Twin pregnancies--a continuing perinatal challenge.

A 5-year retrospective analysis of the management of 177 twin pregnancies was undertaken. Despite increased use of bed rest and ultrasonography as currently recommended, the perinatal mortality among twins (13.2%) remained almost 10 times that for singleton births. Although elective hospitalization for bed rest prolonged the pregnancy, it did not decrease the perinatal mortality. The authors believe this was attributable to bed rest being instituted too late, as 70% of perinatal mortality occurred before the 30th week of gestation, which was also the period of greatest neonatal morbidity. Suggested recommendations for improving management of twin pregnancies are discussed.