Twin pregnancies carry a greater risk of suboptimal infant outcomes compared with singleton pregnancies. The reason for the increase in complications can be attributed to maternal factors resulting in spontaneous or iatrogenic preterm delivery, or fetal factors such as growth restriction, vascular complexities, or labor-associated events. There may also be risks associated with prolonged gestations, which could be chronologically earlier than for singletons, with 38 weeks in twins being considered the equivalent of 41 weeks in singletons.
About half of twin pregnancies reach 37 weeks of gestation without an indication to intervene, but it is unknown whether that is the time to electively deliver them or allow the pregnancy to continue. To answer the question, a group from Australia randomized over 200 uncomplicated twin pregnancies to delivery or standard care.1 If allocated to delivery, induction of labor or elective cesarean delivery was decided upon by the woman and her obstetrician as close to 37 weeks as possible. If allocated to standard care, the woman and her obstetrician followed “usual practice,” which transpired to be delivery at a mean gestational age of 38 weeks.
Despite a difference in somewhat less than 1 week of gestation, those delivered electively at 37 weeks had fewer serious adverse outcomes for the infant compared with those delivered by standard care protocols. There were also fewer growth-restricted neonates in the intervention group without an increase in the complications of prematurity. The authors conclude that their data support the National Institute for Health and Clinical Excellence multiple pregnancy guidelines2 for uncomplicated twin pregnancies to be delivered at 37 weeks, so this management looks set to become accepted practice in the future.
References
- 1.Dodd JM, Crowther CA, Haslam RR, Robinson JS. Twins Timing of Birth Trial Group. Elective birth at 37 weeks of gestation versus standard care for women with an uncomplicated twin pregnancy at term: the Twins Timing of Birth Randomised Trial. BJOG. 2012;119:964–973. doi: 10.1111/j.1471-0528.2012.03356.x. [DOI] [PubMed] [Google Scholar]
- 2.Multiple Pregnancy. The Management of Twin and Triplet Pregnancies in the Antenatal Period. NICE Clinical Guidelines, No. 129. London: RCOG Press; 2011. [PubMed] [Google Scholar]