Impact of intertwin interval on short‐term neonatal outcomes of the second twin in dichorionic pregnancies with vaginal delivery

Benito, Marta; Bonrostro, Carlos De; Agustín, Andrea; Roca, Montserrat; Maza, José Manuel Campillos; Castán, Sergio

doi:10.1002/ijgo.12790

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…While increasing inter-twin delivery interval has been thought to be associated with adverse outcomes in vaginal births of twins, 38 further studies have suggested that in cases of uncomplicated twin delivery with normal fetal monitoring, the intertwin delivery-time interval is not a predictor of adverse pregnancy outcomes. 39 While decreased umbilical cord arterial pH has been seen in the second twin with increasing delivery-time interval, [38][39][40] and a long interval is associated with higher rates of low Apgar score and an increase in cord lactate, 41 these associations do not translate into higher rates of admission to the neonatal intensive care unit. 42 As most of the deliveries in our study were cesarean deliveries, major differences in delivery-time intervals are not expected or relevant in our population.…”

Section: Discussionmentioning

confidence: 99%

Perinatal outcome and long‐term hospitalization of triplets according to birth order

Sabag,

Pariente,

Sheiner

et al. 2023

Birth

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PurposeThe association between birth order and adverse perinatal outcomes has been well studied in twin pregnancies. However, little is known about the differences in immediate perinatal outcomes as well as long‐term hospitalization of the offspring in triplet pregnancies according to their birth order. As such, we aimed to assess the differences in immediate perinatal outcomes and long‐term hospitalizations among triplets by their birth order.MethodsIn a retrospective hospital‐based cohort study, immediate perinatal outcomes and long‐term hospitalizations were compared among triplet siblings according to their birth order. Deliveries occurred between the years 1991 and 2021 in a tertiary medical center. The study groups were followed until 18 years of age for cardiovascular, respiratory, neurological, and infection‐related hospitalizations. Generalized estimation equation (GEE) models were used to control for confounders. Kaplan–Meier survival curves were used to compare cumulative long‐term hospitalization incidences and Cox proportional hazards models were performed to control for confounders.ResultsThe study included 117 triplet deliveries. Rates of small for gestational age (SGA) infants increased linearly by birth order (6.0%, 7.7%, and 15.4% for the first, second, and third siblings, respectively; p‐value for trends = 0.035). Using a GEE model controlling for maternal age, being born third in a triplet pregnancy was independently associated with SGA (third vs. first sibling, adjusted OR 3.0, 95% CI 1.38–6.59, p = 0.005). No significant differences in cardiovascular, respiratory, neurological, and infection‐related hospitalizations were noted among the first, second, and third siblings. Likewise, using Kaplan–Meier survival analyses, no significant differences in the cumulative incidence of long‐term pediatric hospitalizations were noted between the siblings. In Cox proportional hazards models, controlling for weight and gender, birth order in a triplet pregnancy did not exhibit an association with long‐term hospitalizations of the offspring.ConclusionDespite the association between birth order and SGA, birth order in triplets does not seem to have an impact on the risk for long‐term offspring hospitalization.

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Section: Discussionmentioning

confidence: 99%

Perinatal outcome and long‐term hospitalization of triplets according to birth order

Sabag,

Pariente,

Sheiner

et al. 2023

Birth

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“…22,27 Benito et al concluded that second twins delivered after an inter-twin interval exceeding 10 minutes had poorer APGAR scores and higher rates of blood pH <7.15. 28 Current guidance advises that the inter-twin interval should not exceed 30 minutes as this causes poor perinatal outcomes secondary to acute hypoxia due to decreased placental perfusion. 27,29 However, rare cases of extremely delayed inter-delivery intervals up to 131 days have been reported in the interest of delaying extremely premature deliveries.…”

Section: Discussionmentioning

confidence: 99%

Neonatal and Maternal Outcomes in Spontaneously-Conceived Twin Pregnancies According to Mode of Delivery

Stancu¹,

Russu²

2020

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Introduction: Appropriate intrapartum conduct in a twin delivery remains a challenging aspect of obstetric practice. The objective of this study was to compare neonatal and maternal outcomes in twin pregnancies according to mode of delivery.  Materials and methods: This is a single centre retrospective cohort study of all consecutive spontaneously-conceived twin deliver-ies (≥ 24 weeks, estimated fetal weight ≥ 500 grams) over a nine-year period between 01/01/2007 - 31/12/2016 at a tertiary-level centre. Neonatal outcomes included survival, APGAR score, prematurity-associated pathology (PAP), admission to the neonatal intensive care unit (NICU) and length of stay (LOS). Maternal outcomes included postpartum complications and LOS. Statistical analysis comprised Chi-square test with subsequent p-value and odds-ratio with 95% confidence interval. Statistical significance was set at p<0.05. Results: A total of 173 consecutive women with spontaneously-conceived twin deliveries were enrolled in this study, 129 (74.6%) women delivered by caesarean section (CS). The success rate of vaginal delivery (VD) was 93.6% (44/47). A strong statistical correlation was identified between CS and NICU admission; 53.2% vs. 1.5% (p=0.0001). Neonatal LOS in the NICU was significantly longer in the CS group. Prematurity-associated pathology (PAP) was noted in 75 pairs of twins (75/173); 61 pairs were delivered by CS, bearing strong statistical significance (p<0.0001). Postpartum complications occurred in 14.7% of CS compared to 13.6% of VDs.  Conclusion: Neonates delivered by CS had a higher rate of PAP, NICU admission, lower birth weight and longer LOS. This study showed that VD is safe, especially when the first twin is in cephalic presentation

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“…Very strict intertwin intervals of 10 minutes as well as more ease intervals of 30 minutes have been looked at as well [34]. However, a clear de nition of the ideal intertwin interval cannot be deduced from literature.…”

Section: Intertwin Interval Ph and Apgar Scorementioning

confidence: 99%

Twin delivery – does induction of labor make a difference?

Rueegg,

Vonzun,

Zepf

et al. 2024

Preprint

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Purpose Induction of labor as well as delivery in twin pregnancies bear specific risks. The goal of this study was to analyze the delivery mode in twin pregnancies and influence of induction on the cesarean delivery (CD) rate and perinatal outcome and to identify risk factors for CD and an intertwin interval ≥ 15 minutes. Methods This single center retrospective cohort study analyzed the outcome of 267 twin pregnancies. Inclusion criteria for vaginal delivery in twins are gestational age (GA) > 34 weeks, leading twin in cephalic presentation, estimated weight difference ≤ 500g and no previous uterine surgery. Women were divided into three groups: 1 = vaginal delivery, 2 = CD for both twins, 3 = emergency CD for second twin. Outcomes were mode of delivery, and influence of induction on the CD rate. Results We had 156 women (58%) in group 1, 97 (36%) in 2 and 14 (5%) in 3. Induction of labor was performed in 147 cases and led to a higher CD rate (23% vs. 47%, p < 0.001). Induction of labor and nulliparity were associated with a higher risk for CD for both twins. Risk factors for an intertwin interval of ≥ 15 minutes were maternal age and weight of the second twin. An intertwin interval of ≥ 15 minutes was associated with a lower umbilical artery pH in the second twin. Conclusion The rate of CD doubled if induction of labor was necessary. These results emphasize on careful patient counselling that includes information about the risks of deliveries in twin pregnancies.

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Impact of intertwin interval on short‐term neonatal outcomes of the second twin in dichorionic pregnancies with vaginal delivery

Cited by 8 publications

References 16 publications

Perinatal outcome and long‐term hospitalization of triplets according to birth order

Perinatal outcome and long‐term hospitalization of triplets according to birth order

Neonatal and Maternal Outcomes in Spontaneously-Conceived Twin Pregnancies According to Mode of Delivery

Twin delivery – does induction of labor make a difference?

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Impact of intertwin interval on short‐term neonatal outcomes of the second twin in dichorionic pregnancies with vaginal delivery

Cited by 8 publications

References 16 publications

Perinatal outcome and long‐term hospitalization of triplets according to birth order

Perinatal outcome and long‐term hospitalization of triplets according to birth order

Neonatal and Maternal Outcomes in Spontaneously-Conceived Twin Pregnancies&nbsp;According to Mode of Delivery

Twin delivery – does induction of labor make a difference?

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Neonatal and Maternal Outcomes in Spontaneously-Conceived Twin Pregnancies According to Mode of Delivery