Objectives: To define where should twin pregnancies be managed and delivered.
Materials and methods: A literature search was performed using the Pubmed and Cochrane database. Foreign societies guidelines were also consulted.
Results: There is little or no evidence to answer the question. Risk of premature labor and chorionicity are the two main factors involved in twin management. When there is a risk of prematurity, in utero transfer is recommended. Twin care must be performed by a team trained in the specificity of management according to chorionicity. There is not enough evidence to support specialized clinics. Labor and delivery need permanent and immediate disponibility of a perinatal team including an OB-gyn, an anesthesiologist and a pediatrician.
Conclusion: Needs assessment and chorionicity are the best indicators to define the optimal place of care and delivery for twin pregnancies. More than a specific location, it seems more logical to define all necessary means to enforce an optimal management of these pregnancies.
Copyright © 2009 Elsevier Masson SAS. All rights reserved.