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DOI: 10.1055/s-2006-954957
Relationship between Intertwin Delivery Interval and Metabolic Acidosis in the Second Twin
Publikationsverlauf
Publikationsdatum:
08. November 2006 (online)
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ABSTRACT
This study sought to assess the relationship between intertwin delivery interval (ITDI) and metabolic acidosis in the second twin at birth using a retrospective twin delivery cohort from a tertiary-level teaching hospital. Twin births were identified from an obstetrical database during a 10-year period from 1994 to 2004. Mean arterial cord pH and base deficit among different ITDIs were compared by analysis of variance. Logistic regression models were used to estimate effects of ITDI on metabolic acidosis. The incidence of metabolic acidosis in the second twin was defined as pH < 7.0, and base deficit was defined as ≥ 12 mmol/L at birth. After excluding those pregnancies with both twins delivered by cesarean section, birthweight less than 750 g of either twin, antepartum death of either twin, or second twins with missing cord arterial pH, we had 310 twin pairs left for final analysis. Mean pH was significantly lower and base deficit significantly higher for second twin after ITDI exceeded 60 minutes. The incidence of metabolic acidosis increased with increasing ITDI (χ2 test for linear trend, p = 0.02) and the risk of metabolic acidosis (odds ratio, 22.6; 95% confidence interval, 2.5 to 494.1) was increased in the second twins with ITDI longer than 60 minutes compared with those with ITDI less than 15 minutes. The incidence of metabolic acidosis increases with increasing ITDI and there is a statistically significant increased risk of neonatal acidosis after longer than 60 minutes compared with less than 15 minutes of ITDI.
KEYWORDS
Twins - intertwin delivery interval - pH - base deficit - metabolic acidosis
REFERENCES
- 1 Kurtz G R, Keating W J, Loftus J B. Twin pregnancy and delivery: analysis of 500 twin pregnancies. Obstet Gynecol. 1955; 6 370-378
- 2 Farooqui M O, Grossman 3rd J H, Shannon R A. A review of twin pregnancy and perinatal mortality. Obstet Gynecol Surv. 1973; 28(suppl) 144-153
- 3 Leung T Y, Tam W H, Leung T N, Lok I H, Lau T K. Effect of twin-to-twin delivery interval on umbilical cord blood gas in the second twins. BJOG. 2002; 109 63-67
- 4 Brown E, Dixon H. Twin pregnancy. J Obstet Gynaecol Br Commonwealth. 1963; 70 251
- 5 Bartnicki J, Meyenburg M, Saling E. Time interval in twin delivery-the second twin need not always be born shortly after the first. Gynecol Obstet Invest. 1992; 33 19-20
- 6 Brown H L, Miller Jr J M, Neumann D E, Sarpong D F, Gabert H A. Umbilical cord blood gas assessment of twins. Obstet Gynecol. 1990; 75 826-829
- 7 Muller-Holve W, Saling E, Schwarz M. The significance of the time interval in twin delivery. J Perinat Med. 1976; 4 100-105
- 8 Brown H L, Miller Jr J M, Neumann D E, Sarpong D F, Gabert H A. Umbilical cord blood gas assessment of twins. Obstet Gynecol. 1990; 75 826-829
- 9 Rayburn W F, Lavin Jr J P, Miodovnik M, Varner M W. Multiple gestation: time interval between delivery of the first and second twins. Obstet Gynecol. 1984; 63 502-506
- 10 Hankins G D, Speer M. Defining the pathogenesis and pathophysiology of neonatal encephalopathy and cerebral palsy. Obstet Gynecol. 2003; 102 628-636
- 11 Wen S W, Fung Kee Fung K, Oppenheimer L, Demissie K, Yang Q, Walker M. Occurrence and predictors of cesarean delivery for the second twin after vaginal delivery of the first twin. Obstet Gynecol. 2004; 103 413-419
- 12 Brown H L, Miller Jr J M, Neumann D E, Sarpong D F, Gabert H A. Umbilical cord blood gas assessment of twins. Obstet Gynecol. 1990; 75 826-829
- 13 Young B K, Suidan J, Antoine C, Silverman F, Lustig I, Wasserman J. Differences in twins: the importance of birth order. Am J Obstet Gynecol. 1985; 151 915-921
- 14 Hankins G D, Speer M. Defining the pathogenesis and pathophysiology of neonatal encephalopathy and cerebral palsy. Obstet Gynecol. 2003; 102 628-636
- 15 Ferguson W F. Perinatal mortality in multiple gestations. A review of perinatal deaths from 1609 multiple gestations. Obstet Gynecol. 1964; 23 861-870
- 16 Chervenak F A, Johnson R E, Youcha S, Hobbins J C, Berkowitz R L. Intrapartum management of twin gestation. Obstet Gynecol. 1985; 65 119-124
- 17 Rydhstrom H, Ingemarsson I. Interval between birth of the first and the second twin and its impact on second twin perinatal mortality. J Perinat Med. 1990; 18 449-453
- 18 Goodwin T M, Belai I, Hernandez P, Durand M, Paul R H. Asphyxial complications in the term newborn with severe umbilical acidemia. Am J Obstet Gynecol. 1992; 167 1506-1512
- 19 Ruth V J, Raivio K O. Perinatal brain damage: predictive value of metabolic acidosis and the Apgar score. BMJ. 1988; 297 24-27
- 20 Andres R L, Saade G, Gilstrap L C et al.. Association between umbilical blood gas parameters and neonatal morbidity and death in neonates with pathologic fetal acidemia. Am J Obstet Gynecol. 1999; 181 867-871
- 21 Low J A, Lindsay B G, Derrick E J. Threshold of metabolic acidosis associated with newborn complications. Am J Obstet Gynecol. 1997; 177 1391-1394
- 22 Low J A, Victory R, Derrick E J. Predictive value of electronic fetal monitoring for intrapartum fetal asphyxia with metabolic acidosis. Obstet Gynecol. 1999; 93 285-291
Fawaz EdrisM.D. R.D.M.S. F.R.C.S.C.
Obstetrics and Gynecology, Maternal Fetal Medicine, Ottawa Hospital, General Campus
501 Smyth Road, Ottawa, ON, K1H 8L6, Canada