Twin Pregnancy Labor and Delivery Guidelines for Medical Professionals

The maternal-fetal medicine specialists at Brigham and Women's Hospital (BWH) compiled the following labor and delivery guidelines for a twin pregnancy. These guidelines are based on the combined knowledge and experience of BWH's maternal-fetal medicine specialists, current research and professional society guidelines.

Timing of Admission and Delivery

Below are recommendations regarding the optimum time for admission and delivery for an uncomplicated twin pregnancy.

Type of Twins/Optimum Time for Delivery

• Di-Di: By 38 weeks
• Mo-Di: At 37 weeks
• Mo-Mo: 32-34 weeks (Hospital admission between week 24-28 for daily fetal surveillance)

Mode of Delivery

A twin gestation in and of itself does not necessitate a cesarean delivery. The optimal mode of delivery depends on a variety of factors, including:

• The type of twins
• Fetal positions
• Gestational age
• Fetal size
• The obstetric care provider’s experience

Mo-Mo twins should always be delivered by cesarean section to avoid umbilical cord complications for the non-presenting twin at the time of the first twin’s delivery.

A recent randomized trial of Di-Di and Mo-Di twin births indicated that for uncomplicated pregnancies between 32-38 6/7 weeks with a presenting vertex twin, a planned cesarean delivery did not decrease the risk of fetal or neonatal death, or serious neonatal morbidity, compared with a planned vaginal delivery. *

A woman carrying Di-Di or Mo-Di twins is a good candidate for a vaginal birth if:

• The presenting twin is in a vertex position
• The obstetric care provider has experience with internal podalic version and vaginal breech delivery (malpresentation of the second twin)

If your patient had a prior cesarean section, she may still be a good candidate for delivering twins vaginally. Read more about VBAC deliveries.

* A Randomized Trial of Planned Cesarean or Vaginal for Twin Pregnancy,” New England Journal of Medicine, October, 2013.

When to Refer to a Maternal-Fetal Medicine Specialist

In addition to a woman’s routine care from her obstetrician, consultation with and additional care from a maternal-fetal medicine specialist is recommended in different cases

• Di-Di twins: with complications such as discordant growth, high risk of preterm delivery, discordant fetal anomalies.
• Mo-Di twins: with concern for congenital anomalies, unequal placental sharing, discordant growth, TTTS.
• Mo-Mo twins: we recommend to transfer these patients to MFM specialist for inpatient admission between 24-28 weeks

The maternal-fetal medicine specialists at BWH are always happy to answer questions or provide a consult. You can send a question via email or call us directly.

Carolina Bibbo:
cbibbo@partners.org
Phone: (617) 732-5452

Have a Question?

We are happy to respond to general questions about twin pregnancies. Please use our online form to send us your twin pregnancy question, and one of our maternal-fetal medicine specialists will respond. Please note that your question will be emailed and responded through a private and secure system.

Resources

Access research and information about twin gestation and delivery.

• American Congress of Obstetrics and Gynecology practice bulletin about twins (Login Required)
• “A Randomized Trial of Planned Cesarean or Vaginal for Twin Pregnancy,” New England Journal of Medicine, October, 2013
• “Improved Perinatal Survival of Monoamniotic Twins with Intensive Inpatient Monitoring,” American Journal of Obstetrics & Gynecology, January, 2005

Information and support for patients.

• Common questions and answers for women expecting twins from the American College of Obstetrics and Gynecology
• National Organization of Mothers of Twins

Learn about obstetric services provided by Brigham and Women’s Hospital.

Read more about maternal-fetal medicine at Brigham and Women’s Hospital.