In a message dated 10/22/2003 10:01:39 PM Eastern Daylight Time, [log in to unmask] writes:

> For a twin gestation, the risk of still birth increases after 38 weeks,
> that is the ratioanal for induction prior to the due date.
> This lady got
> an extra 1.5 weeks!


I would really appreciate it if you could share the citations for the recent research literature re: the risk is great/significant enough that induction (and increased risk of cesarean) for the multiple pregnancies that go beyond 38 weeks is more appropriate than "expectant management" via weekly or biweekly ultrasound biophysical profile (with cord and placenta function assessment in addition to fetal growth assessment), nonstress testing, etc. I'm aware of Luke et al's one study several years ago that looked at retrospective data and there was no review of maternal confounding variables or expectant management consideration, so is not very helpful.

Care providers now have a "window" to the womb, and earlier more invasive or riskier interventions often are not needed as before. Induction is not without risk for fetal distress, tonic contractions, etc. -- all of which are more significant with the more stressed uterine environment, uterine overdistention, increased abruption risk, etc. associated with multiple pregnancies.

Thanks.

Karen Gromada

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