Optimal gestational age for delivery in uncomplicated dichorionic twin pregnancies: a population-based study

Abstract

The Maltese islands have seen an increase in multiple pregnancy rate in the past century, from 1.04% in 1900-1969 to 1.4% as reported in the 2014 National Obstetric Information report. This increase has been an effect of social customs such as delayed childbearing and the ever-increasing use of assisted reproductive treatments. Twin neonates have been shown to have a higher risk of prematurity, low birth weight, respiratory morbidity and higher mortality rates when compared to their singleton counterparts. Appropriate timing for delivery of twin pregnancies is a matter of acknowledging the dynamic balance that exists between in-utero foetal stillbirth risk and ex-utero neonatal risk. Such a consideration should drive the empowerment of both obstetricians and parents towards more informed decision-making when balancing the risks and benefits of discretionary delivery. This study undertakes a retrospective analysis of gestational age-specific neonatal outcome in 254 uncomplicated dichorionic twin pregnancies. Our data suggests that in the absence of complications, dichorionic twin neonates continue to benefit from advancing gestation with no consequence on foetal or neonatal mortality. Elective delivery should be delayed up until at least 38 weeks (38+°-38+6) in uncomplicated dichorionic twin pregnancies as this is associated with a significant reduction in the proportion of infants with LBW, RDS, TTN, hypoglycaemia or requiring NPICU care. Keywords: Twin pregnancy. Delivery. Gestational age. Neonatal outcome.