Management of twin pregnancies: Remaining challenges and unanswered questions

Abstract

Several professional societies have published guidelines on twin pregnancies over the past few years. These documents provide recommendations on antenatal surveillance and management of twin pregnancies. At the same time, these guidelines identify several key areas where evidence is limited and additional research is needed. In the present review, we summarize available evidence regarding some of these key areas, including the screening and prevention of preterm birth, the definition and management of fetal growth restriction, the diagnosis and management of gestational diabetes, the optimal maternal gestational weight gain, and the mode and timing of delivery. In addition, we describe several online tools related to these areas that can empower individuals with twin pregnancies and assist care providers in counseling these patients.

Keywords: conflicting; controversies; debate; multifetal; questions; twin.

FIGURE 1

Summary of recommendations of professional societies on the timing of delivery in twin pregnancies. Recommendations of the various professional societies on the timing of delivery are shown for dichorionic (green lines), monochorionic diamniotic (orange lines), and monochorionic monoamniotic (red lines) twin pregnancies. Right‐ and left‐pointing arrows represent recommendations to deliver from or until a given gestational age, respectively. FIGO, The International Federation of Gynecology and Obstetrics; ISUOG, The International Society of Ultrasound in Obstetrics and Gynecology; NZ, New Zealand; UK, United Kingdom; USA, United States of America. Adopted from Weitzner et al.