Inter-twin delivery interval, short-term perinatal outcomes and risk of caesarean for the second twin

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Abstract

Objective: To examine the association between inter-twin delivery interval and short-term perinatal outcomes of the second twin after vaginal delivery of the first twin. Methods: Retrospective cohort study including twin pregnancies with a vaginal delivery of the first twin between January 2011 and September 2017 in a tertiary hospital in Melbourne, Australia. The main outcome measure was a composite of adverse neonatal outcome (at least one of perinatal death, admission to neonatal intensive care unit (NICU), endotracheal intubation, Apgar <7 at five minutes and cord lactate >4.0 mmol/L). Proportions of adverse outcomes for the second twin were compared between groups of intervals ≤ or >10 and ≤ or >30 min. Results: The composite adverse neonatal outcome occurred in 201 (58.2%) and a caesarean section occurred in seven cases (2%) of the 345 pregnancies included. Delivery interval was associated with higher cord lactate. Low Apgar scores were more frequent with intervals >30 min (17.9% vs 6.6%, P = 0.03), as well as caesarean section for the second twin (10.7% vs 1.3%, P = 0.01). Composite adverse outcome and admission to NICU were not significantly influenced by the delivery interval. Predictors of adverse outcome were gestational age, abnormal cardiotocography and breech delivery of the second twin. Conclusion: The inter-twin delivery interval is associated with higher rates of low Apgar scores and higher cord lactate for the second twin. These associations do not translate into higher rates of admission to NICU and their long-term clinical implications are uncertain.

Original languageEnglish
Number of pages5
JournalAustralian and New Zealand Journal of Obstetrics and Gynaecology
DOIs
Publication statusAccepted/In press - 1 Jan 2018

Keywords

  • caesarean
  • delivery interval
  • neonatal outcomes
  • twin pregnancies

Cite this

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title = "Inter-twin delivery interval, short-term perinatal outcomes and risk of caesarean for the second twin",
abstract = "Objective: To examine the association between inter-twin delivery interval and short-term perinatal outcomes of the second twin after vaginal delivery of the first twin. Methods: Retrospective cohort study including twin pregnancies with a vaginal delivery of the first twin between January 2011 and September 2017 in a tertiary hospital in Melbourne, Australia. The main outcome measure was a composite of adverse neonatal outcome (at least one of perinatal death, admission to neonatal intensive care unit (NICU), endotracheal intubation, Apgar <7 at five minutes and cord lactate >4.0 mmol/L). Proportions of adverse outcomes for the second twin were compared between groups of intervals ≤ or >10 and ≤ or >30 min. Results: The composite adverse neonatal outcome occurred in 201 (58.2{\%}) and a caesarean section occurred in seven cases (2{\%}) of the 345 pregnancies included. Delivery interval was associated with higher cord lactate. Low Apgar scores were more frequent with intervals >30 min (17.9{\%} vs 6.6{\%}, P = 0.03), as well as caesarean section for the second twin (10.7{\%} vs 1.3{\%}, P = 0.01). Composite adverse outcome and admission to NICU were not significantly influenced by the delivery interval. Predictors of adverse outcome were gestational age, abnormal cardiotocography and breech delivery of the second twin. Conclusion: The inter-twin delivery interval is associated with higher rates of low Apgar scores and higher cord lactate for the second twin. These associations do not translate into higher rates of admission to NICU and their long-term clinical implications are uncertain.",
keywords = "caesarean, delivery interval, neonatal outcomes, twin pregnancies",
author = "Ronit Cukierman and Sarah Heland and Kirsten Palmer and Peter Neil and {da Silva Costa}, Fabricio and Rolnik, {Daniel L.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/ajo.12867",
language = "English",
journal = "Australian and New Zealand Journal of Obstetrics and Gynaecology",
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T1 - Inter-twin delivery interval, short-term perinatal outcomes and risk of caesarean for the second twin

AU - Cukierman, Ronit

AU - Heland, Sarah

AU - Palmer, Kirsten

AU - Neil, Peter

AU - da Silva Costa, Fabricio

AU - Rolnik, Daniel L.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To examine the association between inter-twin delivery interval and short-term perinatal outcomes of the second twin after vaginal delivery of the first twin. Methods: Retrospective cohort study including twin pregnancies with a vaginal delivery of the first twin between January 2011 and September 2017 in a tertiary hospital in Melbourne, Australia. The main outcome measure was a composite of adverse neonatal outcome (at least one of perinatal death, admission to neonatal intensive care unit (NICU), endotracheal intubation, Apgar <7 at five minutes and cord lactate >4.0 mmol/L). Proportions of adverse outcomes for the second twin were compared between groups of intervals ≤ or >10 and ≤ or >30 min. Results: The composite adverse neonatal outcome occurred in 201 (58.2%) and a caesarean section occurred in seven cases (2%) of the 345 pregnancies included. Delivery interval was associated with higher cord lactate. Low Apgar scores were more frequent with intervals >30 min (17.9% vs 6.6%, P = 0.03), as well as caesarean section for the second twin (10.7% vs 1.3%, P = 0.01). Composite adverse outcome and admission to NICU were not significantly influenced by the delivery interval. Predictors of adverse outcome were gestational age, abnormal cardiotocography and breech delivery of the second twin. Conclusion: The inter-twin delivery interval is associated with higher rates of low Apgar scores and higher cord lactate for the second twin. These associations do not translate into higher rates of admission to NICU and their long-term clinical implications are uncertain.

AB - Objective: To examine the association between inter-twin delivery interval and short-term perinatal outcomes of the second twin after vaginal delivery of the first twin. Methods: Retrospective cohort study including twin pregnancies with a vaginal delivery of the first twin between January 2011 and September 2017 in a tertiary hospital in Melbourne, Australia. The main outcome measure was a composite of adverse neonatal outcome (at least one of perinatal death, admission to neonatal intensive care unit (NICU), endotracheal intubation, Apgar <7 at five minutes and cord lactate >4.0 mmol/L). Proportions of adverse outcomes for the second twin were compared between groups of intervals ≤ or >10 and ≤ or >30 min. Results: The composite adverse neonatal outcome occurred in 201 (58.2%) and a caesarean section occurred in seven cases (2%) of the 345 pregnancies included. Delivery interval was associated with higher cord lactate. Low Apgar scores were more frequent with intervals >30 min (17.9% vs 6.6%, P = 0.03), as well as caesarean section for the second twin (10.7% vs 1.3%, P = 0.01). Composite adverse outcome and admission to NICU were not significantly influenced by the delivery interval. Predictors of adverse outcome were gestational age, abnormal cardiotocography and breech delivery of the second twin. Conclusion: The inter-twin delivery interval is associated with higher rates of low Apgar scores and higher cord lactate for the second twin. These associations do not translate into higher rates of admission to NICU and their long-term clinical implications are uncertain.

KW - caesarean

KW - delivery interval

KW - neonatal outcomes

KW - twin pregnancies

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JO - Australian and New Zealand Journal of Obstetrics and Gynaecology

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