Allison Bryant, MD, MPH reviewing Cheong-See F et al. BMJ 2016 Sep 06.

Excess risk for stillbirth in twin pregnancies commonly underlies the recommendation to deliver before the due date, even in the absence of complications — still, the gestational ages at which risks for stillbirth and neonatal complications are minimized have not been determined. In a meta-analysis of global data from 32 cohort studies, researchers evaluated week-by-week risks for fetal death in undelivered twin pregnancies and neonatal death in those delivered after 34 weeks.

Among dichorionic twins, risks for fetal and neonatal death were similar at 37 weeks' gestation (3.4 stillbirths/1000 pregnancies and 2.2 neonatal births/1000 pregnancies); in subsequent weeks, risk for stillbirth (10.6/1000) dwarfed risk for neonatal death (1.5/1000). Among monochorionic twins, differences in prospective risk for stillbirth versus neonatal death did not reach statistical significance for any given week, although risk for stillbirth was higher than risk for neonatal death beyond 36 weeks.

CITATION(S):

Cheong-See F et al. Prospective risk of stillbirth and neonatal complications in twin pregnancies: Systematic review and meta-analysis. BMJ 2016 Sep 06; 354:i4353. 

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