{
  "abstract": "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 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 (β=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.",
  "authors": [
    {
      "affiliations": [
        "Department of Pediatrics, Leiden University Medical Center, Leiden, ZH, The Netherlands"
      ],
      "name": "Mathies Rondagh"
    },
    {
      "affiliations": [
        "Leiden University Medical Center, Leiden, ZH, The Netherlands"
      ],
      "name": "Sylke J Steggerda"
    },
    {
      "affiliations": [
        "Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands"
      ],
      "name": "Marit S de Vos"
    },
    {
      "affiliations": [
        "The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia",
        "Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Stuart B Hooper"
    },
    {
      "affiliations": [
        "The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia",
        "Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Kelly J Crossley"
    },
    {
      "affiliations": [
        "Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands"
      ],
      "name": "Thomas van den Akker"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Leiden University Medical Center, Leiden, ZH, The Netherlands"
      ],
      "name": "L S de Vries"
    },
    {
      "affiliations": [
        "Neonatology, Leiden University Medical Center, Leiden, ZH, The Netherlands"
      ],
      "name": "Sophie G Groene"
    },
    {
      "affiliations": [
        "Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands"
      ],
      "name": "Femke Slaghekke"
    },
    {
      "affiliations": [
        "Neonatology, Leiden University Medical Center, Leiden, ZH, The Netherlands"
      ],
      "name": "Arjan B te Pas"
    },
    {
      "affiliations": [
        "Neonatology, Leiden University Medical Center, Leiden, ZH, The Netherlands"
      ],
      "name": "Enrico Lopriore"
    }
  ],
  "title": "Delayed cord clamping and acute twin-to-twin transfusion syndrome in vaginally born monochorionic twins: a single-centre retrospective cohort study",
  "uid": "f1eaa900-c772-5ce0-a873-4ed794f1dea6"
}