Lianne Verbeek1, Depeng P Zhao1, Johanna M Middeldorp2, Dick Oepkes2, Stuart B Hooper3,4, Arjan B Te Pas1, Enrico Lopriore1. 1. Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. 2. Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands. 3. Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia. 4. Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Abstract
OBJECTIVE: Our objective was to study the differences in haemoglobin (Hb) at birth in dichorionic (DC) versus monochorionic (MC) twins in relation to birth order and mode of delivery. METHODS: All consecutive DC twin pregnancies and uncomplicated MC twin pregnancies with two live-born twins delivered at our centre were included in this retrospective cohort study. Hb levels at birth and on day 2 were evaluated in association with birth order and mode of delivery. The occurrence of polycythaemia (venous haematocrit >65%) was also recorded. RESULTS: A total of 300 DC and 290 MC twin pairs were included. In DC and MC twins delivered vaginally, second-born twins had a higher Hb level at birth compared with their co-twin (mean Hb level 16.7 vs 15.9 g/dL (p<0.01) in DC twins and 17.8 vs 16.1 g/dL (p<0.01) in MC twins). In twins delivered through caesarean section, no intertwin differences in Hb levels were detected. Polycythaemia occurred significantly more often in second-born twins compared with first-born twins delivered vaginally: 10 (5%) vs 2 (1%) (p=0.02) in DC twins and 20 (12%) vs 2 (1%) (p<0.01) in MC twins. CONCLUSIONS: Second-born DC and MC twins delivered vaginally have higher Hb levels at birth compared with first-born twins. Intertwin Hb differences in MC twins may partly be related to blood transfusion through the vascular anastomoses. Since DC twins do not have anastomoses, other factors may lead to Hb differences, including differences in timing of umbilical cord clamping. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: Our objective was to study the differences in haemoglobin (Hb) at birth in dichorionic (DC) versus monochorionic (MC) twins in relation to birth order and mode of delivery. METHODS: All consecutive DC twin pregnancies and uncomplicated MC twin pregnancies with two live-born twins delivered at our centre were included in this retrospective cohort study. Hb levels at birth and on day 2 were evaluated in association with birth order and mode of delivery. The occurrence of polycythaemia (venous haematocrit >65%) was also recorded. RESULTS: A total of 300 DC and 290 MC twin pairs were included. In DC and MC twins delivered vaginally, second-born twins had a higher Hb level at birth compared with their co-twin (mean Hb level 16.7 vs 15.9 g/dL (p<0.01) in DC twins and 17.8 vs 16.1 g/dL (p<0.01) in MC twins). In twins delivered through caesarean section, no intertwin differences in Hb levels were detected. Polycythaemia occurred significantly more often in second-born twins compared with first-born twins delivered vaginally: 10 (5%) vs 2 (1%) (p=0.02) in DC twins and 20 (12%) vs 2 (1%) (p<0.01) in MC twins. CONCLUSIONS: Second-born DC and MC twins delivered vaginally have higher Hb levels at birth compared with first-born twins. Intertwin Hb differences in MC twins may partly be related to blood transfusion through the vascular anastomoses. Since DC twins do not have anastomoses, other factors may lead to Hb differences, including differences in timing of umbilical cord clamping. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Douglas A Blank; Graeme R Polglase; Martin Kluckow; Andrew William Gill; Kelly J Crossley; Alison Moxham; Karyn Rodgers; Valerie Zahra; Ishmael Inocencio; Fiona Stenning; Domeic A LaRosa; Peter G Davis; Stuart B Hooper Journal: Arch Dis Child Fetal Neonatal Ed Date: 2017-12-05 Impact factor: 5.747
Authors: Katarzyna Kosińska-Kaczyńska; Jacek Witwicki; Aleksandra Saletra-Bielińska; Paweł Krajewski; Adam Krysiak; Robert Brawura-Biskupski-Samaha; Izabela Walasik; Magdalena Zgliczyńska; Ewa Malicka; Iwona Szymusik Journal: BMC Pregnancy Childbirth Date: 2022-08-05 Impact factor: 3.105