Latency interval of 3-123 days in one study: Spacing delivery of preterm twins may be helpful. (Obstetrics).

LAKE TAHOE, NEV. -- Preterm twins don't have to be born on the same day--or even in the same month.

That's the message from Dr. Gregory Lindsay, who has successfully delayed the delivery of a second twin for as long as 4 months after its sibling was born.

"There is no evidence indicating the need for delivery of the second twin, but unfortunately the second twin is often delivered because there are indications for delivering the presenting twin," said Dr. Lindsay, director of maternal-fetal medicine at Columbia Rose Medical Center, Denver.

There is very little in the literature evaluating the utility of delayed-interval delivery of multiple gestations, he said at an obstetrics and gynecology conference sponsored by University of California, Davis.

Dr. Lindsay's institution has attempted this approach with about 40 patients and has published the results in the first 24 patients (Am.J. Obstet. Gynecol. 183[6]:1499-503, 2000). They found a 26% neonatal survival rate for the first baby, a latency interval of 3-123 days (mean 36 days), and a 63% survival rate for the remaining baby or babies in the case of triplets.

"I think this is a reasonable thing to attempt, but it is very important to get informed consent from the patient. The patients have to understand what they are choosing. It's a choice between possibly losing both babies because of premature delivery or retaining the second baby in utero but possibly still delivering that baby early and risking serious physical and mental problems," said Dr. Lindsay, also of the University of Colorado in Denver.

Dr. Lindsay said that his center first got involved in delayed-interval deliveries when patients with multiple gestations presented in preterm labor and gave birth to the first baby but then the patients had an arrest of labor.