Twins: more than twice the trouble?

The incidence of twinning is rising, and we are all seeing more of the complications. Twins make up about 20% of all babies in many preterm cohorts; about a half of all twins are premature. The annotation by Chiswick (page 165) provides a characteristically helpful and thoughtful commentary on the two original articles which follow. Hopefully the message that the neonatal criteria which are used to diagnose twin-twin transfusion syndrome (TTS) are inaccurate and underdiagnose the problem is not new to readers of the Archives, who will read the paper of Seng and Rajadurai with this in mind (page 167). Nevertheless, their distinction between acute and chronic TTS may prove to have some implications for management. Cincotta and his colleagues from Bisbane add to their previous contributions to the literature on TTS (page 170). Of 17 pregnancies complicated by TTS which were diagnosed early in pregnancy (the first trimester) 29 babies were liveborn between 23 and 36 weeks of gestation and …