Retningslinjer for oppfølging av tvillingsvangerskap og fødsler

Abstract

ABSTRACT

The objective of this study is to find out how guidelines for management of twin pregnancy and delivery have changed over the past century. It was also in our concern to look into the scientific basis of these recommendations.

The paper is based on a study of literature. The material consisted of a total of 129 articles. This was achieved by a manual search through the Old Medical Library at UiO, in combination with computer search through medical databases. Keywords for the search were “twin”, “multiple” and “pregnancy”. Other criteria were English or Scandinavian language and a systematic index.

The articles were assessed from a chronological point of view. The themes discussed and the guidelines given were compared decade by decade.

There are three main findings concerning antenatal management of twin pregnancy. Obstetricians worldwide have agreed that bed rest should no longer be recommended for women carrying twins. Secondly, the methods for diagnosing twin pregnancies have changed since the 1970-ies from strictly clinical to ultrasound-based. Thirdly, the development of the ultrasound technology has opened for new diagnostic and interventional methods.

On the issues regarding twin delivery, the guidelines have changed. The first half of the 20th century was characterized by lack of antenatal diagnosis of twins, which meant that few twin births were prepared beforehand. Today there are wide diagnostic possibilities and an opportunity to plan twin delivery.

To conclude, the literature shows that obstetrical guidelines change over time. The changes reflect the available medical scientific knowledge and technological development of each given period of time.