What is a delayed twin birth? In what cases can it take place? What are the risks for babies and mothers? Lighting with the gynecologist-obstetrician Adrien Gaudineau.
Sometimes twins are born at a spaced interval, sometimes a few hours. But this situation is rather rare. “A delayed twin birth can only take place in the context of a dizygotic twin pregnancythat is to say that there are two babies (fraternal twins), each in their pocket having their own placenta”explains obstetrician-gynecologist Adrien Gaudineau, also co-author of “More than 100 questions: Pregnancy and childbirth” (MA Publications).
What is a delayed twin birth?
“Usually, this type of delayed delivery occurs when labor begins anda first baby is born then the cervix retracts after his passage and the contractions stop”, he says. He further explains that “twin pregnancies resulting in greater risk of prematurity, the work is therefore likely to start before the end. And full dilation of the cervix (10 centimeters), is not necessarily necessary to allow the premature – and therefore smaller – baby to pass. The cervix has thus easier to retract afterwards”. What about the time elapsed between the two births? “most of the time, the delivery is only postponed by a few hours“, he says. In addition, he recalls: “Delayed twin birth is a very rare situation.”
How to keep the second baby in place?
If the first baby was born prematurely (with the effects of prematurity), “Allowing the second to stay a little longer will allow you to be able to put in place preventive prophylactic measures in order to limit the excessive effects of prematurity“, explains Adrien Gaudineau. To do this, we carry out corticosteroid injections. For the corticosteroids to take effect, it takes at least 12 hours before the second delivery takes place (and for a maximum of 48 hours). A delay that allows the second baby to enjoy the benefit of corticosteroid therapy. “We can consider childbirth which will resume in the hours or the days to come in a more favorable way”, notes the gynecologist. “It has been described in the literature of cases of delayed twin births several weeks, but it is extremely rare, because the risk at the infectious level is necessarily more and more important as the hours go by”, he reports. In effect, once the first baby was born, the cervix opened up, allowing bacteria to enter vaginally and ascending the birth canal. There is then a risk that the pocket of the second baby will be infected. On the other hand, in case of delayed twin birth, the first placenta is still inside, the bacteria can also go to infect it, because it is a food source for the development of bacteria.
What are the risks for the first baby?
In the case of a delayed twin birth, the first baby born will not have been able to benefit from the treatment based on corticosteroids, because the birth will have occurred too quickly. He may therefore be born more fragile than his twin brother or twin sister, or even in some cases not survive. “The chances of survival are sometimes lower for the first baby, born prematurely, than for the second in the event of a delayed twin birth.“reveals Dr. Gaudineau. “It also happens that one of the babies is not viable in utero or that he suffers from a particularly serious and incurable pathology, requiring the termination of the pregnancy selectively on one of the twins”, says the obstetrician. However, the baby will also remain inside until delivery takes place. “Sometimes also, it happens spontaneously, that is to say that we have an initial twin pregnancy, then finally one of the embryos does not evolve and disintegrates spontaneously little by little”he reports.
Is cerclage systematic in the case of a delayed twin birth?
“Strapping is not systematic“, assures Dr. Gaudineau. It’s about a surgical technique to hold the pregnancy in place after the birth of one of the twins. This consists of passing a thread around the collar by stitching inside the collar so as to close artificially. “We can do it when we are in such an extreme prematurity that letting nature take its course would probably lead to the loss of the two babies”, he describes. However, “we can only proceed with a cerclage if the cervix has retracted sufficiently and there are no obvious signs of infection”, he ponders. There are also two problems with this approach according to him: first, the technicality of the gesture is not at all obvious, especially after the delivery of the first baby, having made the structures particularly fragile (risk of bleeding, etc. ). And then, passing a needle through the cervix can pierce the pocket of the second, generating an infectious risk requiring the birth of the baby without delay.
Does the second baby have sequelae?
“This delayed delivery is sometimes beneficial”, remarks the obstetrician-gynecologist: “we can wish it in situations of great prematurity, because the second baby would benefit from corticosteroid therapy“. Nevertheless, he qualifies, “it is often difficult to maintain the delayed delivery, because when the process is launched, stopping the labor and the contractions of the second baby is not obvious”. However, “when the great prematurity is over, the second baby is more likely to go worse than the first at birth. Precisely because he is stayed longer in the womb, suffered contractions and childbirth of the first baby. Moreover, the second babies are frequently a little more sleepy at delivery”, he notes. He also reassures about the follow-up carried out during a delayed delivery: monitoring is carried out to check that the baby is supporting well and that there are no signs of infection which could result in tachycardia in the baby’s heart.
What are the risks for the mother of a second childbirth so close?
For Dr. Gaudineau, “a twin birth is already a double birth. The fact that it is postponed for a few hours does not therefore pose any greater risk for the mother”. According to him, the only real risk is the risk of infection. Or that the placenta detaches despite attempts to hold the second baby, and results in the detachment of the second placenta. “The onset of heavy bleeding can warn of a possible detachment and, at that time, it will be necessary to bring forward the delivery of the second”, he indicates. As for the treatment of corticosteroids injected into the mother, it reassures: it has no negative repercussions on the health of the mother.