Trichorionic triamniotic (TCTA) triplet pregnancies carry high risks of extreme prematurity. In rare cases, delayed-interval delivery after premature expulsion of one or more fetuses may improve outcomes.

We report a 31-year-old woman with a TCTA triplet pregnancy who spontaneously delivered the first two fetuses at 22 + 3 and 22 + 5 weeks. Expectant management of the third fetus was initiated despite sterile intraamniotic inflammation. Broad-spectrum antibiotics, inpatient monitoring, and antenatal corticosteroids were administered. At 27 + 5 weeks, a viable female infant (978 g, Apgar 7/8) was spontaneously delivered. The neonatal course was complicated by early- and late-onset sepsis and persistent seizures requiring multiple antiepileptic drugs, although the infant was ultimately discharged from the NICU after 77 days.

This case supports the feasibility of delayed delivery in TCTA pregnancies when strict selection criteria are met, highlighting the importance of individualized care and multidisciplinary management.