2 were rinsed with iodized serum and a McDonald cerclage was performed under general anaesthesia. Bed rest, tocolysis with 25 mg indomethacin four times a day for two days, nifedipine 4 × 20 mg per day, and a 1.5 gr amoxicillin-clavulanic acid four times a day were administered for ten days while she was hospitalised. In addition, fetal lung maturity was induced by corticosteroids (12 mg betamethasone intramuscularly twice a day). Patient was continuously monitored through clinical assessment (blood pressure, heart rate, and temperature) and laboratory tests (blood cell count, C-reactive protein). Cer- vical length was monitored weekly with transperineal ultra- sonography. Cervical cultures were also taken weekly. Daily fetal monitoring and weekly ultrasounds conﬁrmed fetal growth and wellbeing. As she had no signs of infection accor- ding to the physical and lab ﬁndings, she was discharged at the 28th week of pregnancy. She was advised to take nife- dipine 20 mg four times a day. Transperineal ultrasound re- vealed 27 mm cervical length at the time of discharge of the patient. After her discharge from the hospital we controlled the patient weekly with leukocyte count, C-reactive protein level, obstetric ultrasound, and also with transperineal ultra- sound for cervical length. At each visit we also concentrated on if there were uterine contractions. Nifedipine treatment was stopped at the 34th week. At the 36th gestational week, which was 101 days after delivery of the ﬁrst fetus, other fetus was delivered with cesarean section due to regular con- tractions and breech presentation. The second baby boy weighed 3639 g. Cervicalcerclage suture was also removed during cesarean section. Apgar score was 9 at ﬁrst minute and he had an uneventful neonatal course. 3. Discussion Gestational age is the most important predictor of neonatal survival in infants delivered before the 25th week of gesta- tion. Prolongation of gestational period and increase in fetal weight signiﬁcantly improve the fetal outcome [12, 13]. In recent years, an increasing number of delayed interval deliveries has been reported. In these reports, authors pre- sented patients with similar conditions: multifetal gestation with delivery of the ﬁrst fetus before the 30th week, diamni- otic relationship between the presenting and subsequent fetus or fetuses, intact membranes in the remaining gesta- tional sac, and also absence of fetal distress, lethal anomaly, abruptio placenta, intra-amniotic infection, or maternal indication for delivery [12–16]. Zhang et al. addressed to delayed interval delivery in twins in United States between 1995 and 1998 [14]. It was concluded that when a ﬁrst twin was delivered at the 22th to 23th weeks, delayed delivery of the second twin was associated with reduced perinatal and infant mortality. Rosbergen et al. published a study of 24 cases of attempted delayed interval delivery. The mean of the delay was 19.9 days and the study showed a signiﬁcant increase in birth weight and neonatal survival as well as decrease in adverse outcome [15]. Van der Straeten et al. reported that delayed delivery of the second fetus was associated with 13.4% mortality decrease in six cases [8]. Kalchbrenner et al. published a study of 7 cases and reported Case Reports in Obstetrics and Gynecology that the average birth weight, gestational age, and the dura- tion of ventilatory support were signiﬁcantly reduced with delayed delivery of the second twin with a mean of delivery interval of 36.2 days [4]. Fayad et al. reported a study of 35 cases with a mean interval of 47 days and the survival of the second twin reached to 78.6% and the mean birth weight of the second twin was 1217 g [6]. In one of the largest retrospective series Oyelese et al. reported ﬁndings about im- pacts of delayed interval delivery on perinatal mortality and morbidity in 4257 twins [16]. According to their ﬁndings, decreases in perinatal and infant mortality were observed only when the ﬁrst twin was delivered at 22 to 23 weeks and when the delivery interval was ≤3 weeks. However, for intervals ≥4 weeks or when the ﬁrst twin was delivered at 24 to 28 weeks (regardless of delivery interval), there was no beneﬁt in perinatal or infant mortality. Delayed delivery of ≥4 weeks was associated with increased risk of small- for-gestational-age birth in the second twin, regardless of gestational age at delivery of the ﬁrst. In our case second fetus delivered as 3639 g, so he was appropriate for gestational age. Long-term outcomes of infants who had been delivered as a consequence of delayed interval delivery were lacking. Silent intra-amniotic infection may cause periventricular leukoma- lacia, intraventricular hemorrhage, and cerebral palsy [17, 18]. Small-for-gestational-age may be a sign for long-term sequela that will appear in future. Long-term followup of these fetuses will probably clarify the risks. Optimal management of delayed interval delivery is not deﬁned yet. Cerclage, tocolysis, hospitalization, and antibi- otic therapy are all controversial. Use of prophylactic cerclage in multifetal pregnancies has failed to show any beneﬁtin some studies [19]. However, in a review of seven case series, Zhang et al. suggested that in cases of delayed interval deli- very, immediate cervical cerclage after the ﬁrst delivery was associated with a signiﬁcantly longer interdelivery inter- val [12]. Studies in which cerclage was infrequently used reported a shorter interdelivery interval compared to studies where cerclage was used in all cases (the median was equal to 9 days versus 26 days, resp.). Cerclage may provide stability to the cervix; furthermore, it may minimize the exposure of fetal membranes to vaginal bacteria and acidity [11]. In these reviews, all studies included and used a broad-spec- trum prophylactic antibiotics and parenteral tocolysis and found no evidence of an increased risk of intrauterine infec- tion after cerclage. Fayad et al. observed that the mean inter- val delivery tended to be longer after high ligature of the cord, expulsion of the ﬁrst twin’s placenta, antibiotic therapy, and cerclage, although the diﬀerences were not statistically signiﬁcant [6]. Arabin and van Eyck reported mean delay as 19 days (1–107) in 38 twin pregnancies by totally abstaining from cerclage in a prospective cohort study [20]. Concerns of chorioamnionitis due to closure of cervix may direct clini- cians treatment plan, but in our patient we directly perfor- med cervical cerclage. Still there is no consensus about performing cerclage in case of delaying fetus or fetuses in multifetal pregnancies. Randomized controlled trials will probably solve this conﬂict. Our case was unusual in another point that, although no eﬀort was applied but placenta of the ﬁrst fetus expulsed