Skip to main content Accessibility help
×
Hostname: page-component-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-28T07:28:44.748Z Has data issue: false hasContentIssue false

Chapter 18 - Multiple Pregnancy

from Section 3 - Fetal Medicine

Published online by Cambridge University Press:  20 November 2021

Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
Get access

Summary

Multiple pregnancy is a high-risk pregnancy. The antenatal care of these pregnancies is often complicated and intrapartum care may be technically challenging and require a skilled and experienced clinician. Women with multiple pregnancies have increased risk of adverse outcomes for both mother and fetuses during the pregnancy and childbirth, such as an increased risk of miscarriage, anaemia, hypertensive disorders, haemorrhage, operative delivery, caesarean section (CS) and postnatal complications. Maternal mortality is 2.5 times higher in multiple births than in singletons [1], and there is an increased risk of preterm birth, pre-eclampsia, prelabour rupture of membranes (PROM), placental abruption, other placental abnormalities (including placenta praevia), gestational diabetes, pyelonephritis, postpartum haemorrhage, etc. The hospital admission rate of such patients is six times greater than in singleton pregnancies [2]. Multiple pregnancy is associated with a sixfold increase in the risk of preterm birth, which is the leading cause of infant mortality and long-term mental and physical disability, including cerebral palsy, learning difficulties and chronic lung disease [1]. All these potential complications provide the incentive for doctors to learn more about multifetal pregnancy to enable them to provide optimal clinical care to such patients in accordance with the best available evidence and standards of care.

Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Obstetrics & Maternal-Fetal Medicine
, pp. 147 - 157
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

NICE. Multiple Pregnancy: Antenatal Care for Twin and Triplet Pregnancies. Clinical Guideline CG129. 2011. http://dx.doi.org/10.1016/j.rcl.2013.07.010%0Ahttps://www.nice.org.uk/guidance/cg129CrossRefGoogle Scholar
American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Practice Bulletin No 144: multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol. 2014;123(5):1118–32. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00006250–201405000-00040Google Scholar
European Perinatal Health Report [Internet]. Available from: www.europeristat.comGoogle Scholar
Pison, G, D’Addato, A V. Frequency of twin births in developed countries. Twin Res Hum Genet. 2006;9:250–9.CrossRefGoogle ScholarPubMed
Hoekstra, C, Zhao, ZZ, Lambalk, CB, et al. Dizygotic twinning. Hum Reprod Update. 2008;14(1):37-47.CrossRefGoogle ScholarPubMed
Bręborowicz, GH, Malinowski, W. Atlas ciąży wielopłodowej. Poznań: Ośrodek Wydawnictw Naukowych; 2008.Google Scholar
Manso, P, Vaz, A, Taborda, A, Silva, IS. [Chorionicity and perinatal complications in twin pregnancy: a 10 years case series]. Acta Med Port. 2011;24:695–8.Google ScholarPubMed
Goya, M, Carreras, E, Cabero, L. Re: ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 2016;48(5):669-70.CrossRefGoogle ScholarPubMed
Lopriore, E, Sueters, M, Middeldorp, JM, et al. Twin pregnancies with two separate placental masses can still be monochorionic and have vascular anastomoses. Am J Obstet Gynecol. 2006;194:804–8.CrossRefGoogle ScholarPubMed
Lewi, L, Devlieger, R, De Catte, L, Deprest, J. Assessment of twin gestation. In Coady, AM, Bower, S, eds. Twining’s Textbook of Fetal Abnormalities, 3rd ed. London: Churchill Livingstone, Elsevier Ltd; 2015.Google Scholar
Martin, JA, Hamilton, BE, Sutton, PD, et al. Births: final data for 2005. Natl Vital Stat Rep. 2007;56:1103.Google ScholarPubMed
Slaghekke, F, Kist, WJ, Oepkes, D, et al. Twin anemia-polycythemia sequence: diagnostic criteria, classification, perinatal management and outcome. Fetal Diagn Ther. 2010;27:181–90.CrossRefGoogle ScholarPubMed
Khalil, A. Modified diagnostic criteria for twin-to-twin transfusion syndrome prior to 18 weeks’ gestation: time to change? Ultrasound Obstet Gynecol. 2017;49:804–5.CrossRefGoogle ScholarPubMed
Quintero, RA, Morales, WJ, Allen, MH, et al. Staging of twin-twin transfusion syndrome. J Perinatol. 1999;19:550–5.CrossRefGoogle ScholarPubMed
Khalil, A, Cooper, E, Townsend, R, Thilaganathan, B. Evolution of stage 1 twin-to-twin transfusion syndrome (TTTS): systematic review and meta-analysis. Twin Res Hum Genet. 2016;19:207–16.CrossRefGoogle ScholarPubMed
Habli, M, Bombrys, A, Lewis, D, et al. Incidence of complications in twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation: a single-center experience. Am J Obstet Gynecol. 2009;201:417.e1417.e7.CrossRefGoogle ScholarPubMed
Robyr, R, Lewi, L, Salomon, LJ et al. Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2006;194:796803.CrossRefGoogle ScholarPubMed
van Gemert, MJC, van den Wijngaard, JPHM, Vandenbussche, FPHA. Twin reversed arterial perfusion sequence is more common than generally accepted. Birth Defects Res A Clin Mol Teratol. 2015;103:641–3.CrossRefGoogle ScholarPubMed
Steffensen, TS, Gilbert-Barness, E, Spellacy, W, Quintero, RA. Placental pathology in trap sequence: clinical and pathogenetic implications. Fetal Pediatr Pathol. 2008;27:1329.CrossRefGoogle ScholarPubMed
van Gemert, MJC, Ross, MG, Nikkels, PGJ, Wijngaard JPHM van den. Acardiac twin pregnancies part III: Model simulations. Birth Defects Res Part A Clin Mol Teratol. 2016;106:1008–15.CrossRefGoogle Scholar
D’Antonio, F, Khalil, A, Dias, T, Thilaganathan, B. Weight discordance and perinatal mortality in twins: Analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort. Ultrasound Obstet Gynecol. 2013;41:643–8.Google Scholar
Kalafat, E, Sebghati, M, Thilaganathan, B, et al. Predictive accuracy of Southwest Thames Obstetric Research Collaborative (STORK) chorionicity‐specific twin growth charts for stillbirth: a validation study. Ultrasound Obstet Gynecol. 2019;53:193–9.CrossRefGoogle Scholar
Hillman, SC, Morris, RK, Kilby, MD. Co-twin prognosis after single fetal death. Obstet Gynecol. 2011;118:928–40.CrossRefGoogle ScholarPubMed
D’Antonio, F, Thilaganathan, B, Dias, T, Khalil, A, Southwest Thames Obstetric Research Collaborative (STORK). Influence of chorionicity and gestational age at single fetal loss on risk of preterm birth in twin pregnancy: analysis of STORK multiple pregnancy cohort. Ultrasound Obstet Gynecol. 2017;50:723–7.Google Scholar
Prognosis for the Co-Twin Following Intrauterine Single-Twin Death. Swiss Society of Neonatology; 2016 [Internet]. Available from: www.wikipedia.org.Google Scholar
Landy, H. The vanishing twin: a review. Hum Reprod Update. 1998;4:177–83.CrossRefGoogle ScholarPubMed
Sampson, A, de Crespigny, LC. Vanishing twins: the frequency of spontaneous fetal reduction of a twin pregnancy. Ultrasound Obstet Gynecol. 1992;2(2):107-9.CrossRefGoogle ScholarPubMed
A.C.O.G., S.M-F.M. ACOG Practice Bulletin No. 144: multifetal gestations: twin, triplet and higher order multifetal pregnancies. Obstet Gynecol. 2014;123:1118–32.Google Scholar
National Collaborating Centre for Women’s and Children’s Health. Multiple Pregnancy: The Management of Twin and Triplet Pregnancies in the Antenatal Period. London: RCOG Press; 2011.Google Scholar
Glinianaia, SV, Rankin, J, Wright, C. Congenital anomalies in twins: a register-based study. Hum Reprod. 2008;23:1306–11.CrossRefGoogle ScholarPubMed
Dodd, JM, Crowther, CA, Haslam, RR, Robinson, JS. Elective birth at 37 weeks of gestation versus standard care for women with an uncomplicated twin pregnancy at term. Obstet Gynecol Surv. 2012;67:675–6.CrossRefGoogle Scholar
Cincotta, R, Flenady, V, Hockey, R, King, J. Mortality of twins and singletons by gestational age: a varying coefficient approach. Perinatal Society of Australia and New Zealand, 5th Annual Congress: 2001; Canberra, Australia. 2001. p. 22.Google Scholar
Minakami, H, Sato, I. Reestimating date of delivery in multifetal pregnancies. JAMA. 1996;275:1432–4.CrossRefGoogle ScholarPubMed
Twin and triplet pregnancy: NICE guideline DRAFT. March 2019.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×