Controversial issues in the management of multiple pregnancies

The management of multiple pregnancies represents a true challenge for all sub-specialties concerned with perinatal medicine. Many issues were neglected over the years merely because they were rare and therefore considered not sufficiently important to merit clinical trials. This paper discusses a personal selection of controversial issues, such as multifetal pregnancy reduction of triplets and twins, special cases in multifetal pregnancy reduction, need for invasive genetic studies, management of twin-twin transfusion, discordant fetal conditions, the definition of "term" in multiples, and the controversy about the mode of delivery.