(304) The Optimal Cutoff Time for Defining Prolonged Intertwin Delivery Interval

Prolonged interval between the deliveries of twins is associated with adverse neonatal outcomes. We aimed to establish the best cut-off point for defining prolonged intertwin delivery interval in order to predict adverse neonatal outcome.

Study Design: This was a retrospective cohort study in a single tertiary care center conducted between 2010-2019. All women with twins who reached the second stage of labor were included in the study. The cutoff point for prolonged delivery interval was assessed using ROC curve and Youden's J statistic. Neonatal outcomes were then compared to the previously reported cutoff points for intertwin delivery interval.

Results:

461 women who reached the 2^nd stage of labor were included in our study. As shown in figure 1, by using ROC curve and Youden’s index, a cutoff time of 10 minutes was found to be the best predictor for neonatal acidemia (Arterial cord pH ≤ 7.1) and for a low 5-minute Apgar score (sensitivity of 90% and specificity of 60%; sensitivity of 68% and specificity of 57%, respectively) As shown in Table 1, a second twin delivered more than 10 minutes following the 1st twin was more likely to be acidemic and with a 5-minute Apgar score ≤7. No other neonatal outcome parameters were significant.

Conclusion:

A cutoff point of 10 minutes has been demonstrated to be the optimal intertwin delivery time interval which is associated with adverse neonatal outcome. These findings should be used for counseling and managing twin pregnancies attempting vaginal delivery.