Fetal Surveillance and Timing of Delivery for Multiples

Abstract

This chapter describes the current evidence and recommendations for surveillance and delivery timing for multifetal gestations. Ultrasound surveillance should include early determination of chorionicity, anatomic survey for all twins with fetal echocardiography for monochorionic twins, and growth assessment every 4 weeks. Monochorionic twins should also undergo ultrasound surveillance for twin-twin transfusion syndrome every 2 weeks starting at 16 weeks. Weekly testing with nonstress tests or biophysical profiles is recommended at 32 weeks for monochorionic, diamniotic twins, and 34 weeks for dichorionic twins. If this surveillance is reassuring, optimal delivery timing is 36 weeks 0 days to 37 weeks 0 days for monochorionic, diamniotic twins, and 37 week 0 days to 38 weeks 0 days for dichorionic twins.

Optimal Timing of Delivery Based on the Risk of Stillbirth and Infant Death Associated with Each Additional Week of Expectant Management in Multiple Pregnancies: a National Cohort Study of Koreans

“…Recent studies suggest that delivery should be considered at 37 weeks of gestation in uncomplicated dichorionic twin pregnancies to minimize the risk of perinatal death. 15 16 17 …”

Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: Our 15-Year Experience in a Tertiary-Level Center

“…While we have described that a substantial proportion of obstetric and fetal complications that may require the early termination of pregnancy, it is presently recommended to electively terminate triplet pregnancies around 35–36 weeks. This widely accepted recommendation [ 65 ], originating from the study conducted by Khan et al in 2003 [ 66 ], in which they observed a higher occurrence of stillbirths compared to neonatal deaths beyond weeks 35–36 [ 67 ].…”