Intertwin time interval: how it affects the immediate neonatal outcome of the second twin.

OBJECTIVE

Customarily 30 minutes is used as the upper limit of intertwin birth times. This study was conducted to define factors that influence the immediate neonatal outcome of the second twin and to assess whether a valid cutoff time is evident.

STUDY DESIGN

We evaluated all live born viable vaginal twin deliveries (144) between November 1997 and December 2003. The relationship between intertwin birth time and neonatal outcome was then evaluated continuously and in 15 to 30-minute intervals.

RESULTS

In multivariate analysis, only intertwin birth time predicted umbilical cord pH. Arterial/venous pH decreased linearly at a rate of 0.00063 and 0.00081 U/min. Venous pH was significantly lower in later 15-minute intervals compared with earlier ones (P = .002), and in patients delivering before or after a 30-minute cutoff (7.31 vs 7.26, P = .012).

CONCLUSION

Our study confirmed that longer intertwin birth time is associated with a continuous slow decline in umbilical cord pH. However, the small differences in pH were not large enough to impact clinical management.