Twin gestation and premature birth

Abstract

In summary, it appears that twin gestations achieve the best preterm birth rate reduction by early confirmation of gestational age and chorionicity, serial cervical length assessment, as well as, comprehensive preterm birth prevention management, and excellent clinical antepartum assessment, all of which enables such gestations to have the greatest chance of attaining a gestational age of at least 33 weeks. The message by Elliott et al., in this issue of The Journal is for the obstetrician to be wary of instituting or failing to avoid delivery of twin gestations between 33.0 and 36.9 weeks' gestation when it is not truly indicated. One must remember that although neonatal morbidity and higher health care costs occur with delivery at <32 weeks' gestation, that this group comprises the vast minority of gestations, as upwards of 95% of preterm deliveries occur between 33 and 37 weeks' gestation. Obviously, if there are fetal/maternal indications for delivery, physician judgment is needed to determine whether the baby is better off in utero or in the nursery. On the other hand, physician-allowed or discretionary deliveries between 33.0 and 36.9 weeks' gestation should be abandoned because they correspond to an increase in NICU admissions and hospital days, thus unnecessarily expanding neonatal morbidity as well as cost. Therefore, perhaps it is time for an old dog to learn new tricks. In the past, I had taught my residents that the battle had been won if we could get pregnancies to 34 weeks. Although a desirable achievement, reaching 34 weeks does not entitle the physician to ignore the consequences of near-term delivery. Without indications for delivery we are best advised to use all our clinical skills to continue the gestation, as nature intended, to at least 36 to 37 weeks in utero. © 2005 Nature Publishing Group All rights reserved.