Successful Delayed Interval Delivery in Twin Pregnancies Without Cervical Cerclage: A Case Report

Background: Delayed interval delivery (DID) in twin pregnancies lacks standardized protocols, particularly regarding cervical cerclage. This report presents two rare cases where DID succeed without re-performing cervical cerclage, challenging conventional management strategies for cervical incompetence. Case Presentation: Case 1: A 31-year-old with dichorionic diamniotic twins experienced membrane prolapse during cerclage at 12+5 weeks, leading to first-fetus delivery. Management involved antibiotic prophylaxis, tocolysis, cervical length monitoring, and dexamethasone for fetal lung maturity (without re-cerclage). The remaining fetus was vaginally delivered at 38+6 weeks with normal development. Case 2: A 30-year-old with cerclage failure and first-fetus demise at 20+3 weeks underwent DID with antibiotics, tocolytics, and thromboprophylaxis (no cerclage). Cesarean delivery at 36 weeks yielded a healthy infant with umbilical cord entanglement. Both cases achieved prolonged gestation and favorable outcomes without cervical cerclage. Conclusions: These cases demonstrate that DID in twin pregnancies can succeed without cervical cerclage when combined with targeted infection prevention, uterine contraction inhibition, and fetal lung maturation. The findings challenge the necessity of cerclage in DID and provide clinical evidence for alternative management approaches.