Twin pregnancy: controversies in management


Royal Jubilee Maternity Hospital, Belfast UK Email:


Key content

  • The management of twin pregnancy poses many difficult and controversial issues; questions about management remain unanswered.
  • With the rising incidence of multiple pregnancies due to greater maternal age and advances in assisted conception, the obstetrician is increasingly faced with these issues.
  • This article looks at the controversies and available evidence concerning management and delivery of twin pregnancy.

Learning objectives

  • To understand the issues surrounding screening for aneuploidy in twins and the role of invasive testing.
  • To understand the complex issues involved in the management of single twin demise, twins discordant for fetal anomaly and twin-to-twin transfusion syndrome.
  • To be aware of the evidence available regarding the timing and mode of delivery of twins.

Ethical issues

  • An obligatory single embryo transfer policy in assisted reproduction may be an option for women at high risk of twins, but will this be in conflict with client interests and wishes?
  • Complex ethical issues surround multifetal pregnancy reduction and selective feticide among twins discordant for fetal anomaly; these are matters for continuing debate.

Please cite this article as: Devaseelan P, Ong S. Twin pregnancy: controversies in management. The Obstetrician & Gynaecologist 2010;12:179–185.