Gynecology & Obstetrics
Open Access

Abstract

Delayed-Interval Delivery in Multifetal Pregnancy: A Review and Guidelines for Management

Phuong Lien Tran1, Cyrille Desveaux, Georges Barau, Silvia Iacobelli and Malik Boukerrou

The objective of the study was to review the literature concerning delayed deliveries in multiple pregnancies and to highlight the existing guidelines for a better management of asynchronous births. A literature-search was done using Medline and ScienceDirect. All articles reporting at least 4 cases of delayed delivery were included, if they provided full information on gestational age and outcome of each offspring. The main outcome was the survival rate of the second twin or other higher-order multiples, stratified for gestational age of the first born (before or after 24 weeks of gestation). Secondary outcomes were: management strategies, interval between deliveries, neonatal and maternal complications. Among 18 relevant cohort studies, 391 twin and 34 triplet pregnancies could be analysed. In case of delayed delivery, the survival rate of the second twin or higher-order multiple was respectively 44.8% and 82.7% when the first twin was born before or after 24 weeks of gestation The later was the delivery of the first twin, the higher was the second twin's survival rate, but the shorter was the interval between births (14 vs. 26 days). Conservative measures included: high ligature of umbilical cord, tocolysis, corticoids, antibiotic therapy and cerclage. Main neonatal complications were septicemia (42%), retinopathy (62%) and intraventricular hemorrhage (37%), and the most frequent maternal complication was chorioamniotitis (30%). In spite of higher rates of chorioamniotitis, there was a clear advantage in delaying delivery of remaining multiples, as this improved the outcome of preterm birth. The possible strategies and their grades of recommendation for the management of asynchronous deliveries are summarized.