Prolonged Preservation of an IVF Twin Pregnancy Complicated by Cervical Incompetence, Amniotic Sludge, and Placental Abruption: A Case Report Highlighting Multidisciplinary Management

Background: Cervical incompetence and amniotic sludge are significant risk factors for preterm delivery, particularly in IVF twin pregnancies. This case report highlights the multidisciplinary management of a complex IVF twin pregnancy complicated by cervical incompetence, amniotic sludge, and placental abruption. Case: A 38-year-old primigravida with a history of PCOS conceived twins via IVF. At 22+3 weeks, she presented with cervical incompetence, bulging membranes, and amniotic sludge. Despite aggressive tocolysis, antibiotics, and progesterone support, placental abruption occurred at 27+3 weeks, necessitating cesarean delivery. The twins were delivered with Apgar scores of 6/10 (male) and 7/10 (female) and a combined weight of 1600 grams. Both infants required respiratory support, with no evidence of intracranial hemorrhage. After 40 days in the NICU, the infants were discharged without significant neurological or systemic complications. At discharge, their weights were 1360 g (first twin) and 1260 g (second twin). Retinopathy of prematurity (ROP) screening revealed no abnormalities in either infant. Conclusion : This case underscores the importance of multidisciplinary care in managing complex IVF twin pregnancies. Early intervention and vigilant monitoring can lead to favorable maternal and neonatal outcomes.