The benefits of hospitalization were demonstrated most strikingly in a multicenter cohort study that compared 43 women who were admitted at a median gestational age of 26.5 weeks for inpatient fetal testing two to three times daily vs. 44 women who were followed as outpatients with fetal testing one to three times weekly.
There were no stillbirths in the hospitalized group, but there was a 15% stillbirth rate in the outpatient group. The inpatient group also had significant improvements in birth weight, gestational age at delivery, and neonatal morbidity (Am. J. Obstet. Gynecol. 2005;192:96-101).
This and other evidence suggests that mothers of monoamniotic twins have the best possible outcome when their pregnancies are managed in a hospital setting with fetal monitoring two to three times a day, starting at 24-26 weeks’ gestation, with delivery timed between 32 and 34 weeks’ gestation. This was among the conclusions of the 2011 NIH-SMFM workshop.
Specialized Care
A final consideration regarding the antepartum care of multiples would be the benefit that might be achieved by establishing a specialized twins clinic.
The literature includes numerous reports, including one of our own (Semin. Perinatol 1995;19:387-403), describing improved perinatal outcomes for twins who are cared for by multidisciplinary teams using best practice protocols. Our team includes an obstetrician, a certified nurse-midwife, a nutritionist, an ultrasonographer, and a perinatal nurse.
In our experience, this approach significantly reduces perinatal mortality, primarily by reducing preterm premature rupture of membranes and very low birth weight delivery.
Dr. Newman is currently a professor and the Maas Chair for Reproductive Sciences in the department of obstetrics and gynecology, and vice chairman for academic affairs and women’s health research at the Medical University of South Carolina, Charleston. He established a multidisciplinary twins clinic in 1989 and since then has provided care for more than 1,000 women with twins. Dr. Rogers said he has no relevant financial disclosures.