SEARCH

SEARCH BY CITATION

EDITORIAL COMMENT: Dr R T O'Shea recently reported in this journal that ‘if bed-rest in hospital is to be implemented as a possible means of improving perinatal outcome in twin pregnancy it needs to be effected between 21 and 28 weeks' gestation’ (Twin Pregnancy: Prematurity and Perinatal Mortality. Aust NZ J Obstet Gynaecol 1986;26:165). Dr Fliegner now provides us with supporting data from Victoria. Our main editorial comment remains that ‘a practical compromise could be for patients with multiple pregnancy to be rested in hospital for 2–3 days every 2–4 weeks from 20 weeks' gestation until the dangers of prematurity are past’. The problem of fetal growth retardation is another matter. Use of ultrasonography to detect discordant fetal growth and cardiotocography to detect fetal hypoxia in the last 4–6 weeks of pregnancy are an alternative to routine induction of labour at 38 weeks' gestation. As far as the editor is aware there is no published report of a controlled trial of elective induction of labour in twin pregnancy, and whether or not am-niotomy is as effective as in singleton pregnancies; the 15% incidence of breech presentation of the first twin is another problem!

Summary: Perinatal mortality for multiple pregnancy remains at least 5 times the rate for singleton births. The major causes are neonatal deaths due to gross immaturity before 30 weeks' gestation, and stillbirths due to intrauterine growth retardation at all gestations, but especially after 32 weeks. Sixty four per cent of perinatal losses before 30 weeks' gestation occur before 26 weeks, highlighting the need to commence prophylactic measures earlier than usually recommended. The perinatal mortality in infants in multiple births weighing more than 2,500g is the same as that of singletons, but is 10 times this rate in multiple births weighing between 500g and 2,500g. Because the stillbirth rate in twins proceeding beyond 38 weeks' gestation is 3 times that of singleton births, elective termination of pregnancy is recommended if spontaneous labour has not occurred by this time.