OB recommends client birth before 38 wks- why???

[phathui5]

I have a question of the multiple moms here. I have a client whose OB is telling her that it's safer for twins to be delivered before 38 weeks gestation. Not just her babies, but twins in general.

Is there any medical justification for that? Have any of you heard that before?

[annettemarie]

There's some study-- I'll have to look for it-- that says 37 weeks is term for twins and outcomes start to go down after that.

[UberMama]

I've heard OBs try and justify it, but I am unsure if I believe any of the reasoning. Has she asked him for his reason (specific reason) and sources to back it up?

[turnquia]

What annette says. Dr Luke (the big twin doc) has done a study (its fairly small still) but preliminary research is showing after 38 weeks, placenta function tends to start to decrease. The odds of loosing a baby after 38 weeks go up slightly similar to going past 41 weeks with a singleton.

That said... I feel it should be individially based. Increased monitoring after 38 weeks, etc but just like with over due singletons, some are just meant to cook longer, some need help coming out.

[Gena 22]

It just feels so wrong. I never had the resources or bandwith to critically analyze the Luke study, but I think some of the problems with it are that the sample size is small and that it includes all twins - mono-di, di-di, moms with GD, moms with hypertension, etc.

Here's a great study for your client - stating that in an otherwise uncomplicated twin pregnancy, allowing spontaneous delivery up to 40 weeks is recommended. It's more recent than the Luke study too.

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

Many, but not all, OBs use the Luke study as gospel that all twins need to be delivered before 38 weeks. I hope to live to see that categorically disproved. It stresses out healthy twin moms that don't need another thing to worry about, and prompts too many unnecessary inductions and surgical births.

[annettemarie]

Where I think the study has value is it says "Hey! Heads up! We've seen problems starting around 38 weeks, so be aware!" To me, it doesn't say "Your baby must be induced st 38 weeks." Rather, it lets me know to check things out a little earlier than I normally would in a singleton pregnancy, if that makes any sense. It's nap time.

They were making noise about inducing me at 37 weeks since my first appointment. My stock answer is "Well, if there's a medical reason to induce me at that time, I'll certainly be open to it." Which I will. But I'm not doing it just because we've hit a magic number.