. keep a very close eye on it. You must be very clear that you are providing him with a benefit, you must. rule out infections. In other words, that there is no cause for which it would be better to remove it,” explains Dr. Ferrero.
In December 2021, Laura entered two weeks at Sant Joan de Déu. “Since they saw that I was well and that there was no varieties as for the cervix and the amniotic sac, I was sent home. I was put corticosteroids to mature the lungs of the children. And they gave me a lot of information.” says the mother.
A birth on the floor
But January 16 began with contractions, so she attended with her partner and father of the children, José Carlos Martins, to the hospital again. The family lives in Ruby. On the 17th day, the contractions were so strong that. the baby was born before Laura had time to go down to the delivery room. She gave birth to Ian on the hospital floor. “I remember the nurse stimulating him because he was so tiny. She would say to me: ‘Easy, easy, he’s alive, he’s alive’.” he explains.
Ian was transferred to a incubator. But the doctors decided to keep Laia a few more hours. “They told me that from that moment on we would neither slow down nor provoke labor. That it would be what my body decided. That I was the best incubator for her to continue developing,” says Laura. Laia held on inside for nine more days.
It was explained to Laura that each day that passed was a day gained for the girl. The mother was admitted to the hospital, on bed rest. “She couldn’t even go to see Ian, who was in the neonatal ward”. Nine days later, after bleeding, Laia was born in the delivery room. “Right now they are both fine. It was noticeable from birth that Laia was doing better, especially at the respiratory level”. Now, even though the babies are 10 months old, it is “as if they were seven”, Because they were born 90 days earlier than they should have been. But they have had no sequelae. Ian weighed 1.1 kilos at birth and Laia, 1.190.
There is more extreme cases than those of Laia and Ian. For example, twins born with up to 48 days apart. “The goal of delayed deliveries is to. to lengthen the time of pregnancy to improve the forecast of the second baby. And in general they are doing better, but you have to be very vigilant because there can be risks,” says Dr. Ferrero.
In Spain, the prevalence of prematurity below 37 weeks is around 9%, similar to the European average. The risks of a premature infant range from problems in the lung development a problems a brain level. There are also difficulties at the level of the maturity of other organs, such as the intestine. “These are delicate offspring with a risk of later complications,” the physician explains.
How are they treated? “It depends on the week they are born. The more prematurity, the more intensive care medicine. As of week 35 we consider them late preterm and they are not admitted to a neonatology unit,” concludes Ferrero.