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The optimal cutoff for intertwin delivery interval: A retrospective cohort study
Naphtali Justman1, Shmuel Somer2, Roee Goldfreind1
1Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.
Summary
A 10-minute intertwin delivery interval (IDI) is a key predictor for neonatal acidemia. Longer IDIs increase risks for adverse neonatal outcomes and complications during twin vaginal deliveries.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Perinatal Research
Background:
- Vaginal delivery of twins presents unique challenges, particularly concerning the interval between the birth of the first and second twin.
- Understanding predictors of adverse neonatal outcomes is crucial for effective management during twin deliveries.
Purpose of the Study:
- To establish the optimal cutoff for the intertwin delivery interval (IDI) as a predictor of neonatal acidemia.
- To evaluate the association between prolonged IDI and adverse maternal and neonatal outcomes in twin gestations.
Main Methods:
- Retrospective cohort study of women undergoing vaginal twin delivery between 2010-2019.
- Receiver operating characteristic (ROC) curve analysis and Youden's J statistic were used to determine the IDI cutoff.
- Comparison of maternal and neonatal outcomes between short and prolonged IDI groups.
Main Results:
- An intertwin delivery interval (IDI) of 10 minutes was identified as the optimal cutoff for predicting neonatal acidemia (arterial cord pH ≤ 7.1).
- Neonates delivered after a prolonged IDI ( > 10 minutes) had significantly higher rates of acidemia and low 5-minute Apgar scores.
- Prolonged IDI was also associated with increased rates of cesarean delivery and placental abruption.
Conclusions:
- An intertwin delivery interval exceeding 10 minutes is a significant risk factor for neonatal acidemia and adverse outcomes.
- These findings support the consideration of interventions to shorten the IDI during twin vaginal deliveries to improve neonatal well-being.
- The 10-minute IDI cutoff provides valuable information for counseling and clinical management in twin pregnancies.
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