title: Second-trimester asynchronous multifetal delivery results in poor perinatal outcome.
abstract: OBJECTIVE
  The purpose of this study is to estimate the maternal and fetal morbidities associated with asynchronous delivery.
  
  
  METHODS
  A review of maternal and fetal medical records was performed at 2 tertiary care centers over 12 years. Charts were identified by the International Classification of Diseases, 9th Revision, Clinical Modification codes for twin and triplet gestations. Asynchronous delivery was defined as an active attempt (tocolysis and/or emergent cerclage placement) to increase latency between delivery of the first fetus and subsequent fetuses.
  
  
  RESULTS
  Fourteen cases of asynchronous delivery were identified out of 96922 deliveries including 1352 pregnancies complicated by multifetal gestation. The occurrence rate of asynchronous delivery was 0.14 per 1000 births. The etiology of preterm birth of the first fetus in 12 (86%) of 14 cases was second-trimester rupture of membranes. The mean gestational age for delivery of the first fetus was 21.+/- 2.0 weeks. All women received tocolysis and intravenous antibiotics. Two of 3 attempts at cerclage placement were successful. Median latency obtained was 2 days (range less than 1-70 days). There was 1 survival of a first born. There were 19 retained fetuses, 2 died in utero, 10 died between birth and day 57 of life, and 7 survived (37%; 95% confidence interval 16%, 62%) until hospital discharge. Six of 7 survivors had major sequelae from prematurity. One of 19 fetuses was discharged without major sequelae (5%; 95% confidence interval 0%, 25%). Maternal morbidity included 2 placental abruptions and 8 cases of infectious morbidity including 1 case of septic shock.
  
  
  CONCLUSIONS
  Attempts at asynchronous deliveries are uncommon and are associated with a high rate of perinatal death. Most fetal survivors have significant damage from preterm birth.
authors.affiliation: Department of Obstetrics and Gynecology, Carilion Center for Women and Children, Roanoke, Virginia 24013, USA. jlivingston@carilion.com
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Livingston
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Livingston
authors.forename: Risa
authors.initials: R
authors.lastname: Ramsey
authors.forename: Baha M
authors.initials: BM
authors.lastname: Sibai
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000401:mortality*; D006801:Humans; D008499:Medical Records; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D013714:Tennessee / Q000453:epidemiology; D015149:Tocolytic Agents / Q000627:therapeutic use; D014310:Triplets; D014427:Twins
chemical_list: D015149:Tocolytic Agents