Maternal and Neonatal Outcomes after Delayed-Interval Delivery of Multifetal Pregnancies Ashley S. Roman, M.D., M.P.H., 1 Shira Fishman, M.D., 1 Nathan Fox, M.D., 1 Chad Klauser, M.D., 1 Daniel Saltzman, M.D., 1 and Andrei Rebarber, M.D. 1 ABSTRACT The objective of this study is to evaluate neonatal and maternal outcomes of multiple gestations undergoing delayed-interval delivery at a single institution. A 10-year retrospective review of medical records of patients followed by a Maternal-Fetal Medicine practice in a university-based setting was performed. Patients met criteria for inclusion if a single fetus was delivered spontaneously between 16 and 28 weeks of gestation and a planned attempt was made to prolong the gestation for the remaining fetus(es). Nineteen pregnancies met criteria for inclusion. The median gestational age at delivery of the first fetus was 20 2 / 7 weeks and the last fetus was 25 1 / 7 weeks. The median latency was 16 days (range 0 to 152 days). Three patients (15.8%) delivered within 24 hours. There was a 15.8% survival rate for the firstborn fetus and a 53.8% survival rate for all retained fetuses (p ¼ 0.01). There was a 31.6% incidence of serious maternal morbidity related to the procedure. One patient required a postpartum hysterectomy due to massive hemorrhage and uterine atony. Delayed-interval delivery is associated with a higher neonatal survival rate when retained fetuses are compared with firstborn fetuses. However, the procedure is associated with a significant risk of serious maternal morbidity. KEYWORDS: Multifetal pregnancy, delayed-interval delivery, neonatal morbidity, maternal morbidity In recent years, the incidence of multiple births has increased dramatically. From 1980 to 1999, the rate of multiple births increased by 59%; moreover, the rate of higher-order births increased by 413%. 1 It is well established that multifetal gestations have an increased rate of perinatal morbidity and mortality and are respon- sible for a disproportionate number of preterm births. 2–4 Although medical complications contribute to the high preterm delivery rate in multiple gestations, the vast majority of preterm deliveries are due to idiopathic preterm labor and preterm premature rupture of mem- branes. In the past, delivery of the first or presenting fetus has inevitably led to delivery of the other fetus(es). At early gestational ages, however, each additional day in utero can contribute dramatic increases in perinatal survival. 5 Over the past 15 years, delayed-interval deliv- ery has been reported as a management strategy after the spontaneous preterm birth of one fetus in a multifetal gestation to optimize survival and minimize morbidity of 1 Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York. Address for correspondence and reprint requests: Ashley S. Roman, M.D., M.P.H., 70 East 90th Street, New York, NY 10128 (e-mail: ashley.roman@nyumc.org). Am J Perinatol 2011;28:91–96. Copyright # 2011 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662. Received: December 9, 2009. Accepted after revision: May 4, 2010. Published online: July 6, 2010. DOI: http://dx.doi.org/10.1055/s-0030-1262513. ISSN 0735-1631. 91 Downloaded by: NYU. Copyrighted material.