CASE STUDY Study finds over two-thirds of twins born via C-section, almost 50 percent born prematurely and infant health declining The rate of premature twin births in New South Wales has been steadily rising and is a concerning trend, warned Professor of Obstetrics and Gynaecology at The University of Sydney and Kolling Institute Director of Women and Babies Research Dr Jonathan Morris. Professor Morris and his team at the Kolling Institute’s Women and Babies Research group at Royal North Shore Hospital analysed over 14,000 twin pregnancies between 2003 and 2014. The research found 49 per cent of twins were born before 37 weeks and 69 per cent of all births were planned either by pre-labour caesarean or induction of labour. During this period, there was a two per cent increase in the proportion of twin births occurring at 30 to 34 weeks, an eight percent increase at 35 to 36 weeks and conversely a five percent drop in the proportion of twin births at 37 to 38 weeks and a four percent drop at 39-plus weeks gestation. “Previous research has shown early births placed an infant at increased risk of long-term developmental problems such as poorer school performance,” Professor Morris said. “In the short-term, babies born early were more likely to need help with their breathing, be admitted to a neonatal intensive care unit, have jaundice, and spend longer in hospital.” Couples are waiting longer to start families and the use of fertility treatments and obesity has also gone up over time, raising the likelihood of twin pregnancies. While some preterm multiple births happen spontaneously, the trend toward earlier planned births may be driven by concerns about the risk of stillbirth and increasing trends in maternal risk factors for stillbirth such as advancing age and obesity. “Consistent with a number of studies, we found that as gestational age at birth increases, rates of neonatal morbidity decreases, and the trend toward earlier gestation at delivery in our study was concurrent with a significant increase in neonatal morbidity rates,” Professor Morris said. “We need to carefully evaluate the interventions that we undertake and make sure they’re in the best interest of mums and babies.” Twins are known to be smaller than singleton babies, and the management of their growth poses some unique challenges as the wellbeing of both twins has to be considered at all times.
Jonathan Morris
WWW.NSLHD.HEALTH.NSW.GOV.AU 35
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