To reduce the number of stillbirths, a group of obstetricians proposes to induce childbirth at 37 weeks maximum.
Twin pregnancies should not be approached like the others. Carrying two children can have serious consequences for the mother as well as for the fetuses. Stillbirths are, for example, much more frequent than in women pregnant with a single child. An international group of obstetricians therefore became interested in how to prevent these complications. The solution they present in the British Medical Journal is not classic: the date of delivery should be brought forward by several weeks.
Three weeks early
Doctors put forward two dates, depending on the type of pregnancy and on the condition that there are no complications. When the twins develop in the same placenta (monochorionic), delivery should take place at the 37e week maximum. If they evolve in two placentas (dichorionic), two more weeks are allowed. Delaying childbirth beyond these durations would increase the frequency of deaths in utero : 8.8 more deaths occur per 1,000 births.
Better, however, not to go below 34 weeks. “Early delivery can expose babies to complications, including neonatal death,” said Prof. Shakila Thangaratinam, co-author of the study. Indeed, mortality within 28 days of birth and neonatal intensive care admissions are more common when newborns are too premature. However, one in ten twin pregnancies results in a birth after 32 weeks or before.
28,000 twins in France per year
These recommendations are based on a fairly large literature review: the study group brought together 32 studies on more than 35,000 women pregnant with twins. The aim was to determine how to reduce stillbirths. It must be said that the risk is particularly high: it is multiplied by 13 during a monochorionic pregnancy and by 5 during a dichorionic gestation.
In France, out of 14,100 annual twin pregnancies, 590 result in the death of at least one baby. “The twins’ low birth weight, their prematurity and the complications of childbirth (…) mean that their mortality is much higher than that of children born from simple deliveries, to analyse the National Institute of Demographic Studies (INED). So much so that the recent increase in the frequency of twins in France weighs on the evolution of perinatal and infant mortality by slowing the decline. “
The toll is not about to improve: since the 1970s, the number of twin pregnancies has climbed by 80%. The increased use of infertility treatments partly explains this.
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