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Effect of inter-twin delivery time on Apgar scores of the second twin


Correspondence: Dr Evrim Erdemoglu, Kirkpinar sok 12/4 Cinnah Cad, 06690, Ankara, Turkey. Email:


Objective: The aim of the present study was to analyse the effect of inter-twin delivery time on the Apgar scores of the second twin.

Material: Women attempting vaginal delivery of second twins were studied in 2000. Deliveries before 25 weeks’ gestation, complicated pregnancies, operative deliveries, and deliveries by regional or general anaesthesia were all excluded.

Results: A total of 37 out of 126 twin pregnancies had the criteria to be included in the present study. The major factor identified to influence Apgar scores was gestational age (P < 0.01). There was a linear relationship between delivery interval and the Apgar scores of the second twin, and the addition of delivery interval significantly improved the predictivity of gestational age. There was no influence of presentation and delivery mode of the second twin. Interval was found to be the only significant predictive factor of the Apgar scores in second twins of >1900 g and where the second twin is in a breech presentation. Caesarean section did not improve the outcome of the second twins.

Conclusion: Gestational age is the most important factor influencing the Apgar scores of second twins. The addition of delivery interval improves the predictivity of second twin Apgar score by gestational age. Inter-twin delivery time of >15 min is particularly important in the second twin which presents by the breech method and in the second twin of more than 1900 g.