In particular, monochorionic and dichorionic pregnancies may be 13 times and 5 times more likely to end in stillbirth than your typical single pregnancy, respectively.
Advertisement
Professor Shakila Thangaratinam, of the Women’s Health Research Unit at QMUL’s Blizard Institute, said: “Until now, we did not have clear recommendations on the best time to offer delivery to mothers with twin pregnancies”.
Pregnancy normally lasts about 40 weeks, and babies born after 37 weeks are considered full term.
The risk of stillbirth is higher in twin pregnancies than in singleton pregnancies.
A new review finds that twins should be delivered at weeks 37 and 36 of pregnancy, depending on whether they share a placenta with their sibling.
For the new analysis, an global research team looked at 32 studies published in the past 10 years of women with uncomplicated twin pregnancies whose children died at birth or shortly thereafter.
The researchers looked specifically at the balance between the risk of stillbirths from expectant management (‘watchful waiting’) and the risk of neonatal death from delivery beyond 34 weeks.
In the largest review of its kind the researchers recommend that in the case of pregnancies without complications, women with dichorionic twins (twins with separate placenta) should be offered delivery after 37 weeks.
However, there is no worldwide consensus for when twins should be delivered.
“For women with dichorionic pregnancies, delivery should be considered at 37 weeks’ gestation to minimize the risk of perinatal deaths near term”, wrote the authors.
They analysed the results of 32 studies, published within the past 10 years, of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal mortality (defined as death up to 28 days after delivery) at various gestational ages after 34 weeks.
However, delaying delivery to 38 weeks gestation led to an additional 8.8 deaths per 1,000 due to an increase in stillbirths.
In monochorionic twin pregnancies, “there is no clear evidence to support routine delivery before 36 weeks’ gestation”, they say.
Twins or triplets hold a higher risk of stillbirth or neonatal death.
It’s too soon to tell whether the findings would influence when doctors choose to deliver twins, said Dr. Joseph Wax, a researcher at Tufts University School of Medicine in Boston and Maine Medical Center in Portland who chairs ACOG’s committee on obstetric practice.
“So often these babies will need to be delivered earlier because of complications.in growth or other pregnancy specific problems that come up”.
Advertisement
The guidelines recommend that delivery of dichorionic twins should take place after 37 weeks and after 36 weeks in the case of monochorionic twins. “It just lowers the chance of having a dead baby”.
