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Delayed interval delivery in multiple gestations at periviability-A multicenter retrospective cohort study
Megan Stevenson1,2, Melanie Maykin1,3, Christine Carlos4
1Department of Obstetrics, Gynecology, and Women's Health John A. Burns School of Medicine University of Hawai'i Honolulu, Hawai'i USA.
Background:
Delayed interval delivery (DID) is a rare strategy for preterm multiple gestations where delivery of the remaining fetus(es) is intentionally delayed following the delivery of the first infant, with the goal of improving outcomes for the retained fetus(es). Clinical outcome data remain limited due to the rarity of this scenario, which adds to the complexity of counseling patients who are considering DID.
Objective:
We sought to summarize obstetric care and neonatal outcomes in the setting of DID at periviability in a multicenter cohort.
Study Design:
This multicenter retrospective cohort study analyzed data on periviable births (22w0d-24w6d) from 13 institutions between 2010 and 2020. From this cohort, we obtained cases of delayed interval deliveries where data were available for the retained twin. Management and outcome data were compiled for all viable fetuses. Deliveries were then stratified by the viability of Twin A at delivery and neonatal outcomes were compared between the Twin A and Twin B groups.
Results:
Thirteen pregnant persons and 20 infants from six institutions were included. All cases were dichorionic diamniotic twin gestations delivered from 2013 to 2019. The median intertwin delivery interval was 7 days (range: 29 h-5 weeks) and decreased as gestational age at delivery of Twin A increased. When both twins delivered in the periviable period, survival was 57.1% (4/7) for Twin A and 87.5% (7/8) for Twin B. In contrast, when Twin A delivered previable and Twin B delivered periviable, there were no survivors in either group. The intraamniotic infection (IAI) rate was 14.3% (1/7) in the Twin A group and 53.8% (7/13) in the Twin B group.
Conclusion:
This multi-institutional, contemporary periviable cohort suggests that when a clinically significant delivery interval is achieved, there may be neonatal benefit for the retained twin. However, DID is associated with a higher risk of IAI. These findings contribute to the limited data on DID at periviability and may assist clinicians in counseling patients in this complex scenario.