Does anyone know the clinical reasons for considering 38 weeks term with twins?

[e3chick]

I am currently either 38+2 or 38+6 (depending if you go my dates or the scan dates). I have DCDA twins who have gronw well, and all was well at the last scan at 37 weeks. This will be baby 3 and 4 for me. I am quite comfortable and actually still enjoying being pregnant. However, mention has started to be made of going overdue, as 38 weeks is considered term for twins.
What I want to know is why?
Has anyone else had an explanation, backed up with evidence, for why they may get twitchy at this stage. I cannot find anything particularly fruitful from my recent internet searches, so wonder if it is just habit to induce at 38 weeks, or just for maternal comfort, or if there is some real concrete reasons why the placentae of twins might deteriorate sooner than 40 weeks.

I would like to stop the scans and the fussing now and just wait for things to take their course, but I don't want to do that if there are real dangers.

well, all pregnancies are considered term from 37 completed weeks. Many women ime want to be delivered by 38 weeks with twins due to the discomfort and many women with twin pregnancies will sponaneously labour before 40 weeks anyway. I think it is custom & practice rather than hard evidence (like much in obstetrics!) and the fact that complications of all sorts are more common in twin pregnancies. However, I would feel more relaxed if it wasn't a first pregnancy (as in your case). Good luck and merry christmas!

As far as i know it is based on two things; a research paper which concluded that neonatal outcomes are better if twins are born at 38 weeks and that the risk of stillbirth rises from then. A twin pregnancy is very stressful for the body and it is likely that the placenta/s will degrade towards the end. Any baby should be nice and mature at 38 weeks but a chemical induction carries risks of it's own. It's about risk management. I delivered naturally in MLU at 40+3 7 weeks ago and in order for the hospital to be comfortable i had to have bi-weekly monitoring and scans to keep an eye on things for the last 4 weeks and they talked very seriously about stillbirth. Hope this helps. You can go to term but you have to understand the risks of various options.

Thank you both.
Reikizen you sound like you are an obstetrician. The whisperings of being overdue were being made by a midwife and not my consultant, so I don't actually know what the official line at my PCT is.
Curiosity, I have read studies that mention stillbirth risks rising after 38 weeks, but they are not compelling enough as they all seem to be retrospective studies of the morbidity/mortality with ALL twin pregnancies, without any differentiation for parity, types of twins, or any other health issues in the mother or the babies.

I'll try and get another appointment with the consultant for next week, hopefully, and then see what is said.

Yes, i agree. I didn't feel they were compelling enough either but agreed with my obstetrician that conceding to the monitoring was a good idea just to keep an eye on things and in order for me to be able to get staff that were willing to support my natural delivery. I really trusted her not to induce me for the tiniest reason. In the end she let it go naturally and in mlu with intermittent monitoring and use of the pool even though i'd had some high blood pressure and protein for the last two weeks and been on bed rest. The antenatal monitoring really helped everyone to feel comfortable with my natural delivery and intermittent monitoring plan and so although i really hated it at the time i was glad i'd had it when it came to the birth as i was able to have very little interference. This is the worst part but it will soon be over, hope it goes well for you. I remember being absolutely up the wall with all the pestering they wanted to do too.