June 28, 2005

Early twin delivery may reduce stillbirth risk

NEW YORK (Reuters Health) - The risk of fetal death in twin
pregnancies is higher than previously estimated, a new study
from the UK finds. The researchers suggest this danger could be
eliminated by planning to deliver the babies by c-section at 32

Dr. Nicholas M. Fisk of Imperial College London and
colleagues have observed unexpected late fetal deaths in
apparently uncomplicated twin pregnancies. This prompted them
to conduct the current study, to investigate the risk of such
deaths after 24 weeks gestation.

The researchers evaluated records at their center for 480
twin pregnancies in which the babies shared a single chorion
membrane. The mothers underwent ultrasound monitoring every two

The team identified 151 uncomplicated pregnancies, with
normal ultrasound scans, but among this group there were ten
late unexpected fetal deaths in seven pregnancies -- three
double deaths and four single deaths.

All the fetal deaths occurred within 2 weeks of a normal
scan, at an average gestational age of 34 weeks, the
investigators report in the journal PLoS Medicine. The deaths
remained unexplained after autopsy in three of the five
pregnancies; in two there was evidence of a condition called
twin-twin transfusion syndrome, which can arise when twins
share one chorion membrane.

Strategies to prevent these late fetal deaths could include
more intensive monitoring, Fisk and his colleagues recommend,
or earlier elective delivery. Because most of the fetal deaths
occurred after 32 weeks, they suggest scheduling elective
delivery at this point in the pregnancy.

"If our findings are confirmed in other observational
series," the researchers conclude, "our suggestion that earlier
delivery might prevent this adverse outcome could be tested by
randomized trial."

SOURCE: PloS Medicine, June 2005.