Neonatal outcome of second baby versus first baby in twins delivered vaginally: a comparative study

Abstract

Background: The incidence of twinning has been increasing due to assisted reproductive technology. Despite substantial concerns over the well-being of the second twin with regard to intra partum events, outcome studies on this issue are conflicting. Some have reported no increase in perinatal complications, while others showed significant associations between labor and delivery of the second twin and increased perinatal morbidity and mortality.Methods: All pregnant women of twin pregnancy at more than 28 weeks of gestation, first twin with cephalic presentation were selected for study. Intrauterine death of either of the twins, pregnancies complicated or fetal malformations and those with contraindication to vaginal birth were excluded. After delivery, APGAR score, birth weight, complications, time interval between deliveries, NICU admission and condition on discharge of each baby was noted.Results: Out of 106 women with twin pregnancy 89 of them delivered vaginally, there was statistically no significant difference of live births, still births, early neonatal mortality in the first and second born twins. Neonatal morbidity was more in the second twin than the first twin (23.33% versus 21.11%).Out of all NICU admissions 47.5% were for the first twin and 52.5% for the second twin.Conclusions: Twin vaginal delivery is safe in first cephalic presentation in twin pregnancy. Caution should be taken while delivering babies <1500gm, gestational age <34 weeks, as vaginal delivery in these conditions is associated with increased early neonatal morbidity and neonatal mortality.

The optimal cutoff for intertwin delivery interval: A retrospective cohort study

“…As in several other studies, 3,8,14 the current work found no association between prolonged IDI and birth weight difference ratio ≥ 20%. Yet, the present analysis did identify a trend toward a higher absolute weight difference in the prolonged IDI group.…”

“…Reasons for this include greater access to assisted reproductive technology (ART), increased rate of ovulation induction, and a rise in maternal age 2 . Twin pregnancies make up approximately 1% of all pregnancies 3 . While attempted vaginal delivery rates in twin pregnancies vary by hospital and by local practice, the success rates of completing a vaginal delivery of both twins are approximately 65%–75% 4–7 …”

Risk Factors for Prolonged Intertwin Delivery Interval and Associated Maternal and Second Twin Morbidity

“…7 8 9 11 20 21 While Mekki et al and Algeri et al reported on a correlation between a 25% intertwin birth weight difference and prolonged IDI, 8 11 Stein et al, Srivastava et al, and Armson et al showed a similar association with a birth weight discordancy of 20% or higher. 7 20 21 The present analysis was consistent with these results, by showing that a birth weight ratio higher than 1.2 was associated with an increased IDI, neonatal acidemia, and lower 5-minute Apgar score. The absolute birth weight had no correlation with the IDI or adverse neonatal outcome.…”

“…However, these two studies involved a small sample size and set the IDI of interest at >30 minutes. Other reports 9 10 13 16 21 22 did not address these variables at all. Advanced maternal age and nulliparity have previously been marked as predictors of prolonged second stage of labor in singleton deliveries.…”

“…The impact of birth weight ratio between twin B and twin A on neonatal morbidity and mortality has been demonstrated before. [7][8][9]11,20,21 While Mekki et al and Algeri et al reported on a correlation between a 25% intertwin birth weight difference and prolonged IDI, 8,11 Stein et al, Srivastava et al, and Armson et al showed a similar association with a birth weight discordancy of 20% or higher. 7,20,21 The present analysis was consistent with these results, by showing that a birth weight ratio higher than 1.2 was associated with an increased IDI, neonatal acidemia, and lower 5-minute Apgar score.…”