Multiple Pregnancy

Question 1

A 28-year-old woman (para 1, gravida 3) presents to birth options clinic to create a delivery plan for her current dichorionic twin pregnancy. She has no significant medical history other than a previous classical Caesarean section three years ago. Which of the following is the best advice to offer?

A. Recommend vaginal delivery but advise the patient that there is a significant chance of needing to switch to Caesarean

B. Recommend a normal vaginal delivery

C. Recommend a Caesarean section at 37 weeks gestation

D. Recommend a Caesarean section at 36 weeks gestation

E. Reduce the pregnancy to allow for normal vaginal delivery

Answer 1

C. Recommend a Caesarean section at 37 weeks gestation

A previous classical Caesarean section is an absolute contraindication to normal vaginal delivery. There is a risk of uterine rupture and the foetus may be expelled into the peritoneal cavity. Women with dichorionic twin pregnancies should be offered elective birth from 37 weeks 0 days

Not D: Recommend a Caesarean section at 36 weeks gestation

Women with uncomplicated monochorionic twin pregnancies should be offered elective birth from 36 weeks 0 days, after a course of antenatal corticosteroids has been advised