• DID clinical approaches typically involve a combination of taking swabs, administering antibiotics, and possible tocolysis, antenatal steroids and cerclage 4, with the optimal approach uncertain and a lack of formalised guidance. 5

• Whilst her CL initially shortened, it later remained stable. Careful serial monitoring of the cervical length and awareness of the normal cervical dynamic changes can be useful when deciding if delivery is imminent and antenatal steroids are required.

• Preventing chorioamnionitis was essential. This patients CRP remained stable, therefore the decision to omit antibiotics was made. This may not be feasible in other cases such as following a live birth or when infection markers are present.

• It is important to remember that the uncommon nature of these situations can leave great uncertainty for the patient.

• This case is a successful example that a healthy term birth without maternal or foetal complications using conservative management was possible after spontaneous preterm delivery of a selectively reduced twin. The unique situation limits its wider application.

• Monitor infection carefully—CRP is a useful marker.

• Cervical length may change dynamically—shortening does not always mean imminent delivery.

• Outpatient conservative management without antibiotics may be feasible in selected cases

• Prioritise clear communication-especially when uncertainty exists.

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