Such research, published last month by the British Medical Journal, focuses on recommended delivery times for women carrying twins, something that has not been studied in-depth before in the UK.
In 2014, multiple births accounted for just 3 per cent of UK births, but made up just less than 10 per cent of stillbirths in England, Wales and Scotland. Disturbingly, since 2005, the number of patient safety incidents involving multiple pregnancies, including unexpected stillbirth and neonatal death, has risen by 419 per cent in UK, peaking two to three years ago and resulting in payouts of more than £90m.
It goes without saying that twin pregnancies are higher risk than singleton pregnancies. There is a thirteen-fold increase in rates of stillbirth in monochorionic (shared placenta) and a five-fold increase in dichorionic (individual placenta) twins. The actual risk might be even higher than these estimates because of the policy in many hospitals of planned delivery in twin pregnancies.
Ordinarily, babies are delivered at 40 weeks.The authors of this latest study looked at data on more than 35,000 twin pregnancies and concluded that to reduce the risk of babies dying, the safest time to deliver uncomplicated dichorionic twin pregnancies is 37 weeks’ gestation, 36 weeks for monochorionic pregnancies. They found that a delay of just one week for dichorionic twins (to 38 weeks) saw an additional 8.8 perinatal deaths per 1,000 pregnancies.
I am currently acting for a mother who delivered monochorionic twins after 37 weeks. She had an uncomplicated pregnancy, but one of her twin girls was unexpectedly stillborn. The surviving twin suffered extensive brain damage and will need lifelong care. This tragedy would have been avoided had her twins been delivered at 36 weeks.
For years, groups have advocated delivering twins early. Too often babies left beyond 36-37 weeks pay the price with their mortality or morbidity. Hypervigilance from all medical staff involved in managing multiple pregnancies is vital, something that is recognised by Mark Kilby, professor of foetal medicine at the Royal College of Obstetricians and Gynaecologists, who, welcoming the new research, said:
This new research is an important step forward. Women and their partners, clinicians, and guideline makers need just these types of robust facts and figures around the risk of stillbirth from continuing the pregnancy to make planned decisions on the safest and optimal time to deliver.
The global drive to reduce the number of stillbirths continues, but this report has gone a long way to highlight multiple pregnancies as a major risk factor in high-income countries. Hopefully, it will help prioritise the importance of evaluating the timing of delivery and reduce the numbers of families put through the heartbreak of losing a baby near term.
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