title: Delayed-interval delivery in twin and triplet pregnancies: 17 years of experience in 1 perinatal center.
abstract: OBJECTIVE
  There are few prospective cohorts of delayed-interval delivery for twin and triplet pregnancies. Nonetheless, the procedure is an option to improve perinatal outcome.
  
  
  METHODS
  A standard protocol was designed before candidates for delayed interval were managed by the 2 authors from 1991 to 2007. Perinatal as maternal outcomes were evaluated up to 1 year.
  
  
  RESULTS
  In 93 twin and 34 triplet pregnancies, the inclusion criteria were fulfilled; in 45 twin and 8 triplet pregnancies, there were contraindications to prolong pregnancy; and in 10 twin and 26 triplet pregnancies, asynchronous delivery was not possible because of immediate delivery of the remaining multiples. Thus, the procedure was performed in only 41% (38/93) of twin and 35% (12/34) of triplet pregnancies admitted with threatening early delivery. Among twin pregnancies, the mean delay was 19 (1-107) days. When the first delivery was less than 25 weeks, no first twin but 9 of 18 second twins (50%) survived (P < .001). Survival rate of first twins born beyond 25 weeks was 13 of 20 (65%) compared with 19 of 20 (95%) (P = .03) in corresponding second twins. In 7 of 12 triplet pregnancies with the first born less than 25 weeks, 2 of 14 remaining triplets survived after an interval of 118 days. Beyond 25 weeks, 3 of 5 first and 4 of 10 remaining triplets survived after intervals of 2-13 days (P = n.s.). Delay between second and third triplet was never longer than 2 days. Frequent maternal complications were chorioamnionitis (22%), postpartum hemorrhage, retained placenta (10%), and abruption (6%).
  
  
  CONCLUSIONS
  Our study provides data to assist physicians in the informed consent process when asynchronous delivery is considered and feasible.
authors.affiliation: Department of Obstetrics, Isala Clinics, Zwolle, The Netherlands. clara-angela@wxs.nl
authors.forename: Birgit
authors.initials: B
authors.lastname: Arabin
authors.forename: Jim
authors.initials: J
authors.lastname: van Eyck
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D013997:Time Factors; D014310:Triplets; D014427:Twins; D055815:Young Adult