Twin mortality increases after 40 weeks?

[annettemarie]

Has anyone heard this? Someone said they read a study that said multiples were more likely to die after 40 weeks gestation. I've been looking for a study or citation, but can't find it. Anyone have any insight?

ETA: Found the study:
http://www.ncbi.nlm.nih.gov/pubmed/16579946

[Gena 22]

I'd love to discuss this.

Your study is an improvement on what I think is called the Luke study, suggesting greater mortality after 38 weeks. The study you cite at least shows less need for ventilation after 38-39 weeks for Baby A and 39-40 weeks for Baby B. Which should be a factor. Reading that study, I'd say the optimal time for delivery would be somewhere around 39 weeks.

I induced with castor oil at 39 weeks. In a way I wish I had waited, my girls were on the small side. But then again, my girls were about 20% weight difference, and I wonder if Baby B would have survived another week or two. Impossible to say, but my momma intuition said I needed to get her out. It was a compromise - early for Baby A, right on for Baby B.

My problem with twin studies is that there are so many variables that might contribute. How many sets were mono-di? I'm guessing there were no mono-mono. Did any of the moms had preclampsia? How about GD? What were the stats on the di-di sets where there were no complications? Each set needs to know the risk for their situation, and it's unlikely to be the same. But that would require too big of a study. Twin science has a long way to go.

[annettemarie]

Thanks, Gena! I'm really bad at interpreting studies, I'll admit that. I have a friend who is helping me sort through it. It did occur to me that it didn't seem to differentiate between the different types of twins.

[Gena 22]

Almost no study does. If I were deep into this research, I would look up the effects of common twin complications (like GD, maternal high blood pressure, etc.) in singleton pregnancies. That info might be out there, and I'd try to extrapolate.

Putting together multiple studies to get an answer is what I did when I was pregnant and researching. It'll get you some of the answers you're looking for.

But my big beef with many hospitals / OBs / researchers is treating all twin pregnancies as the same. Maybe they have to for their own risk management. I'd like to say that mono-di and di-di pregnancies carry the same risks, outside of TTTS, but from some of the research I've read says that's just not true. Mono-di is slightly higher risk, not all that rare, and if you include these numbers in a study it will distort the results. Know this is touchy to suggest, but do IVF moms have more complications than spontaneous twins? Maybe, maybe not. There are a lot of these questions. With studies where the sample sizes are small, and the number of bad outcomes are even smaller, treating all twins the same can lead to poor choices - like choosing to have a preterm birth when the risk is not nearly as high as the global studies might have you think.

But, on the other hand, I don't want to hide my head in the sand and say twins perfectly safe. Yes, all sorts of things can happen. I just wanted to know what MY risk was, and make an educated decision.

You may have seen this before, but it's my current fav:

http://www.uptodate.com/home/content...=labordel/5122

[Intertwined]

It makes sense to me, like Gena said, that with the higher risk of complications on both maternal and fetal sides of the coin-mortality would increase. It would certainly follow, for instance, that the further into a twin pregnancy one goes the greater increase in seeing full blown eclampsia and the higher the risk to the babies.

I also agree with Gena about mono-di twins. I think there's a much greater need for better studies for all different types of twinning rather than a "one size fits all". Which of course, doesn't help YOU while you try to research your options.

I have to admit, I am extremely suspicious of the "your twins will die at 40+1 for no reason" line of HCP speak. I just can't believe that in an otherwise normal pregnancy with reasonable precautions that twins are at THAT much of a greater risk for still birth. But I haven't read the studies so I could be wrong.

[mauri456]

I don't have a study for you. But I do have an OB who is very low intervention, backs a home birth MW, has done HB himself.

What he said to me is that 38 weeks in twins is more like 40 weeks in a singleton. He said he wouldnt necessarily induce me at 40 weeks, but would want to watch closer and would want me to work with my midwife on natural techniques. He said for him 40 weeks for twins is like 42 weeks for a singleton.

He does know about my almost 42 week baby with my first pregnancy. He just said if you go that long with the twins he'd be pretty nervous bc it is like 44 weeks with a singleton.

[annettemarie]

Thanks, all! I'm really not a science person, so when this was brought to my attention it seemed, at face value, rather alarming. I really appreciate you all helping me unpack this.