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Obstetrics
Delayed-interval delivery in twin and triplet pregnancies: 17 years of experience in 1 perinatal center

https://doi.org/10.1016/j.ajog.2008.08.046Get rights and content

Objective

There are few prospective cohorts of delayed-interval delivery for twin and triplet pregnancies. Nonetheless, the procedure is an option to improve perinatal outcome.

Study Design

A standard protocol was designed before candidates for delayed interval were managed by the 2 authors from 1991 to 2007. Perinatal as maternal outcomes were evaluated up to 1 year.

Results

In 93 twin and 34 triplet pregnancies, the inclusion criteria were fulfilled; in 45 twin and 8 triplet pregnancies, there were contraindications to prolong pregnancy; and in 10 twin and 26 triplet pregnancies, asynchronous delivery was not possible because of immediate delivery of the remaining multiples. Thus, the procedure was performed in only 41% (38/93) of twin and 35% (12/34) of triplet pregnancies admitted with threatening early delivery. Among twin pregnancies, the mean delay was 19 (1-107) days. When the first delivery was less than 25 weeks, no first twin but 9 of 18 second twins (50%) survived (P < .001). Survival rate of first twins born beyond 25 weeks was 13 of 20 (65%) compared with 19 of 20 (95%) (P = .03) in corresponding second twins. In 7 of 12 triplet pregnancies with the first born less than 25 weeks, 2 of 14 remaining triplets survived after an interval of 118 days. Beyond 25 weeks, 3 of 5 first and 4 of 10 remaining triplets survived after intervals of 2-13 days (P = n.s.). Delay between second and third triplet was never longer than 2 days. Frequent maternal complications were chorioamnionitis (22%), postpartum hemorrhage, retained placenta (10%), and abruption (6%).

Conclusion

Our study provides data to assist physicians in the informed consent process when asynchronous delivery is considered and feasible.

Section snippets

Materials and Methods

From 1991 to 2007, data on twin and triplet pregnancies were collected in our high-risk center. Cases in which the first twin or triplet was born vaginally between 16 and 31 weeks and the delivery of the remaining multiples could be postponed form the definite study group.

All patients were managed by the 2 authors. The intention to delay delivery was to not only reach viability but also strive for improved outcome for the remaining fetus(es) with the possibility of corticosteroid

Results

Using the described protocol, data on 93 twin and 34 triplet pregnancies complicated by threatening early delivery of the first fetus between 16 and 31 gestational weeks were consecutively collected between 1991 and 2007. They were characterized by progressive dilatation and contractions. After admission, 45 twin pregnancies and 8 triplet pregnancies were excluded from further analysis, because there were contraindications to delay pregnancy because of signs of fetal distress, signs of

Comment

This study evaluated the neonatal outcome and maternal risks for twin and triplet pregnancies and for either immature (< 25 weeks) or early premature (25-31 weeks) delivery of first multiples. A standard protocol was established prior to the recruitment and was followed by the 2 authors throughout the observation period.5 This is the first prospective and largest 1-center series that enables the determination of the success rate of attempted delayed-interval delivery balancing the potential

Acknowledgment

In this article, several times we cited Dr Elizabeth Bryan, the wife of Ronald Higgins. Dr Bryan died in February 2008, as we started to write this article. Her enthusiastic lectures, careful studies, and several books, 1 written together with her husband, helped us to understand the joys and sorrows of all our patients with multiple gestations and mainly the frequently ambiguous situation within delay interval delivery. Her work for the Multiple Birth Foundation, the World Twin Research Group,

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    Cite this article as: Arabin B, van Eyck J. Delayed-interval delivery in twin and triplet pregnancies: 17 years of experience in 1 perinatal center. Am J Obstet Gynecol 2009;200:154.e1-154.e8.

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