Delivery room management and umbilical blood gas analysis: multiple vs. single birth

Introduction: Birth is a complex process involving a series of physiological changes while the infant’s transition takes place from intrauterine to extrauterine life. Multiple births are associated with increased risks and often require additional support in the delivery room leading to a higher percentage of neonatal complications. Aim: To compare the need for special assistance and resuscitation procedures in the delivery room between multiple and single births and to investigate the correlation between umbilical cord blood gas analysis and these interventions. Method: We conducted a retrospective review of the medical records of neonates born between January 2019 and May 2021 at the Emergency County Hospital, Targu Mures who required intensive care. Exclusion criteria included newborns transferred from other facilities, lack of umbilical cord blood gas analysis and missing parental consent. Patients were divided into two groups based on multiple or single births. We analyzed maternal, fetal and perinatal factors as well as delivery room management and umbilical cord blood gas. Perinatal risk factors in vitro fertilization, premature birth, low birth weight, maternal anemia and maternal coagulopathy were significantly higher in the multiple birth group. Results: Of the 107 neonates 56% were from multiple gestations and 43% from single pregnancies. The mean gestational age was 35.6 ± 3.7 weeks and the mean birth weight was 2682 ± 908.1 g. No statistically significant differences were found between the two groups regarding the overall need for additional assistance in the delivery room or any of the steps of resuscitation (p=2.99). The only parameter from the blood gas analysis that showed a weak association with the multiple birth group was the pH value (p=0.057). Discussion/Conclusions: Although neonates from multiple pregnancies are at a higher risk for premature birth and lower birth weight, our study found that they did not require more advanced assistance in the delivery room compared to those of single births. Lower Apgar scores at 1 minute and 5 minutes were associated with multiple births. Short term outcomes and duration of hospitalization were similar between the groups.