twin pregnancy delivery time

This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. There is a higher risk of pre-eclampsia, diabetes and post-partum complications, as uterine atony and postpartum hemorrhage.

When the second twin is in a non-cephalic presentation, vaginal delivery is controversial. When using 33 formulas to assess the accuracy of estimation weight by two-dimensional ultrasonography, 25 of these formulas present a weight variation of less than 10% for single pregnancies, but only 3 of these formulas present the same result for twin pregnancies [27].

Access research and information about twin gestation and delivery. Another controversial subject about delivery in twins is the time interval between fetuses in vaginal delivery. We are happy to respond to general questions about twin pregnancies. A woman carrying Di-Di or Mo-Di twins is a good candidate for a vaginal birth if: If your patient had a prior cesarean section, she may still be a good candidate for delivering twins vaginally. This is mainly due to prematurity, complications close to delivery, and placental insufficiency [1]. In some cases, complications after the vaginal delivery of the first twin might require a C-section delivery for the second twin. A twin gestation in and of itself does not necessitate a cesarean delivery. For more information about these cookies and the data The twin birth study did not found statistically significant difference in morbidity and fetal or neonatal mortality between planned cesarean or planned vaginal delivery [14, 53], and a 2-year follow up after delivery found no difference in neurodevelopment and death in both groups [61]. Some studies say that neonatal morbidity is higher for the second twin in those cases and an elective cesarean section should be planned [16, 17]. A large Dutch cohort with 1407 multiple pregnancies showed that after 32 weeks’ gestation, mortality was 11.6% in MC and 5% in dichorionic (DC) [5].

The risk of uterine death was significantly higher in MC than in DC (hazard ratio 8.8, 95% CI 2.7–28.9), and in most cases no change in fetal status was observed. However, others delegate delivery at 32 weeks of gestation [10]. Several techniques and interventions are described but the evidence is not strong, but the main goal is to provide a better outcome for the second twin, and success rates of these particular cases are good according to a systematic review of 2016 [52]. Among the difficulties in twin birth, we highlight: prematurity, non-cephalic presentations, dystocia, funicular prolapse, placental abruption, increased operative incidence, postpartum hemorrhages, perinatal anoxia and tocotraumatism [2]. It’s based on principles of collaboration, unobstructed discovery, and, most importantly, scientific progression. Licensee IntechOpen. *. Therefore, a vaginal delivery is a safe option. There is still a lot of divergence between medical societies for the correct time of delivery. For twins, vaginal delivery is often possible if the first baby is in a head-down position. Depending on complications such as fetal growth restriction, termination of pregnancy is recommended before 38 weeks. Learn more about our Safe Care Commitment. Women’s parity is also a condition with high influence in mode of delivery in a twin pregnancy, as nulliparous usually result in less success when attempting a vaginal delivery [13]. The presentation of twin pairs in a term twin pregnancy is 40% of the times cephalic/cephalic, 35–40% cephalic/non-cephalic and only 20% with the first twin non-cephalic [15]. In this chapter we will review the main aspects related to the time and mode of delivery in multiple pregnancies and issues related to fetal weight assessment. On the other hand, patients with two or more previous cesarean sections should not attempt a vaginal delivery due to higher risk of uterine rupture. The maternal-fetal medicine specialists at Brigham and Women’s Hospital (BWH) compiled the following labor and delivery guidelines for a twin pregnancy. Cesarean delivery can expose mothers to short-term risks such as endometritis, wound complications, surgical injuries, hemorrhage [55], although maternal outcomes past 3 month and long-term risks, including abnormal placentation, are similar both ways cesarean an vaginal planned delivery [56, 57]. For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery. Multiple pregnancies have high rates of mortality and morbidity when compared to single pregnancies. In those cases, the surgery should be planned to the appropriate gestational age, considering chorionicity and amnionicity.

New guidelines such as the American College of Obstetricians and Gynecologists do not recommend an upper limit to the time interval between fetuses, if the fetal heart rate is reassuring, as some studies also suggests [44, 45, 46, 47]. A twin gestation in and of itself does not necessitate a cesarean delivery. You can send a question via email or call us directly. On the other hand, in monoamniotic pregnancies, most specialized centers in the world recommend delivery between 32 and 34 weeks. collected, please refer to our Privacy Policy. This risk was higher between 34 and 37 weeks of gestation in triplet pregnancies. Below are recommendations regarding the optimum time for admission and delivery for an uncomplicated twin pregnancy. Login to your personal dashboard for more detailed statistics on your publications. When both fetuses are on cephalic presentation at delivery, the vaginal route is preferable regardless of weight. However, it is important to notice that the second twin change its presentation in about 20% of the time, after the first one is born [15]. Open Access is an initiative that aims to make scientific research freely available to all. A retrospective study with 1070 twin pregnancies attempted trial of labor between 2003 and 2015 showed that in planned cesarean, the first twin has a lower blood pH and base excess than in vaginal delivery, but the study was unpowered for neonatal outcome assessment [13]. Biometric measurement of these fetuses in the third trimester is greatly impaired due to the technical difficulty of examination. When comparing the weights of fetuses from twin pregnancies to those of single pregnancies, it is observed that fetuses of twin pregnancies have a lower weight than fetuses of single pregnancies, especially from the end of the second trimester.

The decision on either performing an elective cesarean delivery must consider the best neonatal and maternal outcomes, to reduce neonatal morbidity and mortality, maternal complications and preserving the women’s reproductive future. In those cases, regardless the fetal weight, a vaginal delivery can be attempted. The risk of child death after delivery gradually declined as pregnancies neared full term. Prematurity is present in approximately 55% of twin pregnancies, with adverse consequences even in short and long term [22]. In selected cases an EXIT procedure can be performed in order to stabilize the fetuses with cardiac union to examine and close the vessel communication safely [43]. However, both a systematic review and meta-analysis [14] and a recent published prospective cohort study [18] support that cesarean deliveries neither add neonatal morbidity nor mortality. The twin birth study, showed that planned cesarean section was not superior to planned vaginal delivery regarding maternal risk or neonatal mortality or morbidity [53], and ever since some society guidelines suggest attempt to vaginal delivery to diamniotic twin pregnancies if the first twin is in cephalic presentation [54]. However, vaginal delivery is possible if the fetus’ weight is above 1,500g.

In those cases, the second twin can either be delivered by breech extraction or an external cephalic version can be attempted. Accuracy in the estimation of fetal weight is of paramount importance for the proper follow-up of prenatal care and ultrasonography study has been the main tool for this evaluation. The time of delivery in twin pregnancies is around 38 weeks for dichorionic pairs, 36 weeks for monochorionic and 32 weeks for monoamniotic. This parameter is based on evaluation of 50% of bone diaphysis length (arm and thigh). When the first twin is in cephalic presentation and the second non-cephalic, cesarean section is indicated if the fetus weight is less than 1,500g. However, studies have shown that formulas using two-dimensional parameters can generate variations of up to 15% in relation to the real weight of the fetus [25]. How? Therefore, it is important to consider the fetal presentation and weight when deciding the delivery mode, regardless gestational age.

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