Study on 37w vs 38w with twins?

macchiatto

Did you guys see this article about the new study that came out suggesting twins do actually tend to have better outcomes if they are delivered at 37w versus 38w+?

https://health.foxnews.mobi/quickPage.html?page=31737&content=74408577&pageNum=-1

I admit, I'm a little surprised, since when I was pg it seems like delivering anywhere from 36-38w was common, but from reading this board it seems like more recently more drs and hospitals are not scheduling twin deliveries before 38 or 39w unless there's a medical reason to do it sooner. Maybe the pendulum will swing back a bit now?
(My guys were born at 37w6d via scheduled induction.)

GypsyEsq

Interesting. Looks like the study compared birth outcomes and noted better birth weights at 37 weeks but doesn't really say what monitoring moms were having in the 38th week. I'd be curious to see the actual abstract. 

jquirke9881

Thank you for sharing.  I wish the article went into more detail.  My doctor schedules at 38 weeks.

cutebride73

I agree it looks interesting and would like to read more about the study.  My OB practice seems to be in the camp of going past 38 weeks - to 39 or even 40 - if you don't go into labor on your own before that.  The thought of that stresses me out incredibly.  I mean I pray I make it to 36 weeks without any issues.  And getting to 37 weeks would be great.  I just can't imagine going past 38 weeks. 

macchiatto

Yeah, I would be really interested in more details, too. Maybe some of you who are currently pg could ask your OBs if they've seen it and have more info on it, what their opinions are? And I'm hoping E&RMommy weighs in!

amh04

macchiatto:

Yeah, I would be really interested in more details, too. Maybe some of you who are currently pg could ask your OBs if they've seen it and have more info on it, what their opinions are? And I'm hoping E&RMommy weighs in!

I'll definitely print it off and ask my doctor at my next appointment in a few weeks and let you guys know what they say in reference to it. I'm wondering what the big differences they found between 37w and 38w are as well...

Thanks for sharing!

SpinningJess

cutebride73:

I agree it looks interesting and would like to read more about the study.  My OB practice seems to be in the camp of going past 38 weeks - to 39 or even 40 - if you don't go into labor on your own before that. 

This is the same camp my OB was in, too.  Said she never scheduled induction/c-section for twins before 39 weeks, but apparently with all of my false alarm trips and the fact that I looked miserable, she felt sorry for me and scheduled my c/s at 38 weeks.  I went at 36w5d though so it didn't really matter. 

Thank you for sharing, OP!

mrsemily08

It would be really interesting to see the whole thing.

Our MFM didn't want them going past 37w. He said he felt outcomes were best in the 37th week for twin gestations (they were born at 35w1d, so we never discussed this in significant detail). 

srbmvp

My OB cited several studies in our decision to induce at 37 weeks, but he said it was because I was mono/di and the increased risks associated with that. This article seems to say ALL twins should go early, interesting....

ColleenS629

My OB and MFM would have induced or scheduled my c/s for 38w had I not had complications. As it was, Baby A was not growing well after 28w (noticed at my 32w growth u/s) but they allowed me to go to 36w with frequent monitoring. At that point, his growth slowed too much so they scheduled my c/s for the first available OR time my OB could get which was at 36w5d. My Baby B wasn't ready and ended up in the NICU for breathing. I don't know if he would have done better just 2 days later at 37w.

MelleTX

When I first met with my OB she told me to get it in my head that they would be here at 38 weeks. She said I needed to keep the mindset of 38 weeks so I would not worry about them going early, but that I also would not go past 38 weeks. 

GypsyEsq

My OB won't let me go past 40 assuming all is well.  But I'm also going for a VBAC so that figures into as well.  But I'm curious what my MFM would say.  I see him tomorrow and since he doesn't deliver we don't talk about delivery plans at all but I'll ask.  I certainly understand taking them early if there are size discordance issues or other - but to say that all twins (regardless of mo/mo, mo/di or di/di or actual monitoring) should go at 37 or that at 37 they have better outcomes - just seems counterintuitive to me.  But...what do I know.  I still really resist the characterization that twins develop faster in utero and have been trying to find data to back that up for months now.

hanncanna

I work in medical education and I have access to a lot of medical journals; I do medical research all the time. My doula sent this over to me this morning and this was my response to her----bottom line, these summaries that are popping up in so many places do not have enough information to be useful and on top of that, I'm unable to find the original article or abstract to learn more about the study.

-------------------------

Interesting----what they don't say is the condition of the babies of the women who were induced at 37 weeks.  I would expect that twins who experienced a healthy uterine environment would grow at a rate that would make them full term size and capable of life on the outside by 37 weeks. Twins who had trouble growing might stay in longer than 37 weeks, and then the issue with them being born at 38 weeks or later wouldn't be because they were born at 38 weeks or later--rather it would be because of the uterine environment they experienced during those 38 + weeks. What doctor would induce at 37 weeks if the lungs weren't fully developed or there was some other problem? The women who weren't induced at 37 weeks would then be removed from the study.

Without the article, I can't decide whether or not to change my mind about letting the babies come when they want, through the natural onset of labor.

I looked around for the article but no one cites it directly. So I went to the BJOG website and looked at their current issue--

https://www.bjog.org/details/issue/2042715/Volume_119_Issue_7_June_2012.html 

Nothing there regarding twins, 37 weeks or a study from Dodd.

I am definitely open to changing my mind, but at this point I really believe that the babies will come when they are ready. Unless there's a serious emergent issue, I would rather let labor come when it does and not be induced. I will be more comfortable post-delivery knowing that This is when the babies needed to come and This is how delivery needed to happen--I won't have that same level of comfort if I or my doctor intervenes without a really solid medical reason. I am controlling up to a point but when it comes to major life things like this, I am rather fatalistic...I like dealing with consequences when I know it wasn't up to me!

Thanks for the heads-up on the article. I am going to keep looking. Maybe it will turn up in the next few days in full text or even abstract form so I can get some more information out of it. 

MrsLnt

My MFM was very firmly in the "not beyond 38w" camp. I think part of it is, they think the risks of placenta breakdown or other things outweigh the benefits, so, from a risk management standpoint, it's safer to let the babies come on the earlier side and let neonatology deal with any complications resulting from prematurity, than risk postmaturity issues that may not be detected until it's too late. 

tst1998

Here is a link to the protocol they used for the study (hopefully it works):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978123/?tool=pubmed

But the article is not yet available online, even if you go to the journal's webpage. They don't specify type of twins in the enrollment criteria, which I suspect makes a big difference in outcomes, so hopefully they looked at that in the actual study. It looks like there have been several other studies looking at this over the last 10 years, but this is the first randomized control trial that has been done.

leapgirl8

Our doctor said he prefers not to go more than few days past 37w because of problems with the placenta that he has seen in his own patients who insist on pushing it to 38w or beyond. We delivered at 37w3d and it felt just right. DW did not want to be pregnant for a moment longer and the babies came out big and healthy.

macchiatto

tst1998:

Here is a link to the protocol they used for the study (hopefully it works):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978123/?tool=pubmed

But the article is not yet available online, even if you go to the journal's webpage. They don't specify type of twins in the enrollment criteria, which I suspect makes a big difference in outcomes, so hopefully they looked at that in the actual study. It looks like there have been several other studies looking at this over the last 10 years, but this is the first randomized control trial that has been done.

Thanks!

amanda31H

Hmmmm...I'm also interested to see if E&R Mommy weighs in. 

I remember my doctor not wanting me to go much past 37 weeks, but I had mo/di twins and my understanding was that the one placenta could potentially start to break down.  Like PP said, I wonder what "type" of twin was studied.

MrsOjoButtons

Wouldn't the placenta breakdown be a moot point in a di/di pregnancy since one placenta is supporting only one baby?

macchiatto

MrsOjoButtons:

Wouldn't the placenta breakdown be a moot point in a di/di pregnancy since one placenta is supporting only one baby?

Good question. I keep hearing it starts to break down after 38w with twins, not just mo/mo or mo/di twins ... maybe the mother's body having to support two placentas can lead to it breaking down earlier?

lrrb

Mine believed in 37 weeks.  I think I could have convinced him to let me go at 36 weeks but my water broke at 33w4d so it didn?t get to that point but I can not IMAGINE going ANY longer than I did.  Honestly I was in PURE HELL and as bad as it sounds I was relieved my water broke when it did I didn?t think I could take one more day.  Plus my twins were big 5.6 and 4.13 for 33 weekers so they did wonderfully....