Introduction: The prevalence of twin pregnancies continues to increase. These pregnancies have higher rates of complications including cervical insufficiency, preterm prelabor rupture of membranes, preterm labor, and preterm birth. In cases of pre-viable or extreme preterm delivery of Twin A, attempts to prolong the pregnancy to improve outcomes for Twin B are reasonable. Optimal management of delayed interval delivery has not been established.

Case Presentation: This is a case of a dichorionic diamniotic twin gestation with pre-viable delivery of Twin A at 19w5d gestation. To delay delivery of Twin B, the patient received tocolysis, latency antibiotics, and a rescue cerclage. The patient was subsequently discharged to home with nightly vaginal progesterone. Pregnancy was prolonged an additional 19 weeks with uneventful vaginal delivery of Twin B weighing 2710g with APGAR scores of 8 and 9 at one and five minutes respectively.

Final Diagnosis: Twin gestation with delayed interval delivery of twin B at full-term

Management/Outcome/Follow-up: Delayed interval delivery of Twin B can improve neonatal survival and outcomes. This case adds to the current literature which supports intervention with tocolytics, latency antibiotics and/or cerclage, however no consensus exists. A retrospective multi center study could achieve the power to make recommendations for optimal management, but would likely be confounded by evolving and improving perinatal care of twin pregnancies. Thus, additional case reports may allow for development of a management consensus.