Exploring the Optimal Intertwin Delivery Interval for Vaginal Delivery.

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Maternal-Fetal Medicine

Background:

• The impact of extended intertwin delivery intervals (IDI) on maternal and neonatal outcomes remains under-investigated.
• Optimizing delivery management for twin gestations is crucial for mitigating potential complications.

Purpose of the Study:

• To determine the critical intertwin delivery interval (IDI) threshold associated with Cesarean delivery (CD).
• To compare maternal and neonatal adverse outcomes between short and prolonged IDI groups.

Main Methods:

• Retrospective cohort study of 461 women with twin pregnancies reaching the second stage of labor (2010-2019).
• Youden J statistic and ROC curve analysis were used to identify the predictive cutoff for CD.
• Maternal and neonatal outcomes were compared between short (<15 min) and prolonged (≥15 min) IDI groups.

Main Results:

• An intertwin delivery interval of 15 minutes was identified as the optimal cutoff (sensitivity 80%, specificity 75%).
• The prolonged IDI group (≥15 min) showed significantly higher rates of postpartum hemorrhage (39.1% vs. 24.7%) and placental abruption (4% vs. 1%).
• Neonatal outcomes were worse in the prolonged IDI group, with increased rates of acidemia (15.7% vs. 4.3%) and low 5-minute Apgar scores (9.7% vs. 3.5%).

Conclusions:

• Intertwin delivery intervals exceeding 15 minutes are linked to elevated risks of adverse maternal and neonatal complications.
• These findings support the use of a 15-minute IDI threshold in counseling and managing twin pregnancies undergoing attempted vaginal delivery.