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Chapter 23 - Timing of Delivery in Multiple Pregnancy

Published online by Cambridge University Press:  11 October 2022

Leanne Bricker
Affiliation:
Corniche Hospital, Abu Dhabi
Julian N. Robinson
Affiliation:
Brigham & Women's Hospital, Boston
Baskaran Thilaganathan
Affiliation:
St George's Hospital Medical School, University of London
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Summary

Multiple pregnancies are at higher risk of stillbirth, spontaneous or elective preterm delivery and neonatal death. These risks vary with gestation and are further increased for monochorionic pregnancies, and therefore accurate assessment of both gestational age and chorionicity is mandatory to plan further delivery. The risk of stillbirth per ongoing pregnancies increases with advancing gestational age, whereas the risk of neonatal death per livebirth decreases. The optimal timing of birth in uncomplicated multiple pregnancies is not well established and recommendations for timing of birth vary between institutions and countries. The latest evidence supports scheduled birth at 37 weeks for dichorionic diamniotic twins, at 36 weeks for monochorionic diamniotic, at 32-34 weeks for monochorionic monoamniotic twins, at 35 weeks for trichorionic triamniotic and dichorionic triamniotic triplets. For monochorionic triplets and higher order multiples there is no evidence to guide recommendations, but it seems reasonable to aim for delivery after 32 weeks gestation if possible.This chapter discusses timing of birth in uncomplicated multiple pregnancies, namely pregnancies without evidence of fetal anomaly, fetal growth discordance, preeclampsia or complications related to monochorionicity such as twin-to-twin transfusion syndrome. The management of the latter are reviewed in the corresponding individual chapters covering such pregnancy complications.

Type
Chapter
Information
Management of Multiple Pregnancies
A Practical Guide
, pp. 241 - 248
Publisher: Cambridge University Press
Print publication year: 2022

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References

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