Delayed versus immediate cord clamping in dichorionic twins <32 weeks: a retrospective study

Abstract

Objectives

Strong evidence imply that delayed cord clamping (DCC) provides significant benefits for singleton neonates. However, there is little information about the safety or efficacy of DCC in twins to recommend for or against DCC in twins in guidelines. We aimed to determine the effect of DCC on dichorionic twins born at <32 weeks of gestation.

Study design

This is a retrospective cohort study comparing the neonatal and maternal outcomes of immediate cord clamping (ICC) [<15 second (s)] versus DCC (at 60 s). Generalized estimating equations models were performed accounting for twin correlation.

Results

A total of 82 pairs of twins (DCC: 41; ICC: 41) were included in analysis. The primary outcome of death before discharge occurred in 3.66% of twins in the DCC group and 7.32% in the ICC group, without a significant difference between the groups. Compared to ICC group, DCC was associated with increased hemoglobin levels [β1 coefficient 6.51; 95% confidence interval (CI) 0.69–12.32. β2 coefficient 5.80; 95% CI 0.07–11.54] at 12–24 h of life. There were no significant differences between the groups in neonatal death, neonatal major morbidities and maternal bleeding complications, although DCC was associated with higher estimated maternal blood loss in the cesarean section group (p = .005).

Conclusions

DCC for 60 s in dichorionic twins born at <32 weeks of gestation was associated with increased neonatal hemoglobin levels, when compared with ICC. The finding of a higher estimated maternal blood loss by cesarean section in the DCC group calls for further trials to assess maternal safety of this procedure in this patient population.

Keywords:

• Delayed cord clamping
• immediate cord clamping
• very preterm twins
• dichorionic-diamniotic
• retrospective cohort study

Acknowledgements

Gratitude is expressed to our patients and families. We thank the obstetricians and midwives participating in this study. We thank Dr Dingmei Wang of Fudan university for her valuable suggestions.

Author contributions

Conceived and designed the study: LW, XY Z, HG, WC, and LG Z. Performed data collection and data analysis: LW, JF O, and GY X. Drafted the original manuscript: LW and XY Z. Revised the final manuscript: LW, YW, HG, WC, LG Z and XY Z. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and materials

The data are included in the article and supplementary materials.

Additional information

Funding

This study was supported by the [Chongqing Health Commission] under Grant [2021MSXM239]; [Joint Scientific Research Grants of Chongqing Health Commission and Science and Technology Bureau] under Grant [2023QNXM037] and [Scientific Research Grants of Women and Children’s Hospital of Chongqing Medical University] under Grant [2020YJQN01].