Twins Should Be Delivered At 37 Weeks To Minimise Stillbirth And Newborn Deaths, Suggests Study

Twins should be delivered at 37 weeks to minimise stillbirths and newborn deaths, a large international study in The British Medical Journal (BMJ) has found.

The risk of stillbirth is higher in twin pregnancies than in singleton pregnancies. Uncomplicated twin pregnancies are often delivered early in an attempt to prevent stillbirth.

The Royal College of Obstetricians and Gynaecologists (RCOG) suggests that in dichorionic (DC) twin pregnancies (twins that have two individual placentas), delivery should be planned at 37 to 38 weeks. In monochorionic (MC) twin pregnancies (twins that share the same placenta), delivery should be planned at 36 to 37 weeks.

The researchers found that, in DC pregnancies, the risk of stillbirth and neonatal mortality (death during first 28 days of life) were “balanced” until 37 weeks’ gestation.

However, delay in delivery by a week (to 38 weeks) led to an additional 8.8 deaths per 1,000 due to an increase in stillbirth.

A team of researchers analysed the results of 32 studies, published within the past 10 years, that reported rates of stillbirth and neonatal mortality after 34 weeks for mothers with uncomplicated twin pregnancies.

The studies included 35,171 twin pregnancies (29,685 DC pregnancies and 5,486 MC pregnancies).

In MC pregnancies, the risk of stillbirth was higher than neonatal death after 36 weeks’ gestation. But the researchers stated more data is needed to make a clear recommendation on best time to deliver twins in MC pregnancies.

The authors also pointed out that the actual risk of stillbirth near term for twin pregnancies “might be higher than reported estimates because of the policy of planned delivery in twin pregnancies”.

But, they said: “Our study provides comprehensive estimates comparing risks of stillbirth and neonatal mortality at various gestational ages, which is required for the planning of delivery in uncomplicated twin pregnancies.

“This information will complement the ongoing national and international efforts to reduce the rates of stillbirths and unexpected neonatal complications in babies born near term.”