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BJOG. 2002 Jan;109(1):63-7.

Effect of twin-to-twin delivery interval on umbilical cord blood gas in the second twins.

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  • 1Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.

Abstract

OBJECTIVE:

To examine the effect of twin-to-twin delivery interval on the umbilical cord blood gas status of the second twin following vaginal delivery.

DESIGN:

A retrospective study.

SETTING:

The department of obstetrics and gynaecology in a university teaching hospital.

POPULATION:

Twin deliveries at or beyond 34 weeks of gestation over a period of five years, with the first twin delivered vaginally. Twins with any antepartum complications including discordant growth, intrauterine growth restriction, intrauterine death, fetal malformations and pre-eclampsia were excluded.

METHODS:

The correlation between the twin-to-twin delivery interval, and both the umbilical arterial and venous blood gas parameters of the second twin, including pH, partial pressure of CO2 and base excess, were studied.

RESULTS:

A total of 118 cases were reviewed. The mean gestation at delivery was 37.1 weeks. The median twin-to-twin delivery interval was 16.5 minutes. There were significant negative correlations between twin-to-twin delivery interval and both the umbilical cord arterial and venous pH and base excess of the second twin (P <0.05). There were also significant positive correlations between both arterial and venous partial pressure of CO2 and the delivery interval (P <0.05). Similar changes were found even if the analyses were limited to those who had normal vaginal deliveries. The umbilical arterial pH of Twin 2 was <7.00 in none of the cases delivered within 15 minutes of the birth of Twin 1, 5.9% if within 16-30 minutes, and 27% if more than 30 minutes. Among those with an inter-twin delivery interval of more than 30 minutes, 73% had cardiotocographic evidence of fetal distress which required operative delivery.

CONCLUSIONS:

Umbilical cord arterial and venous values of pH, partial pressure of CO2 and base excess of the second twin deteriorate with increasing twin-to-twin delivery interval. Risks of fetal distress and acidosis in the second twin are high when the twin-to-twin delivery interval is beyond 30 minutes.

Comment in

PMID:
11843376
[PubMed - indexed for MEDLINE]
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