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

Figures & data

Figure 1. Flow chart of participants. 

Table 1. Maternal characteristics.

Maternal characteristics	ICC (n = 41)	DCC (n = 41)	p value
Maternal age, mean (SD), y	29.92 (3.82)	30.42 (3.34)	.374
Pregnancy-induced hypertension or preeclampsia, n(%)	4 (9.76)	4 (9.76)	1.000
Maternal chorioamnionitis, n(%)	5 (12.20)	6 (14.63)	.746
Steroids given before delivery, n(%)	18 (43.90)	28 (68.29)	.026*
Rupture of membranes (≥18 h), n(%)	14 (34.15)	16 (39.02)	.819
Assisted reproductive technology, n(%)	36 (87.80)	36 (87.80)	1.000
Maternal diabetes, n(%)	3 (7.31)	14 (34.15)	.003*
Pre-gestational diabetes	0	0
Gestational diabetes	3	14

SD: standard deviation; *Statistically significant.

Table 2. Neonatal demographics by treatment group.

Neonatal characteristics	ICC (n = 82)	DCC (n = 82)	p value
Gestational age, median (IQR) weeks	30.00(28.68, 31.32)	30.14(29.29,30.14)	.191
$\le$29^+6, n(%)	40(48.78)	38(46.34)	.876
30^+0 – 31^+6, n(%)	42(51.22)	44(53.66)
Birth weight (kilogram), mean (SD)	1.33(0.26)	1.35(0.33)	.720
Birth weight by kilogram, n(%)			.446
$\le$1.000	10(12.20)	12(14.63)
1.001–1.500	51(62.19)	43(52.44)
>1.501	21(25.61)	27(32.93)
Cesarean section, n(%)	64(78.05)	78(95.12)	.001*
Male Sex, n(%)	41(50.00)	36(43.90)	.434
Small for gestational age, n(%)	9(10.98)	11(13.41)	.633

IQR: interquartile range; *Statistically significant.

Table 3. Maternal outcomes.

Outcome	ICC	DCC	Difference (95% CI)	P
Estimated blood loss (EBL), mean (min to max), ml, VD group	305(246, 447)	478(340, 535)	113.00(–193.00–270.00)	.209
EBL, median (IQR), ml, CS group	492(408.75, 582.5)	570(515, 665)	87.00(25.00–145.00)	.005*
PPH (EBL >1000 ml in CS or >500 ml in VD), n(%)	2(4.88)	2(4.88)	1.00(0.13–7.46)	1.000
Blood transfusion, n(%)	7(17.07)	2(4.88)	0.25(0.05–1.28)	.155
Hysterectomy, n(%)	1(2.44)	0(0.00)	——	1.000
Maternal hemoglobin decrease, mean (SD), g/L	5.63(15.25)	1.63(11.48)	4.01(–1.97–9.99)	.186
postpartum infection, n(%)	1(2.44)	1(2.44)	——	1.000

*Statistically significant.

Table 4. Neonatal outcomes.

Outcomes	ICC, n(%)	DCC, n(%)	Point estimate (95%CI)	Adjusted point estimate_1(95%CI)	Adjusted point estimate_2(95%CI)
Death	6(7.32)	3(3.66)	0.48(0.08–2.78)	0.48(0.08–3.06)	0.44(0.05–4.03)
NEC stage $\gg$2	12(14.63)	14(18.18)	1.29(0.52–3.17)	1.34(0.54–3.34)	1.512(0.56–4.12)
IVH	10(12.20)	13(16.67)	1.43(0.54–3.80)	1.45(0.54–3.88)	1.67(0.53–5.21)
PVL	0(0.00)	0(0.00)	——	——	——
RDS	41(50.00)	48(58.54)	1.41(0.68–2.95)	1.47(0.69–3.15)	1.43(0.63–3.25)
PDA requiring medical or surgical treatment	20(24.39)	15(19.48)	0.76(0.32–1.82)	0.78(0.31–1.93)	0.85(0.31–2.30)
BPD	12(15.19)	5(6.58)	0.39(0.12–1.33)	0.37(0.10–1.39)	0.32(0.07–1.43)
BPD by severity
Mild	6(7.59)	3(3.95)
Moderate	3(3.80)	2(2.63)	0.37(0.11–1.26)	0.36(0.10–1.36)	0.26(0.05–1.24)
Severe	3(3.80)	0(0.00)
EOS	14(17.07)	7(8.86)	0.46(0.15–1.45)	0.46(0.15–1.44)	0.43(0.14–1.39)
LOS	15(18.29)	17(21.52)	1.22(0.54–2.79)	1.23(0.54–2.84)	1.44(0.56–3.72)
Hemoglobin, mean(SD)	165.84(17.70)	171.93(18.61)	3.20(–0.19–12.36)	6.51(0.69–12.32)*	5.80(0.07–11.54)*
HCT, mean(SD)	50.97(5.86)	52.58(5.55)	1.64(–0.32–3.61)	1.81(–0.04–3.65)	1.53(–0.32–3.37)
Blood transfusion within the first week	4(4.88)	1(1.22)	0.24(0.02–2.44)	0.21(0.02–2.75)	0.27(0.03–2.90)
Total number of packed red blood transfuion, median(IQR)	0(0.0)	0(0.0)	–0.12(–2.72–0.51)	–0.11(–0.21–0.42)	–0.07(–0.24–0.39)
Duration of mechanical ventilation, median(IQR), hours	0(0.0)	0(0.0)	–30.57(–78.02–16.88)	–25.27(–61.48–10.92)	–14.06(–35.96–7.84)

Generalized estimating equations models were performed to account for the correlation between twins. Gestational age and birth weight were selected for the statistical model (1) Gestational age, birth weight, mode of delivery, administration of antenatal corticosteriods and maternal diabetes were selected for the statistical model (2), can’t be calculated for the low incidence. *Statistically significant.

Availability of data and materials

The data are included in the article and supplementary materials.