title: Twin-to-twin delivery time: neonatal outcome of the second twin.
abstract: OBJECTIVE
  To examine the effect of twin-to-twin delivery time (TTDT) on neonatal outcome.
  
  
  METHODS
  We evaluated twin deliveries >34 weeks of gestation. Twin pregnancies with both twins delivered by cesarean section and pregnancies with antenatal complications were excluded. We analyzed TTDT and neonatal outcomes of the second twin (umbilical arterial pH value (pH(art)), Apgar scores at 1, 5 and 10 minutes, need for intensive care). The study population was divided into two homogenous groups based on the mode of delivery: (A) vertex presentation and vaginal delivery of both twins, (B) vertex presentation and vaginal or vaginal operative delivery of twin I, breech or transverse presentation and vaginal breech delivery or cesarean section (CS) of twin II.
  
  
  RESULTS
  A total of 207 twin pairs were included in our study. In Group A (n = 151) there were no significant correlations between TTDT and pH(art) or Apgar scores at 1,5 and 10 minutes of twin II (p = .156; 0.861; 0.151 and 0.384, respectively). In Group B (n = 56), the mean pH(art) of twin II was inversely correlated to TTDT, but not significantly (p = .417). TTDT was inversely related to 1-min and 5-min Apgar scores, but not significantly (p = .330; p = .138, respectively). The 10-min Apgar score showed no correlation with TTDT (p = .638).
  
  
  CONCLUSIONS
  Increasing TTDT was not associated with adverse fetal outcome. Expectant management of the second twin appears possible and elapsed time alone does not appear to be an indication for intervention.
authors.affiliation: Department of Obstetrics and Gynecology, Medical University Graz, Graz, Austria. susanne.schneuber@medunigraz.at
authors.forename: Susanne
authors.initials: S
authors.lastname: Schneuber
authors.forename: Eva
authors.initials: E
authors.lastname: Magnet
authors.forename: Josef
authors.initials: J
authors.lastname: Haas
authors.forename: Albrecht
authors.initials: A
authors.lastname: Giuliani
authors.forename: Thomas
authors.initials: T
authors.lastname: Freidl
authors.forename: Uwe
authors.initials: U
authors.lastname: Lang
authors.forename: Vesna
authors.initials: V
authors.lastname: Bjelic-Radisic
mesh_terms: D001034:Apgar Score; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin; D013997:Time Factors