Delayed-Interval Delivery in Multifetal Pregnancy: A Review and Guidelines for ManagementPhuong Lien Tran1, Cyrille Desveaux1,2, Georges Barau1, Silvia Iacobelli2,3 and Malik Boukerrou1,2,4*
- *Corresponding Author:
- Malik Boukerrou
Gynecology and Obstetrics Unit
University Hospital of Reunion Island
BP 350 - 97448 Saint Pierre Cedex, France
Tél: 02 62 35 90 00
E-mail: [email protected]
Received Date: October 11, 2015; Accepted Date: October 23, 2015; Published Date: November 07, 2015
Citation: Tran PL, Desveaux C, Barau G, Iacobelli S, Boukerrou M (2015) Delayed- Interval Delivery in Multifetal Pregnancy: A Review and Guidelines for Management. Gynecol Obstet (Sunnyvale) 5:333. doi: 10.4172/2161-0932.1000333
Copyright: © 2015 Tran PL, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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.