Survival Rate for Twins Delivered at 32 Weeks Gestation

The survival rate for twins delivered at 32 weeks gestation is excellent, with approximately 95-96% survival rate based on current evidence.

Factors Affecting Survival at 32 Weeks Gestation

Twins born between 28-31 weeks have lower mortality rates compared to singletons at the same gestational age (3.9% vs 6.5%), suggesting that by 32 weeks, mortality rates would be even lower 1
Chorionicity significantly impacts outcomes, with dichorionic twins generally having better outcomes than monochorionic twins 2
For monochorionic diamniotic twins without complications, delivery is typically recommended between 34-36 weeks of gestation 3
For dichorionic twins with a previous single fetal demise but no other complications, delivery can be delayed until 39 weeks 4

The rate of preterm birth at <32 weeks is approximately 7.4% for dichorionic twins, 14.2% for monochorionic diamniotic twins, and 26.8% for monochorionic monoamniotic twins 2
Common complications for twins delivered at 32 weeks include:
- Respiratory distress syndrome (though less common than in earlier gestational ages) 5
- Need for NICU admission 6
- Potential for mild neurodevelopmental issues 1

For twins delivered before 32 weeks, meta-analysis data shows no significant difference in neonatal mortality between vaginal delivery and cesarean section (OR 0.84,95% CI 0.57-1.24) 5
No significant differences were found in key morbidity outcomes including:
- 5-minute Apgar scores <7 5
- Necrotizing enterocolitis 5
- Intraventricular hemorrhage 5
- Respiratory distress syndrome 5

For monochorionic twins with TTTS who have undergone successful fetoscopic laser surgery, delivery is recommended between 34-36 weeks of gestation 3
In TTTS pregnancies complicated by post-treatment single fetal demise, full-term delivery (39 weeks) of the surviving co-twin is recommended unless other indications for earlier delivery exist 3

Weekly surveillance is recommended for monochorionic twins after laser therapy for TTTS for 6 weeks, followed by every-other-week surveillance 3
For uncomplicated twin pregnancies, ultrasound assessments should be performed every 3-4 weeks, including fetal biometry, amniotic fluid volume assessment, and umbilical artery Doppler studies 4
Antenatal corticosteroids should be considered for fetal lung maturation, particularly in pregnancies complicated by TTTS and those undergoing invasive interventions 3

Failing to determine chorionicity early in pregnancy, which significantly impacts management decisions and outcomes 3
Not recognizing signs of TTTS or twin anemia-polycythemia sequence (TAPS), which require specialized management 3
Delaying referral to a specialized fetal care center when indicated for advanced disease stages 3
Not accounting for discordant growth, which may indicate selective intrauterine growth restriction and impact outcomes 4