Diagnosis and treatment of twin pregnancy

Maternal recognition of twin pregnancy

In a retrospective survey of 336 mothers of recently born multiples, 71% reported suspicions of twin pregnancy prior to medical confirmation. Primiparous and multiparous reports of symptoms may be utilized to significantly increase the early diagnosis of the presence of multiples.

Ultrasound evaluation of polyhydramnios and twin pregnancy

We analyzed the ultrasound examinations and medical records of 75 pairs of twins who were delivered between January, 1983, and December, 1984, to study the relationship between increased amniotic fluid volume, fetal abnormalities, and preterm labor. Ten of these 75 twin pregnancies demonstrated elevated amniotic fluid volume that persisted throughout pregnancy. Total intrauterine volumes were elevated in these cases, and nine of the ten pregnancies were abnormal. In addition, it was noted that elevation of the amniotic fluid volume alone did not explain the high rate of preterm labor and delivery in twin gestations.

Cesarean delivery of the second twin after vaginal delivery of the first twin

Cesarean birth of twin B after the vaginal delivery of twin A is an infrequent event. There is little information in the literature documenting outcome of vaginal-abdominal delivery. We reviewed our 10-year experience in the management of such cases and compared outcomes with twins delivered by repeat cesarean section and vaginal delivery in the same time period. Twenty-one cases of combined vaginal-cesarean section deliveries were managed at our institute in a 10-year period. There was no apparent increase in maternal and perinatal morbidity and mortality when twin B was delivered by cesarean section after vaginal delivery of twin A.

Do breech presentations in twins and singletons run different risks?

We have compared breech twins and breech single births in a population recorded between 1974 and 1978 in 10 Belgian maternity centers. In 190 twin pregnancies, 38 first and 65 second twins were delivered in breech presentation. These twins were compared to 853 singleton breeches, of which 95 delivered by cesarean section were excluded. Data were stratified according to birthweight. No significant difference between twins and singletons was found in terms of perinatal mortality rates. However, Apgar scores below 7 at 5 minutes were significantly less numerous among first twins than among singletons. Therefore, first twins in breech presentation might be at lower risk of fetal distress. This difference should be taken into account in the management of first twins presenting by the breech.

Bed rest in twin pregnancy

A total of 146 twin pregnancies were studied to evaluate the importance of bed rest. A significantly reduced frequency of preterm delivery was found after bed rest in hospital as compared to bed rest at home or no bed rest at all. An increase in gestational age and in birth weight was seen after bed rest. No effect was found on the intrauterine increase of fetal weight per time. Early routine ultrasound is recommended, so that effective bed rest may be instituted in due time.

A reappraisal of perinatal mortality factors in twins

During the last 33 years, the perinatal mortality of twins has decreased regularly in our department. When examined by duration of pregnancy, mortality was lowest at 37-38 weeks. Below 38 weeks, fetal loss was paradoxically higher in twins born from multiparae. When delivery occurred beyond 38 weeks, mortality rates were increased, but only differences for primiparous group showed statistical significance. Near-term fetal loss was predominantly due to antepartal intrauterine deaths. Analysis of individual cases indicated that early termination of pregnancy might help prevent near-term stillbirths in twins delivered by primiparae. Efforts should be directed at specific detection of twins threatened by antepartum death.