Should apparently uncomplicated monochorionic twins be delivered electively at 32 weeks?

Area of Science:

• Perinatology
• Maternal-Fetal Medicine
• Twin Gestation Research

Background:

• Monochorionic diamniotic twins face higher risks than dichorionic twins.
• Optimal timing for delivery in uncomplicated monochorionic diamniotic twins remains debated.
• Understanding fetal death risk is crucial for management decisions.

Purpose of the Study:

• To estimate the optimal delivery time for uncomplicated monochorionic diamniotic twin pregnancies.
• To investigate the residual risk of fetal death after viability in these pregnancies.

Main Methods:

• Retrospective review of 576 multiple pregnancies (1996-2007).
• Selection of 111 uncomplicated monochorionic and 290 dichorionic diamniotic twin pregnancies delivered after 24 weeks.
• Calculation of prospective risk of fetal death in two-week intervals from 24 weeks' gestation.

Main Results:

• The rate of unexpected single intrauterine deaths was 2.7% for monochorionic and 2.8% for dichorionic diamniotic pregnancies.
• The prospective risk of unexpected stillbirth after 32 weeks was 1.3% for monochorionic and 0.8% for dichorionic pregnancies.

Conclusions:

• The prospective risk of fetal death in uncomplicated monochorionic diamniotic twins after 32 weeks is lower than previously reported.
• This risk is similar to that observed in dichorionic twin pregnancies.
• The findings do not support the routine practice of elective preterm delivery for these specific twin pregnancies.