Labor and Delivery of Twin Pregnancies

Twin pregnancies represent 3% of all births in the United States.  Currently, approximately 75% of all twin pregnancies are delivered via cesarean.   However, recent studies suggest that this high rate may not be necessary and that vaginal delivery of twins can be achieved safely for the mother and her twins.  At MFM Associates, we care for and deliver many twin pregnancies.  The article below is a review of twin delivery written by Dr. Stephanie Melka, Dr. James Miller, and Dr. Nathan Fox.  It was published in December 2017 in Obstetrics and Gynecology Clinics of North America.

Twin Pregnancy in Women 45 Years or Older

With advances in assisted reproductive technology including In-vitro fertilization (IVF) and egg donation, women are now able to conceive well into their 40’s and 50’s. However, uncertainty exists regarding the safety of these pregnancies for women and their newborns. Additionally, twin pregnancy is a common result of IVF, and all twin pregnancies are higher-risk pregnancies.

Pregnancy Outcomes in Patients With Prior Uterine Rupture of Dehiscence

Women with a history of uterine rupture in labor or women with a uterine “window” (extreme thinning of the lower uterine portion) are often told that they should not conceive again because the risks are too great.  In this study, we reported excellent outcomes in a cohort of women with prior uterine rupture or uterine window.  With close monitoring and early delivery, none of the women in this study had any severe complications.

Rescue Corticosteroids in Twin Pregnancies and Short-Term Neonatal Outcomes

Singleton babies born prematurely, particularly those born prior to 34 weeks, have improved outcomes if their mothers received antenatal corticosteroids (AQCS) prior to delivery.   Recent studies suggest that a second (“rescue”) course of ACS further improve outcomes.   Twin pregnancies have a far higher risk of preterm birth, but there are less data examining the effect of corticosteroids and rescue corticosteroids on neonatal outcomes.  In this study, we found that twins born prior to 34 weeks had improved short-term outcomes if their mothers were exposed to a rescue course of ACS.

Type of Congenital Uterine Anomaly and Adverse Pregnancy Outcomes

A uterine anomaly (also called mullerian anomaly) refers to  a uterus that does not have normal shape (pear-shaped0.  There are several subtypes of uterine anomalies and each can have a different impact pregnancy for women with these uterine abnormalities.  In this study, we report pregnancy complication rates in a large cohort of women with uterine anomalies, based on the whether the defect was minor or major.

The Independent Associations of a Short Cervix, Positive Fetal Fibronextin, Amniotic Fluid Sludge, and Cervical Funneling with Spontaneous Preterm Birth in Twin Pregnancies

In twin pregnancies, a short cervical length on ultrasound, as well as a positive fetal fibronectin test, are both associated with an increased risk of preterm birth.  In this study, we found that the presence of amniotic fluid sludge (particulate matter seen on ultrasound just above the cervix) also increased the risk of preterm birth.