ĭelivery planning of mo-mo twins is dependent upon fetal well-being and maternal comorbidities. Perinatal mortality is estimated to be between 30% and 40% due to high risks for fetal anomalies, twin reversed arterial perfusion syndrome (a-cardiac twinning), twin-twin transfusion syndrome, cord entanglement, or acute vascular events. The reported incidence is 8 per 100,000 pregnancies. Monoamniotic monochorionic (mo-mo) twins are rarely seen. For more information regarding the pathophysiology of twinning or prenatal management, refer to StatPearls "Twin Births." The delivery of twins is determined by twin type and maternal and fetal conditions around the time of delivery.ĭelivery planning of twins is dependent on twin types: monochorionic monoamniotic, monochorionic diamniotic, and dichorionic diamniotic. These conditions include cord prolapse, vertical incision on the uterus from prior surgery, placenta previa or accreta spectrum, infections such as current herpes outbreak, or fetal intolerance of labor. All conditions that are contraindications to vaginal delivery in singleton pregnancies will also prevent vaginal delivery in twin gestations. Twins with fetal growth discordance (greater than 20% difference in estimated fetal weight) preclude a patient from a vaginal delivery. The presenting twin must be in the cephalic position for vaginal delivery to be considered. First, the patient should desire a trial of labor. Not all patients with a twin gestation should attempt a vaginal delivery. However, the management of twin delivery is challenging for obstetricians due to issues associated with monitoring both twins during labor and the maneuvers that may be necessary to deliver the second twin. The Twin Birth Study, the first large randomized controlled trial evaluating twin birth outcomes, found there was no increased risk of neonatal morbidity or mortality in patients who underwent vaginal delivery versus cesarean section. There has been further debate regarding what types of twin pregnancies are candidates for vaginal delivery given the risks associated with a change in fetal lie after delivery of the first twin, risk of placental abruption due to the abrupt decompression of the uterus after delivery of the first twin, cord prolapse, and changes in cervical dilation that may hinder the delivery of the second twin. Current American College of Obstetrics and Gynecology (ACOG) guidelines state that twin gestation, in general, is not an indication for a cesarean section. The recommended mode of delivery for twin gestations has been debated in the literature. live births triplet and higher-order births were 80 per 100,000 live births. Multifetal gestations are associated with higher risks than their singleton counterparts.
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