Skip to main content
SpringerLink
Log in

Maternal Complications in Multifetal Pregnancy

  • Chapter
  • First Online:
Twin and Higher-order Pregnancies

  • 596 Accesses

Abstract

Although attention for fetal complications of multifetal pregnancies prevails in modern obstetric teaching and literature, it is a moral and medical imperative to also consider the health of the woman herself in clinical decision-making. Multifetal pregnancy poses her at increased risk of antepartum and peripartum complications compared to singleton pregnancies. It is important to be aware of such risks, and to, as much as possible, avoid iatrogenic multifetal pregnancies as well as medical procedures without medical indication, both of which may be harmful to the woman.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Organization. The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD MM. Publication date: 2012. ISBN: 978 92 4 154845 8. Accessible on: https://apps.who.int/iris/bitstream/handle/10665/70929/9789241548458_eng.pdf;jsessionid=A660C360F3FD05CF80085A0EA22059B1?sequence=1

  2. Say L, Souza JP, Pattinson RC, WHO working group on Maternal Mortality and Morbidity classifications. Maternal near miss–towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol. 2009;23(3):287–96.

    Article  PubMed  Google Scholar 

  3. Brown MA, Magee LA, Kenny LC, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018;72(1):24–43.

    Article  CAS  PubMed  Google Scholar 

  4. World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Publication date: 2012. ISBN: 978 92 4 154850 2. Accesible on: https://apps.who.int/iris/bitstream/handle/10665/75411/9789241548502_eng.pdf?sequence=1

  5. Nederlandse Vereniging voor Obstetrie en Gynaecologie. NVOG-richtlijn Hemorrhagia Postpartum (HPP). Arnhem: NVOG; 2013. Accessible on: https://www.nvog.nl/wp-content/uploads/2018/02/Hemorrhagia-postpartum-HPP-3.0-14-11-2013.pdf

  6. Mavrides E, Allard S, Chandraharan E, Collins P, Green L, Hunt BJ, Riris S, Thomson AJ, on behalf of the Royal College of Obstetricians and Gynaecologists. Prevention and Management of Postpartum Haemorrhage. BJOG. 2017;124(5):e106–e49.

    Article  Google Scholar 

  7. Schaap T, Bloemenkamp K, Deneux-Tharaux C, et al. Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity. BJOG. 2019;126(3):394–401.

    Article  CAS  PubMed  Google Scholar 

  8. Louik C, Hernandez-Diaz S, Werler MM, Mitchell AA. Nausea and vomiting in pregnancy: maternal characteristics and risk factors. Paediatr Perinat Epidemiol. 2006;20(4):270–8.

    Article  PubMed  Google Scholar 

  9. Fiaschi L, Nelson-Piercy C, Deb S, King R, Tata LJ. Clinical management of nausea and vomiting in pregnancy and hyperemesis gravidarum across primary and secondary care: a population-based study. BJOG. 2019;126(10):1201–11.

    Article  CAS  PubMed  Google Scholar 

  10. Pritchard JA. Changes in the blood volume during pregnancy and delivery. Anesthesiology. 1965;26:393–9.

    Article  CAS  PubMed  Google Scholar 

  11. Ru Y, Pressman EK, Cooper EM, et al. Iron deficiency and anemia are prevalent in women with multiple gestations. Am J Clin Nutr. 2016;104(4):1052–60.

    Article  CAS  PubMed  Google Scholar 

  12. Kametas NA, McAuliffe F, Krampl E, Chambers J, Nicolaides KH. Maternal cardiac function in twin pregnancy. Obstet Gynecol. 2003;102(4):806–15.

    PubMed  Google Scholar 

  13. Kuleva M, Youssef A, Maroni E, et al. Maternal cardiac function in normal twin pregnancy: a longitudinal study. Ultrasound Obstet Gynecol. 2011;38(5):575–80.

    Article  CAS  PubMed  Google Scholar 

  14. Macdonald-Wallis C, Lawlor DA, Fraser A, May M, Nelson SM, Tilling K. Blood pressure change in normotensive, gestational hypertensive, preeclamptic, and essential hypertensive pregnancies. Hypertension. 2012;59(6):1241–8.

    Article  CAS  PubMed  Google Scholar 

  15. Campbell DM. Maternal adaptation in twin pregnancy. Semin Perinatol. 1986;10(1):14–8.

    CAS  PubMed  Google Scholar 

  16. Redford DH. Uterine growth in twin pregnancy by measurement of total intrauterine volume. Acta Genet Med Gemellol. 1982;31(3–4):145–8.

    Article  CAS  PubMed  Google Scholar 

  17. Schwartz DB, Daoud Y, Zazula P, et al. Gestational diabetes mellitus: metabolic and blood glucose parameters in singleton versus twin pregnancies. Am J Obstet Gynecol. 1999;181(4):912–4.

    Article  CAS  PubMed  Google Scholar 

  18. Sivan E, Maman E, Homko CJ, Lipitz S, Cohen S, Schiff E. Impact of fetal reduction on the incidence of gestational diabetes. Obstet Gynecol. 2002;99(1):91–4.

    PubMed  Google Scholar 

  19. Roach VJ, Lau TK, Wilson D, Rogers MS. The incidence of gestational diabetes in multiple pregnancy. Aust N Z J Obstet Gynaecol. 1998;38(1):56–7.

    Article  CAS  PubMed  Google Scholar 

  20. Rauh-Hain JA, Rana S, Tamez H, Wang A, Cohen B, Cohen A, et al. Risk for developing gestational diabetes in women with twin pregnancies. J Matern Fetal Neonatal Med. 2009;22(4):293–9.

    Article  PubMed  Google Scholar 

  21. Weissman A, Drugan A. Glucose tolerance in singleton, twin and triplet pregnancies. J Perinat Med. 2016;44(8):893–7.

    Article  CAS  PubMed  Google Scholar 

  22. Buhling KJ, Henrich W, Starr E, et al. Risk for gestational diabetes and hypertension for women with twin pregnancy compared to singleton pregnancy. Arch Gynecol Obstet. 2003;269(1):33–6.

    Article  PubMed  Google Scholar 

  23. Henderson CE, Scarpelli S, LaRosa D, Divon MY. Assessing the risk of gestational diabetes in twin gestation. J Natl Med Assoc. 1995;87(10):757–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Naidoo L, Jailal I, Moodley J, Desai R. Intravenous glucose tolerance tests in women with twin pregnancy. Obstet Gynecol. 1985;66(4):500–2.

    CAS  PubMed  Google Scholar 

  25. Weissgerber TL, Mudd LM. Preeclampsia and diabetes. Curr Diab Rep. 2015;15(3):9.

    Article  PubMed  CAS  Google Scholar 

  26. Naylor CD, Sermer M, Chen E, Sykora K. Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? Toronto Trihospital Gestational Diabetes Investigators. JAMA. 1996;275(15):1165–70.

    Article  CAS  PubMed  Google Scholar 

  27. Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med. 2013;159(2):123–9.

    Article  PubMed  Google Scholar 

  28. Kremer AE, Oude Elferink RP, Beuers U. Pathophysiology and current management of pruritus in liver disease. Clin Res Hepatol Gastroenterol. 2011;35(2):89–97.

    Article  CAS  PubMed  Google Scholar 

  29. Gonzalez MC, Reyes H, Arrese M, et al. Intrahepatic cholestasis of pregnancy in twin pregnancies. J Hepatol. 1989;9(1):84–90.

    Article  CAS  PubMed  Google Scholar 

  30. Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology. 2004;40(2):467–74.

    Article  PubMed  Google Scholar 

  31. Cui Y, Xu B, Zhang X, He Y, Shao Y, Ding M. Diagnostic and therapeutic profiles of serum bile acids in women with intrahepatic cholestasis of pregnancy-a pseudo-targeted metabolomics study. Clin Chim Acta. 2018;483:135–41.

    Article  CAS  PubMed  Google Scholar 

  32. Grymowicz M, Czajkowski K, Smolarczyk R. Pregnancy course in patients with intrahepatic cholestasis of pregnancy treated with very low doses of ursodeoxycholic acid. Scand J Gastroenterol. 2016;51(1):78–85.

    Article  CAS  PubMed  Google Scholar 

  33. Garcia-Flores J, Canamares M, Cruceyra M, et al. Clinical value of maternal bile acid quantification in intrahepatic cholestasis of pregnancy as an adverse perinatal outcome predictor. Gynecol Obstet Investig. 2015;79(4):222–8.

    Article  CAS  Google Scholar 

  34. Savander M, Ropponen A, Avela K, et al. Genetic evidence of heterogeneity in intrahepatic cholestasis of pregnancy. Gut. 2003;52(7):1025–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Ovadia C, Seed PT, Sklavounos A, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet. 2019;393(10174):899–909.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Matz H, Orion E, Wolf R. Pruritic urticarial papules and plaques of pregnancy: polymorphic eruption of pregnancy (PUPPP). Clin Dermatol. 2006;24(2):105–8.

    Article  PubMed  Google Scholar 

  37. Cohen LM, Capeless EL, Krusinski PA, Maloney ME. Pruritic urticarial papules and plaques of pregnancy and its relationship to maternal-fetal weight gain and twin pregnancy. Arch Dermatol. 1989;125(11):1534–6.

    Article  CAS  PubMed  Google Scholar 

  38. Elling SV, McKenna P, Powell FC. Pruritic urticarial papules and plaques of pregnancy in twin and triplet pregnancies. J Eur Acad Dermatol Venereol. 2000;14(5):378–81.

    Article  CAS  PubMed  Google Scholar 

  39. Hauth JC, Ewell MG, Levine RJ, et al. Pregnancy outcomes in healthy nulliparas who developed hypertension. Calcium for Preeclampsia Prevention Study Group. Obstet Gynecol. 2000;95(1):24–8.

    CAS  PubMed  Google Scholar 

  40. Buchbinder A, Sibai BM, Caritis S, et al. Adverse perinatal outcomes are significantly higher in severe gestational hypertension than in mild preeclampsia. Am J Obstet Gynecol. 2002;186(1):66–71.

    Article  PubMed  Google Scholar 

  41. Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010;376(9741):631–44.

    Article  PubMed  Google Scholar 

  42. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33.

    Article  PubMed  Google Scholar 

  43. Conde-Agudelo A, Belizan JM, Lindmark G. Maternal morbidity and mortality associated with multiple gestations. Obstet Gynecol. 2000 Jun;95(6 Pt 1):899–904.

    Article  CAS  PubMed  Google Scholar 

  44. Sibai BM, Hauth J, Caritis S, et al. Hypertensive disorders in twin versus singleton gestations. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol. 2000;182(4):938–42.

    Article  CAS  PubMed  Google Scholar 

  45. Luke B, Brown MB. Contemporary risks of maternal morbidity and adverse outcomes with increasing maternal age and plurality. Fertil Steril. 2007;88(2):283–93.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Day MC, Barton JR, O'Brien JM, Istwan NB, Sibai BM. The effect of fetal number on the development of hypertensive conditions of pregnancy. Obstet Gynecol. 2005;106(5 Pt 1):927–31.

    Article  PubMed  Google Scholar 

  47. Walker MC, Murphy KE, Pan S, Yang Q, Wen SW. Adverse maternal outcomes in multifetal pregnancies. BJOG. 2004;111(11):1294–6.

    Article  PubMed  Google Scholar 

  48. Long PA, Oats JN. Preeclampsia in twin pregnancy–severity and pathogenesis. Aust N Z J Obstet Gynaecol. 1987;27(1):1–5.

    Article  CAS  PubMed  Google Scholar 

  49. Duley L, Meher S, Hunter KE, Seidler AL, Askie LM. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2019;2019(10):CD004659.

    PubMed Central  Google Scholar 

  50. The American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 202: gestational hypertension and preeclampsia. Obstet Gynecol. 2019;133(1):e1–e25.

    Google Scholar 

  51. World Health Organization. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. Publication date: 2011. ISBN: 978 92 4 154833 5 Accessible on: https://apps.who.int/iris/bitstream/handle/10665/44703/9789241548335_eng.pdf?sequence=1

  52. National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. Clinical guideline [NG133]. Publication date: 2019. Accessible on: https://www.nice.org.uk/guidance/ng133

  53. Bergeron TS, Roberge S, Carpentier C, Sibai B, McCaw-Binns A, Bujold E. Prevention of preeclampsia with aspirin in multiple gestations: a systematic review and meta-analysis. Am J Perinatol. 2016;33(6):605–10.

    Article  PubMed  Google Scholar 

  54. Feng B, Zhai J, Cai Y. Effect of twin pregnancy chorionic properties on maternal and fetal outcomes. Taiwan J Obstet Gynecol. 2018;57(3):351–4.

    Article  PubMed  Google Scholar 

  55. Lucovnik M, Blickstein I, Lasic M, et al. Hypertensive disorders during monozygotic and dizygotic twin gestations: a population-based study. Hypertens Pregnancy. 2016;35(4):542–7.

    Article  PubMed  Google Scholar 

  56. Qin J, Wang H, Sheng X, Liang D, Tan H, Xia J. Pregnancy-related complications and adverse pregnancy outcomes in multiple pregnancies resulting from assisted reproductive technology: a meta-analysis of cohort studies. Fertil Steril. 2015;103(6):1492–508, e1–7.

    Article  PubMed  Google Scholar 

  57. Lynch A, McDuffie R Jr, Murphy J, Faber K, Orleans M. Preeclampsia in multiple gestation: the role of assisted reproductive technologies. Obstet Gynecol. 2002;99(3):445–51.

    PubMed  Google Scholar 

  58. Fox NS, Roman AS, Saltzman DH, Klauser CK, Rebarber A. Obesity and adverse pregnancy outcomes in twin pregnancies. J Matern Fetal Neonatal Med. 2014;27(4):355–9.

    Article  CAS  PubMed  Google Scholar 

  59. Lucovnik M, Blickstein I, Verdenik I, Trojner-Bregar A, Tul N. Maternal obesity in singleton versus twin gestations: a population-based matched case-control study. J Matern Fetal Neonatal Med. 2015;28(6):623–5.

    Article  PubMed  Google Scholar 

  60. Al-Obaidly S, Parrish J, Murphy KE, Maxwell C. Maternal pre-gravid body mass index and obstetric outcomes in twin gestations. J Perinatol. 2014;34(6):425–8.

    Article  CAS  PubMed  Google Scholar 

  61. The American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol. 2013;121(1):210–2.

    Article  Google Scholar 

  62. Pettit KE, Lacoursiere DY, Schrimmer DB, Alblewi H, Moore TR, Ramos GA. Maternal and neonatal outcomes in women with twin pregnancies with excessive gestational weight gain. J Matern Fetal Neonatal Med. 2016;29(13):2182–5.

    Article  PubMed  Google Scholar 

  63. Fox NS, Saltzman DH, Kurtz H, Rebarber A. Excessive weight gain in term twin pregnancies: examining the 2009 Institute of Medicine definitions. Obstet Gynecol. 2011;118(5):1000–4.

    Article  PubMed  Google Scholar 

  64. Bodnar LM, Pugh SJ, Abrams B, Himes KP, Hutcheon JA. Gestational weight gain in twin pregnancies and maternal and child health: a systematic review. J Perinatol. 2014;34(4):252–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Virkus RA, Lokkegaard E, Lidegaard O, et al. Risk factors for venous thromboembolism in 1.3 million pregnancies: a nationwide prospective cohort. PLoS One. 2014;9(5):e96495.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  66. Jacobsen AF, Skjeldestad FE, Sandset PM. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium–a register-based case-control study. Am J Obstet Gynecol. 2008;198(2):233, e1–7

    Article  PubMed  Google Scholar 

  67. Henriksson P, Westerlund E, Wallen H, Brandt L, Hovatta O, Ekbom A. Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilisation: cross sectional study. BMJ. 2013;346:e8632.

    Article  PubMed  PubMed Central  Google Scholar 

  68. James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol. 2006;194(5):1311–5.

    Article  PubMed  Google Scholar 

  69. Jacobsen AF, Skjeldestad FE, Sandset PM. Ante- and postnatal risk factors of venous thrombosis: a hospital-based case-control study. J Thromb Haemost. 2008;6(6):905–12.

    Article  CAS  PubMed  Google Scholar 

  70. Lindqvist P, Dahlback B, Marsal K. Thrombotic risk during pregnancy: a population study. Obstet Gynecol. 1999;94(4):595–9.

    CAS  PubMed  Google Scholar 

  71. Sultan AA, Tata LJ, West J, et al. Risk factors for first venous thromboembolism around pregnancy: a population-based cohort study from the United Kingdom. Blood. 2013;121(19):3953–61.

    Article  PubMed  CAS  Google Scholar 

  72. Liu S, Liston RM, Joseph KS, et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176(4):455–60.

    Article  PubMed  PubMed Central  Google Scholar 

  73. The Royal College of Obstetricians and Gynaecologists. Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperiom. Green-top Guideline No 37a. 2015.

    Google Scholar 

  74. Nederlandse Internisten Vereniging. Tromboseprofylaxe bij vrouwen na een sectio caesarea. Publication date: 2016. Accessible on: https://richtlijnendatabase.nl/richtlijn/antitrombotisch_beleid/preventie_vte_in_de_verloskunde/trombo-embolie_na_een_sectio_caesarea.html

  75. Gill P PA, Van Hook MD JW. Uterine Atony. [Updated 2019 May 2019]. In: StatPearls [Internet] Treasure Island (FL): StatPearls Publishing. 2020 Jan. Accessible on: https://www.ncbi.nlm.nih.gov/books/NBK493238/#_NBK493238_pubdet_

  76. Suzuki S, Kikuchi F, Ouchi N, et al. Risk factors for postpartum hemorrhage after vaginal delivery of twins. J Nippon Med Sch. 2007;74(6):414–7.

    Article  PubMed  Google Scholar 

  77. Marocchini M, Lauferon J, Quantin C, Sagot P. Postpartum hemorrhage with transfusion: trends, near misses, risk factors and management at the scale of a perinatal network. J Gynecol Obstet Hum Reprod. 2017;46(5):455–60.

    Article  CAS  PubMed  Google Scholar 

  78. Kramer MS, Berg C, Abenhaim H, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol. 2013;209(5):449, e1–7

    Article  PubMed  Google Scholar 

  79. Blitz MJ, Yukhayev A, Pachtman SL, et al. Twin pregnancy and risk of postpartum hemorrhage. J Matern Fetal Neonatal Med. 2019;5:1–6.

    Google Scholar 

  80. Nyflot LT, Sandven I, Stray-Pedersen B, et al. Risk factors for severe postpartum hemorrhage: a case-control study. BMC Pregnancy Childbirth. 2017;17(1):17.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Davey MA, Flood M, Pollock W, Cullinane F, McDonald S. Risk factors for severe postpartum haemorrhage: a population-based retrospective cohort study. Aust N Z J Obstet Gynaecol. 2019;60(4):522–32.

    Article  PubMed  Google Scholar 

  82. Butwick AJ, Ramachandran B, Hegde P, Riley ET, El-Sayed YY, Nelson LM. Risk factors for severe postpartum hemorrhage after cesarean delivery: case-control studies. Anesth Analg. 2017;125(2):523–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Ramler PI, van den Akker T, Henriquez D, et al. Women receiving massive transfusion due to postpartum hemorrhage: a comparison over time between two nationwide cohort studies. Acta Obstet Gynecol Scand. 2019;98(6):795–804.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Witteveen T, Van Den Akker T, Zwart JJ, Bloemenkamp KW, Van Roosmalen J. Severe acute maternal morbidity in multiple pregnancies: a nationwide cohort study. Am J Obstet Gynecol. 2016;214(5):641, e1-e10.

    Article  PubMed  Google Scholar 

  85. Zwart JJ, Dijk PD, van Roosmalen J. Peripartum hysterectomy and arterial embolization for major obstetric hemorrhage: a 2-year nationwide cohort study in the Netherlands. Am J Obstet Gynecol. 2010;202(2):150, e1–7

    Article  PubMed  Google Scholar 

  86. Maraschini A, Lega I, D'Aloja P, et al. Women undergoing peripartum hysterectomy due to obstetric hemorrhage: a prospective population-based study. Acta Obstet Gynecol Scand. 2019;99(2):274–82.

    Article  PubMed  Google Scholar 

  87. Francois K, Ortiz J, Harris C, Foley MR, Elliott JP. Is peripartum hysterectomy more common in multiple gestations? Obstet Gynecol. 2005;105(6):1369–72.

    Article  PubMed  Google Scholar 

  88. Karami M, Jenabi E, Fereidooni B. The association of placenta previa and assisted reproductive techniques: a meta-analysis. J Matern Fetal Neonatal Med. 2018;31(14):1940–7.

    Article  PubMed  Google Scholar 

  89. auf Altenstadt JFS, Hukkelhoven CW, van Roosmalen J, Bloemenkamp KW. Pre-eclampsia increases the risk of postpartum haemorrhage: a nationwide cohort study in the Netherlands. PLoS One. 2013;8(12):e81959.

    Article  CAS  Google Scholar 

  90. Fan D, Xia Q, Liu L, et al. The incidence of postpartum hemorrhage in pregnant women with placenta previa: a systematic review and meta-analysis. PLoS One. 2017;12(1):e0170194.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  91. Kainer F, Hasbargen U. Emergencies associated with pregnancy and delivery: peripartum hemorrhage. Dtsch Arztebl Int. 2008;105(37):629–38.

    PubMed  PubMed Central  Google Scholar 

  92. National Institute for Health and Care Excellence. Twin and triplet pregnancy – evidence reviews for interventions to prevent postpartum haemorrhage in the third stage of labour. Clinical guideline [NG137]. Publication date: 2019. Accessible on: https://www.nice.org.uk/guidance/ng137/evidence/i-interventions-to-prevent-postpartum-haemorrhage-in-the-third-stage-of-labour-pdf-6898605381

  93. Kim ML, Hur YM, Ryu H, Lee MJ, Seong SJ, Shin JS. Clinical outcomes of prophylactic compression sutures for treatment of uterine atony during the cesarean delivery of twins. BMC Pregnancy Childbirth. 2020;20(1):40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Knight M, Nelson-Piercy C, Kurinczuk JJ, Spark P, Brocklehurst P, System UKOS. A prospective national study of acute fatty liver of pregnancy in the UK. Gut. 2008;57(7):951–6.

    Article  CAS  PubMed  Google Scholar 

  95. Fitzpatrick KE, van den Akker T, Bloemenkamp KWM, et al. Risk factors, management, and outcomes of amniotic fluid embolism: a multicountry, population-based cohort and nested case-control study. PLoS Med. 2019;16(11):e1002962.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Santana DS, Cecatti JG, Surita FG, et al. Twin pregnancy and severe maternal outcomes: the World Health Organization multicountry survey on maternal and newborn health. Obstet Gynecol. 2016;127(4):631–41.

    Article  PubMed  Google Scholar 

  97. Madar H, Goffinet F, Seco A, Rozenberg P, Dupont C, Deneux-Tharaux C. Severe acute maternal morbidity in twin compared with singleton pregnancies. Obstet Gynecol. 2019;133(6):1141–50.

    Article  PubMed  Google Scholar 

  98. Le Ray C, Pelage L, Seco A, Bouvier-Colle MH, Chantry AA, Deneux-Tharaux C, et al. Risk of severe maternal morbidity associated with in vitro fertilisation: a population-based study. BJOG. 2019;126(8):1033–41.

    Article  PubMed  Google Scholar 

  99. MacKay AP, Berg CJ, King JC, Duran C, Chang J. Pregnancy-related mortality among women with multifetal pregnancies. Obstet Gynecol. 2006;107(3):563–8.

    Article  PubMed  Google Scholar 

  100. Luke B, Brown MB. Maternal morbidity and infant death in twin vs triplet and quadruplet pregnancies. Am J Obstet Gynecol. 2008;198(4):401, e1–10

    Article  PubMed  Google Scholar 

  101. El-Toukhy T, Bhattacharya S, Akanda VA, on behalf of the Royal College of Obstetricians and Gynaecologists. Multiple pregnancies following assisted conception: scientific impact paper no. 22. BJOG. 2018;125(5):e12–e8.

    Article  Google Scholar 

  102. Kulkarni AD, Jamieson DJ, Jones HW, et al. Fertility treatments and multiple births in the United States. N Engl J Med. 2013;369(23):2218–25.

    Article  CAS  PubMed  Google Scholar 

Key Reading

  • Madar H, Goffinet F, Seco A, Rozenberg P, Dupont C, Deneux-Tharaux C. Severe acute maternal morbidity in twin compared with singleton pregnancies. Obstet Gynecol. 2019;133(6):1141–50.

    Article  PubMed  Google Scholar 

  • Santana DS, Cecatti JG, Surita FG, et al. Twin pregnancy and severe maternal outcomes: the world health organization multicountry survey on maternal and newborn health. Obstet Gynecol. 2016;127(4):631–41.

    Article  PubMed  Google Scholar 

  • Witteveen T, Van Den Akker T, Zwart JJ, Bloemenkamp KW, Van Roosmalen J. Severe acute maternal morbidity in multiple pregnancies: a nationwide cohort study. Am J Obstet Gynecol. 2016;214(5):641, e1–e10.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands

    Paul Ian Ramler & Thomas van den Akker

  2. Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands

    Thomas van den Akker

Authors
  1. Paul Ian Ramler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas van den Akker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas van den Akker .

Editor information

Editors and Affiliations

  1. Fetal Medicine Unit, St George’s University Hospitals, NHS Foundation Trust, London, UK

    Asma Khalil

  2. Department of Obstetrics & Gynaecology, University Hospitals Leuven, Leuven, Belgium

    Liesbeth Lewi

  3. Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands

    Enrico Lopriore

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ramler, P.I., van den Akker, T. (2021). Maternal Complications in Multifetal Pregnancy. In: Khalil, A., Lewi, L., Lopriore, E. (eds) Twin and Higher-order Pregnancies. Springer, Cham. https://doi.org/10.1007/978-3-030-47652-6_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-47652-6_23

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-47651-9

  • Online ISBN: 978-3-030-47652-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation