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Timing of Delivery in Multiple Gestation

Clinical Obstetrics and Gynecology, ISSN: 0009-9201, Vol: 47, Issue: 1, Page: 237-247
2004
  • 5
    Citations
  • 0
    Usage
  • 19
    Captures
  • 0
    Mentions
  • 0
    Social Media
Metric Options:   Counts1 Year3 Year

Metrics Details

  • Citations
    5
    • Citation Indexes
      5
  • Captures
    19

Conference Paper Description

The management of twins at term involves balancing the risk of prematurity with the risk of untoward and catastrophic perinatal loss. This equilibrium is even more significant in triplets and higher-order multiples. Unfortunately, there is little evidence from good randomized studies to guide treatment. However, from the available evidence, several conclusions can be made. The optimal time for delivery of well grown twins is between 37 and 38 weeks. Pregnancy that progresses beyond 38 weeks should be conceptually considered as being similar to a postdates singleton pregnancy and delivery should be undertaken by 39 weeks. In triplet pregnancies, the nadir in perinatal complications is at 34 and 35 weeks. Accordingly, delivery of patients with triplets should be considered in those pregnancies that achieve 35 weeks. Triplets should be considered postterm at 36 weeks and delivery of triplets should occur by 37 weeks. Prolongation beyond those limits of pregnancy requires good evidence of appropriate fetal growth and amniotic fluid volume, normal umbilical artery Doppler studies, unequivocally reassuring fetal testing of all infants, and an absence of any adverse maternal conditions such as preeclampsia, PIH, cholestatic jaundice, PUPPP, or unexplained vaginal bleeding. Confirmation of fetal lung maturity might be reassuring in some cases; such as those with complicated by overt or gestational diabetes, but in our opinion is unnecessary with otherwise uncomplicated twin or triplet gestations at the limits of pregnancy described above.

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