Scheduling a C-section for twins requires balancing maximizing fetal growth time with minimizing the risks associated with prolonged gestation of multiple babies. Unlike a singleton pregnancy, where the timing for a planned delivery is often set at 39 weeks, the presence of two fetuses necessitates an earlier date. The goal is to choose the optimal and safest moment for delivery, determined by the individual medical circumstances of the mother and the babies.
Standard Guidelines for Scheduled Twin Delivery
The baseline recommendation for twin delivery timing considers the lowest-risk scenario: dichorionic-diamniotic (Di/Di) twins, who have separate placentas and amniotic sacs. For an uncomplicated Di/Di pregnancy, a planned delivery is generally recommended between 37 weeks and 38 weeks and six days of gestation. This window is chosen because, after 38 weeks, the risk of stillbirth begins to outweigh the benefits of continued growth. Scheduling within this range allows the babies to reach near-term maturity while mitigating the rising risks of late multiple pregnancy complications.
The optimal target for a scheduled C-section in uncomplicated Di/Di twin pregnancies often falls within this 37 to 38-week range. Although many Di/Di pregnancies are eligible for planned vaginal delivery, a scheduled C-section is frequently chosen due to factors like the twins’ positioning or a previous C-section. For instance, if the first twin is not positioned head-down, a C-section is generally recommended.
The Critical Role of Chorionicity in Timing
The greatest factor determining the timing of a twin C-section is chorionicity, which refers to whether the twins share a placenta. This distinction is made early in pregnancy and dictates the level of risk and the delivery schedule. Di/Di twins, who have separate placentas, have the latest delivery window.
Monochorionic twins share a single placenta and blood supply, carrying significantly higher risks that necessitate an earlier delivery. Monochorionic-diamniotic (Mo/Di) twins share a placenta but have separate sacs. The shared organ increases the likelihood of complications like Twin-to-Twin Transfusion Syndrome (TTTS). To avoid the increased risk of stillbirth after 36 weeks, the planned C-section for Mo/Di twins is usually scheduled between 36 weeks and 36 weeks and six days.
The highest risk type is the monochorionic-monoamniotic (Mo/Mo) twin pregnancy, where the babies share both a placenta and a single amniotic sac. This unique situation presents the severe risk of the twins’ umbilical cords becoming tangled, which can lead to sudden loss of blood flow for one or both babies. Because the risk of cord entanglement outweighs the risks of late-preterm birth, Mo/Mo twins are scheduled for the earliest delivery, typically by C-section between 32 and 34 weeks of gestation.
Medical Conditions That Require Earlier Scheduling
The established guidelines assume an uncomplicated pregnancy; however, various maternal or fetal complications can override these dates, requiring an earlier delivery. Maternal complications, such as the sudden onset of severe preeclampsia, involve dangerously high blood pressure and can compromise placental function, requiring immediate intervention. Similarly, a placental abruption, where the placenta prematurely separates from the uterine wall, necessitates an emergency C-section.
Fetal complications also frequently push the delivery date forward, often resulting in an emergency procedure. Severe intrauterine growth restriction (IUGR) in one or both twins, which indicates the babies are not growing properly, may force an earlier delivery when the environment inside the womb is deemed less safe than the outside. For monochorionic twins, conditions like severe TTTS or monitoring of fetal distress can also mandate a delivery prior to the planned date. These scenarios shift the delivery from a planned, elective procedure to a medically mandated one, with the timing determined by the specific severity of the condition.
Preparing for the Scheduled C-Section Date
Once the optimal date for the planned C-section is set, preparation shifts to the logistics of the delivery. The medical team provides detailed pre-operative instructions, typically including fasting from food and drink to minimize the risk of aspiration during surgery. Necessary pre-operative testing, such as blood work, may also be required in the days leading up to the procedure.
Parents should prepare for the hospital stay by having a well-organized hospital bag tailored for two newborns and a longer postpartum recovery than a vaginal delivery. On the day of the scheduled C-section, pre-registration and administrative tasks are finalized to ensure a smooth transition to the operating room. The delivery itself involves a larger-than-normal team, including two pediatric teams—one for each baby—which helps ensure both twins receive immediate, specialized attention upon birth.