[Twin pregnancies: where should we manage them? Where should they deliver?].
OBJECTIVE
To define where should twin pregnancies be managed and delivered.


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.


CONCLUSIONS
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.
CHRU Lille, Maternité Jeanne-de-Flandre, pôle d'obstétrique, 1, rue Eugène Avinée, 59034 Lille cedex, France. p-deruelle@chru-lille.fr
P
P
Deruelle
C
C
Coulon
P
P
Vaast
V
V
Houfflin-Debarge
D036861:Delivery, Obstetric / Q000592:standards*; D004200:Diseases in Twins / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000628:therapy; D005602:France; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000628:therapy; D059285:Pregnancy, Twin; D011295:Prenatal Care / Q000592:standards*; D012307:Risk Factors