Relationship between Twin-to-twin Delivery Interval and Umbilical Artery Acid-base Status in the Second Twin

Suh, Yoo‐Hun; Park, Kyo Hoon; Hong, Joon Seok; Yoon, Bo Hyun; Shim, Soon Sup; Park, Joong Shin; Jun, Jong Kwan; Syn, Hee Chul

doi:10.3346/jkms.2007.22.2.248

Cited by 20 publications

(23 citation statements)

References 26 publications

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“…It has been proposed that the TTDT should be less than 15 minutes and certainly not more than 30 minutes (MacLennan AH, 1994). Similarly, other authors suggest that fetal acidemia may develop when the TTDT exceeds 20 minutes (Suh et al, 2007). These observations have been supported by another cohort study that found a higher risk of metabolic acidosis of the second twin after a TTDT of more than 60 minutes (Edris et al, 2006).…”

Section: Discussionsupporting

confidence: 74%

“…E-mail: susanne. schneuber@medunigraz.at should be delivered within 15-30 minutes of the first twin (Edris et al, 2006;Erdemoglu et al, 2003;Hartley & Hitti, 2005;Leung et al, 2004;MacLennan, 1994;McGrail & Bryant, 2005;Stein et al, 2008;Suh et al, 2007); other studies concluded that the TTDT is of minor importance. (Bartnicki et al, 1992;Briese et al, 1994;Rayburn et al, 1984;Rydström & Ingemarsson, 1990) The present study investigated the relationship between TTDT and neonatal outcome.…”

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confidence: 99%

“…Twin gestation is estimated to complicate 1-2% of all pregnancies (Carvalho et al, 2007;Suh et al, 2007) and twin pregnancies are associated with increased perinatal morbidity and mortality (Smith et al, 2007). Morbidity at second twins is higher than at first twins (Bjelic-Radisic et al, 2007;Oyelese et al, 2005;Yang et al, 2006), mainly due to intrapartum hypoxia (Smith et al, 2002;Suh et al, 2006).…”

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Twin-to-Twin Delivery Time: Neonatal Outcome of the Second Twin

et al. 2011

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Objective: To examine the effect of twin-to-twin delivery time (TTDT) on neonatal outcome. Methods: We evaluated twin deliveries >34 weeks of gestation. Twin pregnancies with both twins delivered by cesarean section and pregnancies with antenatal complications were excluded. We analyzed TTDT and neonatal outcomes of the second twin (umbilical arterial pH value (pH art ), Apgar scores at 1, 5 and 10 minutes, need for intensive care). The study population was divided into two homogenous groups based on the mode of delivery: (A) vertex presentation and vaginal delivery of both twins, (B) vertex presentation and vaginal or vaginal operative delivery of twin I, breech or transverse presentation and vaginal breech delivery or cesarean section (CS) of twin II. Results: A total of 207 twin pairs were included in our study. In Group A (n = 151) there were no significant correlations between TTDT and pH art or Apgar scores at 1,5 and 10 minutes of twin II (p = .156; 0.861; 0.151 and 0.384, respectively). In Group B (n = 56), the mean pH art of twin II was inversely correlated to TTDT, but not significantly (p = .417). TTDT was inversely related to 1-min and 5-min Apgar scores, but not significantly (p = .330; p = .138, respectively). The 10-min Apgar score showed no correlation with TTDT (p = .638). Conclusion: Increasing TTDT was not associated with adverse fetal outcome. Expectant management of the second twin appears possible and elapsed time alone does not appear to be an indication for intervention.

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confidence: 74%

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Twin-to-Twin Delivery Time: Neonatal Outcome of the Second Twin

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“…Respecto a estudios previamente publicados con un objeto similar de estudio, algunos autores concluyen que el pH del segundo gemelo es más bajo que el del primero (1,3,7,11-16) y parece deteriorarse con más rapidez (17), también describen una correlación negativa entre el intervalo de nacimiento entre gemelos y las diferencias en el pH de ambos gemelos o el valor del pH de cordón del segundo (11,(17)(18)(19)(20). Sin embargo, no tienen en consideración el estado ácido-base del primer gemelo, ni el deterioro del pH de cordón umbilical del segundo gemelo respecto al primero.…”

Section: Discussionunclassified

Relación entre el intervalo de nacimiento entre gemelos y el pH de cordón umbilical: ¿existe asociación entre la acidosis del primer gemelo y el segundo?

Lago

Martínez

Cortés

et al. 2015

Rev. chil. obstet. ginecol.

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RESUMENObjetivos: Determinar si el intervalo de nacimiento vía vaginal entre gemelos, se relaciona con un descenso de pH arterial/venoso de cordón umbilical del segundo gemelo respecto al primero, y establecer si el pH acidótico del primer gemelo predice la acidosis del segundo. Método: Estudio de cohortes retrospectivo en 77 pares de gemelos realizado en el Hospital de Getafe, España, en el periodo 2008-2013. Se relacionó el tiempo transcurrido entre el nacimiento de los gemelos con el resultado del pH de cordón y el exceso de bases. Estudiamos la correlación entre el tiempo transcurrido entre ambos nacimientos y la diferencia entre los valores de pH del primer y segundo gemelo, y la correlación con la diferencia de exceso de base. Resultados: Hubo correlación lineal significativa entre el tiempo transcurrido entre el nacimiento de los gemelos y la diferencia de pH venoso del segundo gemelo respecto del primero (R=0,560; p=0,0001), así como con el pH arterial (R=0,502; p=0,0001). El pH <7,20 del primer gemelo se asoció con acidosis en el cordón del 2º gemelo (<7,20, p=0,000; <7,15, p=0,0001; <7,10, p=0,0001; <7,05, p=0,001; <7,00, p=0,0001). Conclusiones: El pH del segundo gemelo siempre fue igual o menor que el del primer gemelo, hubo una correlación lineal entre el intervalo de nacimiento entre gemelos y el descenso del pH venoso y arterial del segundo gemelo respecto al primero. El pH acidótico del primer gemelo predice la acidosis del segundo.PALABRAS CLAVE: Intervalo de tiempo en parto gemelar, acidosis fetal, pH de cordón umbilical, estado ácido-base fetal SUMMARYObjectives: Determinate if the twin-to-twin vaginal delivery time interval, is related with a decline of the arterio-venous cord blood pH of the second twin regarding to the first twin, and to evaluate if the acidotic pH of first twin can predict the acidosis status of the second one. Method: A retrospective descriptive cohort study was performed at the Hospital of Getafe, Spain, in the period 2008-2013, with 77 pairs of twins that were registered and met the inclusion criteria. The twin-to-twin delivery time interval and the cord blood status results were registered. A statistical analysis was performed to study the relation of the twin-to-twin delivery time interval with the pH value differences between first and second twins, and with the base excess. Results: A positive linear correlation between the twin-to-twin delivery time interval and the difference of venous pH of the second twin respect to the first one was found (R=0.560; p=0.0001), and also with the difference on arterial pH (R=0.502; p=0.0001). A pH value <7.20 of the first twin was associated with blood cord acidosis of the second twin (<7.20, p=0.000; <7.15, p=0.0001; <7.10, p=0.0001; <7.05, p=0,001; <7.00, p=0.0001). Conclusions: The second twin pH was equal to or less than the first twin pH in all cases.There is a linear relation between twin-to-twin delivery time interval and the decrease of the pH value of the second twin regarding to the first one. The acidosis of first twin ...

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“…(8,12,20,38) Abnormal (non-cephalic) presentation (7) and the vaginal route of delivery have been described as risk factors for birth asphyxia. (12,21) Apgar scores < 7 at 1 and 5 mins have been found in 13%-32% and 2%-12% of twins, respectively, (9,19) just as active resuscitation measures are said to be required in nearly 30% of twins. (9) In our study, the incidence of low Apgar scores (score < 7) at 1 min and 5 mins of life was around 8% and 4%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Reappraisal of twinning: epidemiology and outcome in the early neonatal period

Gupta¹

2014

Singapore Med J

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INTRODUCTIONThe present study aimed to determine the epidemiology, maternal complications and adverse neonatal outcomes associated with twin births at a tertiary care hospital in India.METHODS A prospective observational study was conducted on all successively born twin pairs (≥ 23 weeks of gestation) and their mothers from January to September 2005. Main outcome measures included maternal medical/obstetric complications, labour characteristics and the morbidities/mortality observed during the early neonatal period. RESULTSThe twinning rate was 1 in 54 deliveries. Around 10% of mothers had a predisposition for twinning in the form of familial tendency or consumption of clomiphene. Anaemia (85%) was the most common maternal complication, followed by gestational hypertension (17%). Nearly one-third of births were delivered via Caesarean section. Prematurity (61%) was the most common neonatal complication followed by early-onset neonatal sepsis (21%). The risk of early neonatal death was 27%. Shorter gestation and low birth weight were significantly associated with adverse neonatal outcome (p < 0.05). Factors such as chorionicity, mode of delivery, birth order, inter-twin delivery time interval, gender and intra-pair birth weight discordance did not affect neonatal morbidity or mortality (p ≥ 0.05). CONCLUSIONThe rates of maternal complications and early neonatal morbidities/mortality were quite high in twin gestations. Except for the prematurity and low birth weight, none of the other factors, including inter-twin delivery time interval of more than 15 mins, were found to affect neonatal outcome.

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Relationship between Twin-to-twin Delivery Interval and Umbilical Artery Acid-base Status in the Second Twin

Cited by 20 publications

References 26 publications

Twin-to-Twin Delivery Time: Neonatal Outcome of the Second Twin

Twin-to-Twin Delivery Time: Neonatal Outcome of the Second Twin

Relación entre el intervalo de nacimiento entre gemelos y el pH de cordón umbilical: ¿existe asociación entre la acidosis del primer gemelo y el segundo?

Reappraisal of twinning: epidemiology and outcome in the early neonatal period

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