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Exploring the Optimal Intertwin Delivery Interval for Vaginal Delivery.

Naphtali Justman1, Roee Goldfriend2, Bar Rosh3

  • 1Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel. njustman88@gmail.com.

Reproductive Sciences (Thousand Oaks, Calif.)
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Prolonged twin delivery intervals over 15 minutes increase risks for mothers and newborns. This study identifies 15 minutes as a critical threshold for managing twin pregnancies to improve outcomes.

Keywords:
CutoffIntertwin delivery intervalMaternal morbidityNeonatal morbidityTwin gestationsVaginal delivery

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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.