Abstract
Key content The management of twin pregnancy poses many difficult and controversial issues; questions about management remain unanswered. With the rising incidence of multiple pregnancies due to greater maternal age and advances in assisted conception, the obstetrician is increasingly faced with these issues. This article looks at the controversies and available evidence concerning management and delivery of twin pregnancy. Learning objectives To understand the issues surrounding screening for aneuploidy in twins and the role of invasive testing. To understand the complex issues involved in the management of single twin demise, twins discordant for fetal anomaly and twin‐to‐twin transfusion syndrome. To be aware of the evidence available regarding the timing and mode of delivery of twins. Ethical issues An obligatory single embryo transfer policy in assisted reproduction may be an option for women at high risk of twins, but will this be in conflict with client interests and wishes? Complex ethical issues surround multifetal pregnancy reduction and selective feticide among twins discordant for fetal anomaly; these are matters for continuing debate. Please cite this article as: Devaseelan P, Ong S. Twin pregnancy: controversies in management. The Obstetrician & Gynaecologist 2010;12:179–185.
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