Multiple gestation: time interval between delivery of the first and second twins

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Neonatology

Background:

• The conventional medical guideline suggests limiting the interval between the birth of the first and second twins to 15-30 minutes.
• This practice is based on the assumption that prolonged intervals increase risks for the second twin.

Purpose of the Study:

• To challenge the established time restriction for twin delivery intervals.
• To evaluate the outcomes of second twins delivered with intervals exceeding 15 minutes.

Main Methods:

• A clinical investigation involving 115 twin deliveries at 34 or more weeks' gestation.
• Attempted vaginal delivery at four regional perinatal centers between 1981 and 1982.
• Analysis of delivery intervals, infant Apgar scores, trauma signs, and maternal complications.

Main Results:

• The mean interval between twin births was 21 minutes (range: 1-134 minutes).
• 61% of deliveries had intervals ≤15 minutes, while 39% exceeded 15 minutes.
• Second twins delivered after >15 minutes showed no increased trauma or low Apgar scores, excluding prematurity-related issues.
• Maternal complications were infrequent; however, combined vaginal-abdominal delivery was more common with longer intervals (P < .02).

Conclusions:

• A strict time restriction for twin delivery intervals is unnecessary with continuous fetal and uterine monitoring.
• Delayed delivery of the second twin, when appropriately monitored, does not appear to compromise infant outcomes.
• This finding supports a more flexible approach to twin delivery management.