Multiple pregnancy has received increasing attention over the last decade, with the National Institute for Health and Care Excellence (NICE) guideline on multiple pregnancy already in its second edition.1 The first review article about multiple pregnancy in The Obstetrician and Gynaecologist (TOG) was published in 2000 by Taylor and Fisk (TOG 2000;2:4–10). Looking again at this article and seeing the photograph of a young Myles Taylor (as all TOG articles featured the authors’ photos then!) brought back fond (…) memories of reading this for the MRCOG examination. It is interesting to compare the older article with a 2010 Review by Devaseelan and Ong (TOG 2010;12:179–85). Most aspects of care were largely unchanged, but the Eurofoetus trial2 had proven that endoscopic laser ablation of placental anastomoses was the treatment of choice for severe twin-to-twin transfusion syndrome (TTTS). Soon after the publication of the Eurofoetus study,2 Smith and Denbow wrote a comprehensive review on TTTS (TOG 2006;8:1–6) and its evolving management in light of the landmark trial. The complex management of TTTS has also been reviewed in the two Advances in fetal therapy articles published in 2005 (TOG 2005;7:183–9) by O’Brien and Kumar and in 2010 (TOG 2010;12:94–102) by Morris et al.

Monoamniotic twin pregnancies are rare and challenging to manage. Dias et al. reviewed the pathophysiology, outcomes and management of these pregnancies in 2012 (TOG 2012;14:71–8). Even more challenging is the management of higher order multiple pregnancies and multiple pregnancies where one fetus has severe genetic or congenital abnormalities. Beriwal et al. summarised elegantly Multifetal pregnancy reduction and selective termination in 2020 (TOG 2020;22:284–92). Importantly, the authors highlighted the ethical, legal and psychological considerations for women, couples and doctors in these difficult cases.

Beyond the rare multiple pregnancy cases that are mainly managed in fetal medicine units, the major challenge and source of neonatal mortality and morbidity in multiple pregnancies is preterm birth. Effective prevention strategies are still not available, but the most recent evidence was finely appraised by Murray et al. in 2018 (TOG 2018;20:57–63). For both preterm and term births, mode of delivery can be a difficult decision. Breeze and Smith reviewed the evidence for mode of delivery in twins in 2004 (TOG 2004;6:222–6). The Twin Birth Study has been published since then3 and has answered some questions about the safety of vaginal birth and caesarean section and actual mode of delivery depending on original intention.

Overall, TOG has published a comprehensive selection of articles on the management of multiple pregnancy. As it is now 11 years since the last general multiple pregnancy review article (TOG 2010;12:179–85), perhaps it is time for another up-to-date review incorporating the latest evidence from the Twin Birth Study,3 the STOPPIT-2 trial4 and other relevant studies.