The effect of chorionicity and twin-to-twin delivery time interval on short-term outcome of the second twin

Hjortø, Sofie; Nickelsen, Carsten; Petersen, Janne; Secher, Niels Jørgen

doi:10.3109/14767058.2013.799657

Cited by 22 publications

(22 citation statements)

References 13 publications

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“…However, some studies also support our findings that maternal age (Milsom et al, 2002) and BMI at birth (Kiran et al, 2005;Rode et al, 2005) are not associated with Apgar score. Monochorionicity was an important risk factor for adverse perinatal outcomes in twins (Dube et al, 2002;Hjorto et al, 2014;Lindroos et al, 2018; van Beijsterveldt et al, 2016), but was not associated with Apgar scores in our study.…”

Section: Discussioncontrasting

confidence: 61%

“…A multiple pregnancy is a risk factor for adverse outcomes, including low Apgar scores (Morley et al, 1989;Pourali et al, 2016;Svenvik et al, 2015;Thorngren-Jerneck & Herbst, 2001). This holds specifically for MC pregnancies (Hjorto et al, 2014;Lindroos et al, 2018) and DC pregnancies with discordant fetal weight (Vulic et al, 2017). Again, some studies failed to find an association with chorionicity (Machado et al, 2017).…”

Section: Pregnancy Characteristicsmentioning

confidence: 99%

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Pre- and Perinatal Characteristics Associated with Apgar Scores in a Review and in a New Study of Dutch Twins

et al. 2019

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A literature review was carried out to identify pre and perinatal characteristics associated with variation in Apgar scores in population-based studies. The parameters identified in the literature search were included in the classical twin design study to estimate effects of pre and perinatal factors shared and nonshared by twins and to test for a contribution of genetic factors in 1- and 5-min Apgar scores in a large sample of Dutch monozygotic (MZ) and dizygotic (DZ) twins. The sample included MZ and DZ twins (N = 5181 pairs) recruited by the Netherlands Twin Register shortly after birth, with data on prenatal characteristics and Apgar scores at first and/or fifth minutes. The ordinal regression and structural equation modeling were used to analyze the effects of characteristics identified in the literature review and to estimate genetic and nongenetic variance components. The literature review identified 63 papers. Consistent with the review, we observed statistically significant effects of birth order, zygosity and gestational age (GA) for 1- and 5-min Apgar scores of both twins. Apgar scores are higher in first-born versus second-born twins and DZ first-born versus MZ first-born twins. Birth weight had an effect on the 5-min Apgar of the first born. Fetal presentation and mode of delivery had different effects on Apgar scores of first- and second-born twins. Parental characteristics and chorionicity did not have significant main effects on Apgar scores. The MZ twins’ Apgar correlations equaled the DZ Apgar correlations. Our analyses suggest that individual differences in 1- and 5-min Apgar scores are attributable to shared and nonshared pre and perinatal factors, but not to genotypic factors of the newborns. The main predictors of Apgar scores are birth order, zygosity, GA, birth weight, mode of delivery and fetal presentation.

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Section: Discussioncontrasting

confidence: 61%

Section: Pregnancy Characteristicsmentioning

confidence: 99%

Pre- and Perinatal Characteristics Associated with Apgar Scores in a Review and in a New Study of Dutch Twins

et al. 2019

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“…Vaginal delivered preterm MC second twin may be at an increased risk compared to DC preterm second twin, a difference that may diminishes towards term, as foetuses at risk are already sorted out (Joseph and Kramer 2017). A stated hypothesis is that the decrease in pH in MC second twin may exceed that of DC second twin, which was not confirmed in vaginally delivered twin pregnancies at term (Hjortø et al 2014). The aim of the present study was to investigate the effect of chorionicity on umbilical pH in relation to increasing twin-to-twin DTI from 30 weeks of gestation and compare the outcome before and after 34 weeks of gestation.…”

Section: Introductionmentioning

confidence: 99%

“…Major available published studies have not discriminated between monochorionic (MC) and dichorionic (DC) vaginally delivered twins when examining the relationship between umbilical pH and twin-to-twin DTI. However, a recent study found no effect of chorionicity and twin-to-twin DTI on the short-term outcome of second twin after 36 weeks of gestation (Hjortø et al 2014). But there is a risk for substantial bias, as a higher incidence of complications during pregnancy are probably to be found in MC twins and the problematic ones are possibly selected for caesarean section (Ylilehto et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Short-term outcome of the second twin during vaginal delivery is dependent on delivery time interval but not chorionicity

Axelsdóttir

Ajne

2018

Journal of Obstetrics and Gynaecology

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The decrease in pH in monochorionic (MC) second twin may exceed that of dichorionic (DC) second twin during vaginal twin delivery. The aim of this study was to investigate the effect of chorionicity on the umbilical artery pH of the second twin in relation to increased twin-to-twin delivery time interval (DTI) from 30 weeks of gestation. A hospital based cohort of all twin deliveries after 30 completed weeks of gestation with the first twin delivered vaginally between 2007 and 2012 in four delivery units in Stockholm county was conducted. The changes of umbilical pH in MC twins compared to DC twins in relation to twin-to-twin DTI was studied using linear regression. The predictors for acidosis (pH 7.10) in the second twin were studied by logistic regression. The cohort included 681 DC and 186 MC twin pairs. There was a correlation between the umbilical pH and the twin-to-twin DTI but independent of the chorionicity, the pH decreased in average by 0.0012 units/min (p < .001). Twin-to twin DTI was a predictor for acidosis of the second twin (p < .01).

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“…The present results are in agreement with several studies reporting that a longer time interval is related to a lower Apgar score at 1, 5, and 10 minutes, and a lower mean umbilical pH . An intertwin interval more than 30 minutes has also been associated with a worsening in arterial and venous umbilical cord pH, partial pressure of CO 2 , and base excess, leading to an increased risk of fetal distress and acidosis in the second twin …”

Section: Discussionmentioning

confidence: 99%

Impact of intertwin interval on short‐term neonatal outcomes of the second twin in dichorionic pregnancies with vaginal delivery

Benito

Bonrostro

Agustín

et al. 2019

Intl J Gynecology & Obste

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Objective To examine the effect of intertwin interval on umbilical cord pH and Apgar scores of the second twin after vaginal delivery. Methods A retrospective study of twin deliveries at a university hospital in Spain between August 2012 and September 2017. Inclusion criteria were vaginal delivery of both twins at 32 gestational weeks or more. Exclusion criteria were monochorionic pregnancies and indication for cesarean delivery. The sample was dichotomized by intertwin interval (<10 and ≥10 minutes). Neonatal outcomes including Apgar scores and umbilical cord pH were evaluated. Results Overall, 323 twin deliveries were included. Intertwin interval was less than 10 minutes in 277 (85.6%) cases, and 10 minutes or longer in 46 (14.2%). There were no differences in maternal or obstetric characteristics between the groups. Incidence of instrumental delivery (P<0.001) and internal podalic version (P<0.001) for the second twin was higher in the longer interval group. A longer interval was associated with higher frequencies of 1‐minute Apgar score below 4 (P=0.009), 5‐minute Apgar score below 7 (P<0.001), and umbilical cord pH below 7.15 (P<0.001). Conclusion Second twins with an intertwin interval of 10 minutes or longer are more likely to have poorer Apgar scores and arterial blood pH below 7.15.

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The effect of chorionicity and twin-to-twin delivery time interval on short-term outcome of the second twin

Abstract: Increasing delivery interval was associated with a significant decrease in pH and Apgar, but there was no difference between MC and DC twins. Low Apgar of the first twin increased the risk of second twin NICU admission.

Cited by 22 publications

References 13 publications

Pre- and Perinatal Characteristics Associated with Apgar Scores in a Review and in a New Study of Dutch Twins

Pre- and Perinatal Characteristics Associated with Apgar Scores in a Review and in a New Study of Dutch Twins

Short-term outcome of the second twin during vaginal delivery is dependent on delivery time interval but not chorionicity

Impact of intertwin interval on short‐term neonatal outcomes of the second twin in dichorionic pregnancies with vaginal delivery

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