Delayed cord clamping and acute twin-to-twin transfusion syndrome in vaginally born monochorionic twins: a single-centre retrospective cohort study

Rondagh, M.; Steggerda, S.J.; Vos, M.S. de; Hooper, S.B.; Crossley, K.J.; Akker, T. van den; Vries, L.S. de; Groene, S.G.; Slaghekke, F.; Pas, A.B. te; Lopriore, E.

doi:doi:10.1136/archdischild-2025-329451

Objective To evaluate the prevalence of acute peripartum twin-to-twin transfusion syndrome (TTTS) in vaginally born monochorionic (MC) twin pregnancies, comparing early cord clamping (ECC) to delayed cord clamping (DCC). Design, setting and patients Single-centre retrospective cohort study including vaginally born MC twins at our institution between January 2020 and April 2025. Acute peripartum TTTS was defined as intertwin haemoglobin (Hb) difference >8 g/dL within 12 hours after birth, without signs of chronic TTTS or twin anaemia polycythaemia sequence. Twins were categorised to the ECC and DCC group if cord clamping occurred <= 60 s or >60 s after birth of the first twin, respectively. Results Thirty-five twin pregnancies were included (n=17 in the ECC group; n=18 in the DCC group). Acute peripartum TTTS occurred in 0% (0/17) in the ECC group compared with 17% (3/18) in the DCC group (p<0.01). In the ECC group, no cases of severe brain injury were observed, whereas 8% (3/36) of...Show moreObjective To evaluate the prevalence of acute peripartum twin-to-twin transfusion syndrome (TTTS) in vaginally born monochorionic (MC) twin pregnancies, comparing early cord clamping (ECC) to delayed cord clamping (DCC). Design, setting and patients Single-centre retrospective cohort study including vaginally born MC twins at our institution between January 2020 and April 2025. Acute peripartum TTTS was defined as intertwin haemoglobin (Hb) difference >8 g/dL within 12 hours after birth, without signs of chronic TTTS or twin anaemia polycythaemia sequence. Twins were categorised to the ECC and DCC group if cord clamping occurred <= 60 s or >60 s after birth of the first twin, respectively. Results Thirty-five twin pregnancies were included (n=17 in the ECC group; n=18 in the DCC group). Acute peripartum TTTS occurred in 0% (0/17) in the ECC group compared with 17% (3/18) in the DCC group (p<0.01). In the ECC group, no cases of severe brain injury were observed, whereas 8% (3/36) of infants in the DCC group, all with acute peripartum TTTS, showed severe brain injury (p<0.01). DCC time of the first born infant was associated with larger intertwin Hb difference (beta=0.01, p=0.04). Potential risk factors for acute TTTS included interval between birth and cord clamping of the first infant (OR 1.02, 95% CI 1.00 to 1.03, p<0.03) and total combined diameter of bidirectional placental anastomoses (OR 1.34, 95% CI 0.97 to 1.84, p=0.07). Conclusion DCC in MC twin pregnancies may be associated with a higher prevalence of acute peripartum TTTS and severe brain injury and is therefore not recommended.Show less

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Delayed cord clamping and acute twin-to-twin transfusion syndrome in vaginally born monochorionic twins: a single-centre retrospective cohort study