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Deliver twins at 37 weeks to give them the best chance

Twins should be delivered at 37 weeks to minimise stillbirths and newborn deaths, say experts who analysed more than 35,000 twin pregnancies.
Twins should be delivered at 37 weeks to minimise stillbirths and newborn deaths

Twins should be delivered at 37 weeks to minimise stillbirths and newborn deaths, say experts who analysed more than 35,000 twin pregnancies.

Current recommendations on delivery timing vary from 34 to 37 weeks in monochorionic twin pregnancies (twins that share the same placenta) and from 37 to 39 weeks for dichorionic twins (individual placentas).

To examine the evidence behind these recommendations, a team of international researchers analysed the results of 32 studies published in the last decade, of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal mortality at various gestational ages after 34 weeks.

They found that in dichorionic pregnancies, the risk of death was balanced until 37 weeks gestation, but delay in delivery by a week beyond that led to

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Twins should be delivered at 37 weeks to minimise stillbirths and newborn deaths, say experts who analysed more than 35,000 twin pregnancies. 

Twins should be delivered at 37 weeks to minimise stillbirths and newborn deaths
Research suggests that for women with dichorionic twin pregnancies, 
delivery should be considered at 37 weeks. Photo: IStock

Current recommendations on delivery timing vary from 34 to 37 weeks in monochorionic twin pregnancies (twins that share the same placenta) and from 37 to 39 weeks for dichorionic twins (individual placentas).

To examine the evidence behind these recommendations, a team of international researchers analysed the results of 32 studies published in the last decade, of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal mortality at various gestational ages after 34 weeks. 

They found that in dichorionic pregnancies, the risk of death was balanced until 37 weeks’ gestation, but delay in delivery by a week beyond that led to an additional 8.8 deaths per 1,000, due to an increase in stillbirth.

In monochorionic pregnancies, the risk of stillbirth appears to be higher than neonatal death beyond 36 weeks’ gestation, but the researchers said more evidence is needed before a clear recommendation can be made on the best time to deliver monochorionic pregnancies. 

Based on the figures, the researchers suggest that delivery should be considered at 37 weeks for women with dichorionic twin pregnancies, 'to prevent the significant increase in stillbirths associated with expectant management compared with the risk of neonatal deaths associated with early delivery’. 

In monochorionic twin pregnancies there is no clear evidence to support routine delivery before 36 weeks, they said. 


Cheong-See F et al (2016) Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. doi: 10.1136/bmj.i4353

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