Twins with separate placentas would ideally be delivered after 37 weeks’ gestation, and those sharing a placenta delivered at 36 weeks, British experts say today.
The risk of stillbirth is higher in twin pregnancies than in singleton pregnancies, explain the researchers, led by Professor Shakila Thangaratinam at Queen Mary University of London, UK.
They write in today’s (7 September) BMJ that there is a 13-fold increase in rates of stillbirth in monochorionic twins <!sharing a placenta> and a five-fold increase in dichorionic twins <!separate placentas> compared with singleton pregnancies.
Twins are often delivered early in an attempt to prevent late stillbirth, but this is associated with neonatal complications.
The team explains that the global drive to prevent stillbirth has highlighted multiple pregnancy as a major risk factor. So they examined the risk at different gestational ages by reviewing 32 reliable published studies involving 29,685 dichorionic and 5,486 monochorionic pregnancies.
For dichorionic twin pregnancies beyond 34 weeks the risk of stillbirth versus the risk of neonatal death from premature delivery were balanced at 37 weeks’ gestation. "Delay in delivery by a week, to 38 weeks, led to an additional 8.8 perinatal deaths per 1,000 pregnancies," they report.
For monochorionic pregnancies, there was a trend towards an increase in stillbirths compared with neonatal deaths after 36 weeks. The team adds: "The actual risk of stillbirth near term might be higher than reported estimates because of the policy of planned delivery in twin pregnancies."
Professor Thangaratinam says: "Until now, we did not have clear recommendations on the best time to offer delivery to mothers with twin pregnancies. We hope that this research will be useful to national guideline and hospital policy makers."
Cheong-See, F. et al. Prospective risk of stillbirth and neonatal complications in twin pregnancies: A systematic review and meta-analysis. BMJ 7 September 2016 doi: 10.1136/bmj.i4353 [abstract]
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