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Minerva Ginecologica 2009 February;61(1):23-33


language: English

Actual controversies in twin delivery: from the analysis of the case histories to a reasoned protocol

Valsecchi L. 1, Serafini A. 1, Maniscalsco L. 1, Frontino G. 2, Cardani A. 1, Cavoretto P. 1

1 Department of Gynecology and Obstetrics IRCCS San Raffaele, Milan, Italy 2 Department of Pediatrics IRCCS San Raffaele, Milan, Italy


Aim. Twin pregnancy has to be considered a risk pregnancy. One of its most controversial aspects is delivery. There is no agreement on the following topics: gestational age at term (GA), mode of delivery, use of epidural analgesia or oxytocic acceleration, impact of chorionicity and amnionicity. The aim of this study was to develop a twin delivery management protocol.
Methods. A retrospective study over a cohort population of 481 twin deliveries that occurred in the Department of Obstetrics of the San Raffaele Hospital of Milan (Italy) from 1996 to 2007 was conducted, and the results were compared with those present in literature.
Results. Management of twin pregnancies that exceed the XXXVII week is controversial. There is an inclination towards fixing bichorionic and monochorionic pregnancy terms at XXXVIII and XXXV weeks respectively. In our case history, 73.8% of monochorionic and 15% of bichorionic pregnant women delivered after the XXV and XXXVIII week respectively, without repercussions on the neonatal outcome. A longer gestational age appears to decrease the occurrence of lower Apgar scores and neonatal morbidity. This study, which exclusively considered twin pregnant women with both fetuses in cephalic presentation eligible for a vaginal delivery, did not find any significant differences in neonatal outcome among the types of deliveries. Moreover, the authors observed that the average maternal blood loss in cesarean section (CS) is significantly greater than that of vaginal deliveries.
Conclusion. In consideration of its safety for mother and fetuses, vaginal delivery of two cephalic fetuses at XXXVIII and XXXV weeks for bichorionic and monochorionic pregancies respectively may be considered as a valid alternative to elective cesarean section.

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