BMJ  2007;334:545-546 (17 March), doi:10.1136/bmj.39146.541100.80

Editorials

Perinatal death in twins

Should all term multiple pregnancies be delivered by elective caesarean section?

The first 150 words of the full text of this article appear below.

Twin pregnancies are becoming more common because of the increasing use of assisted reproduction technologies.1 They are associated with an eight to tenfold increase in the perinatal mortality rate,2 mainly because 40-70% of twins are born preterm.3 However, the safety of term vaginal delivery for twins has long been of concern; some large epidemiological studies have suggested that the second twin is at especially high risk of death.4 Complications associated with the second twin include the longer second stage, compound presentation leading to trauma during delivery, cord prolapse, and premature separation of the placenta.5 However, the only randomised controlled trial identified by a Cochrane review6 of caesarean section compared with vaginal delivery in twins7 and other small retrospective studies8 have not confirmed clinicians' subjective impressions of poor outcome in the second twin.

The study by Smith and colleagues in this week's BMJ is welcome for the light it sheds on . . . [Full text of this article]

Philip Steer, professor

Chelsea and Westminster Hospital, London SW10 9NH

p.steer@imperial.ac.uk


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Relevant Article

Birth order of twins and risk of perinatal death related to delivery in England, Northern Ireland, and Wales, 1994-2003: retrospective cohort study
Gordon C S Smith, Kate M Fleming, and Ian R White
BMJ 2007 334: 576. [Abstract] [Full Text] [PDF]

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