Multiple pregnancy is associated with both maternal and fetal complications. While women with a twin pregnancy are more likely to give birth prematurely, approximately 46% will give birth after 37 weeks’ gestation. For women whose twin pregnancy continues beyond 37 weeks’ gestation, there is a higher risk of perinatal mortality and morbidity with advancing gestational age.
The Australian study looked at 235 women with an uncomplicated twin pregnancy at 36 weeks gestation. They were divided into women who planned an elective birth from 37 weeks (elective birth group) and women who planned birth from 38 weeks (standard care group).
In the elective birth group, where there was a plan for vaginal birth, this involved induction of labour and where there was a plan for a caesarean, this involved an elective caesarean section. In the standard care group, where there was a plan for vaginal birth, this involved either awaiting the spontaneous onset of labour, or induction of labour. Where there was a plan for a caesarean, this involved an elective caesarean section.
Serious adverse infant outcomes included fetal death, severe respiratory distress, low apgar score, seizures and systemic infection within 48 hours of birth.
Babies born in the elective birth group were at statistically significantly lower risk of serious adverse infant outcomes (4.7%) when compared with infants in the standard care group (12·2%), reflecting a reduction in birth weight less than the third centile using singleton gestational age-specific charts (elective birth group, 3·0%, versus standard care group, 10·1%).
The risk of serious adverse maternal outcomes did not differ significantly between women in the elective birth group (1.7%) and women in the standard care group (5.9%) found the researchers.
Furthermore, while women in the elective birth group were more likely to require induction of labour, this was not associated with a statistically significant difference in the woman’s chance of achieving a vaginal birth or of requiring a caesarean section.
Professor Jodie Dodd, Australian Research Centre for Health of Women and Babies (ARCH), Robinson Institute, The University of Adelaide, South Australia and co-author of the paper said:
“Induction of labour for women with an uncomplicated singleton pregnancy has been recommended at or beyond 41 weeks’ gestation as an intervention to reduce the risk of perinatal death. While the increase in perinatal mortality and morbidity seen in twin pregnancies beyond 37 weeks’ gestation parallels that seen in singleton pregnancies beyond 41 weeks’, the role of planned early term birth for women with a twin pregnancy remains unclear.
“The findings of our study support recommendations for women with an uncomplicated twin pregnancy to give birth at 37 weeks’ gestation.”
Mike Marsh, Deputy Editor-in-Chief of BJOG added:
“This paper supports current UK guidance concerning delivery of multiple pregnancy. It is known that continuing an uncomplicated twin pregnancy beyond 38 weeks increases the risks of adverse outcomes. It is important that the obstetrician caring for the mother discusses with her the timing and mode of delivery early in the third trimester.”
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Please include a link to the paper in online coverage: http://dx.doi.org/10.1111/j.1471-0528.2012.03356.x
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Dodd J, Crowther C, Haslam R, Robinson J. 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;119:964–974.