Second-trimester asynchronous multifetal delivery results in poor perinatal outcome

Area of Science:

• Perinatal Medicine
• Maternal-Fetal Medicine
• High-Risk Obstetrics

Background:

• Asynchronous delivery, a strategy to prolong latency between births in multifetal gestations, presents unique challenges.
• Inter-delivery intervals are often managed with tocolysis and cerclage, but outcomes remain a concern.

Purpose of the Study:

• To estimate the maternal and fetal morbidities associated with asynchronous delivery.
• To evaluate the outcomes of pregnancies managed with asynchronous delivery techniques.

Main Methods:

• Retrospective review of maternal and fetal medical records from two tertiary care centers over 12 years.
• Identification of cases using ICD-9-CM codes for twin and triplet gestations.
• Definition of asynchronous delivery as an active attempt to increase latency between fetal deliveries.

Main Results:

• Fourteen asynchronous delivery cases were identified out of 96,922 deliveries (0.14 per 1000 births).
• The primary indication for intervention was second-trimester rupture of membranes (86%).
• Fetal survival to hospital discharge was 37%, with 86% of survivors experiencing major sequelae from extreme prematurity. Maternal morbidity included placental abruption and infectious complications.

Conclusions:

• Asynchronous delivery attempts are infrequent but carry a substantial risk of perinatal mortality.
• The majority of surviving infants suffer significant long-term morbidities due to extreme preterm birth.
• These findings underscore the critical risks associated with managing multifetal gestations requiring asynchronous delivery.