Multifetal pregnancy increases the risk of

Preeclampsia Preeclampsia and Eclampsia Preeclampsia is new-onset or worsening of existing hypertension with proteinuria after 20 weeks gestation. Eclampsia is unexplained generalized seizures in patients with preeclampsia. Diagnosis... read more
Gestational diabetes Diabetes Mellitus in Pregnancy Pregnancy aggravates preexisting type 1 (insulin-dependent) and type 2 (non–insulin-dependent) diabetes but does not appear to exacerbate diabetic retinopathy, nephropathy, or neuropathy ( 1)... read more
Postpartum hemorrhage Postpartum Hemorrhage Postpartum hemorrhage is blood loss of > 1000 mL or blood loss accompanied by symptoms or signs of hypovolemia within 24 hours of birth. Diagnosis is clinical. Treatment depends on etiology... read more
Cesarean delivery Cesarean Delivery Cesarean delivery is surgical delivery by incision into the uterus. Up to 30% of deliveries in the US are cesarean. The rate of cesarean delivery fluctuates. It has recently increased, partly... read more
Preterm delivery Preterm Labor Labor (contractions resulting in cervical change) that begins before 37 weeks gestation is considered preterm. Risk factors include prelabor rupture of membranes, uterine abnormalities, infection... read more
Growth restriction Small-for-Gestational-Age (SGA) Infant Infants whose weight is the 10th percentile for gestational age are classified as small for gestational age. Complications include perinatal asphyxia, meconium aspiration, polycythemia, and... read more
Stillbirth Stillbirth Stillbirth is delivery of a dead fetus at > 20 weeks gestation. Maternal and fetal testing is done to determine the cause. Management is as for routine care after live delivery. Stillbirth,... read more
Neonatal death, largely due to prematurity Premature Infants An infant born before 37 weeks gestation is considered premature. Prematurity is defined by the gestational age at which infants are born. Previously, any infant weighing 2.5 kg was termed premature... read more
Postpartum depression Postpartum Depression Postpartum depression is depressive symptoms that last > 2 weeks after delivery and meet criteria for major depression. Postpartum depression occurs in 10 to 15% of women after delivery. Although... read more

The overdistended uterus tends to stimulate preterm labor Preterm Labor Labor (contractions resulting in cervical change) that begins before 37 weeks gestation is considered preterm. Risk factors include prelabor rupture of membranes, uterine abnormalities, infection... read more , causing preterm delivery. Average gestation is

Twins: 35 to 36 weeks
Triplets: 32 weeks
Quadruplets: 30 weeks

Fetal presentation may be abnormal. The uterus may contract after delivery of the first child, shearing away the placenta and increasing risk for the remaining fetuses. Sometimes uterine distention impairs postpartum uterine contraction, leading to atony and maternal hemorrhage Postpartum Hemorrhage Postpartum hemorrhage is blood loss of > 1000 mL or blood loss accompanied by symptoms or signs of hypovolemia within 24 hours of birth. Diagnosis is clinical. Treatment depends on etiology... read more .

Some complications develop only in multifetal pregnancies. An example is twin-twin transfusion syndrome (when twins share the same placenta; this syndrome results in vascular communication between the two, which can lead to unequal sharing of blood).

Prenatal ultrasonography

Multifetal pregnancy is suspected if the uterus is large for dates; it is evident on prenatal ultrasonography.

Cesarean delivery when indicated

Cesarean delivery Cesarean Delivery Cesarean delivery is surgical delivery by incision into the uterus. Up to 30% of deliveries in the US are cesarean. The rate of cesarean delivery fluctuates. It has recently increased, partly... read more is done when indicated. Cesarean delivery is recommended for twins unless the presenting twin is in vertex presentation. Higher-order multiples are typically delivered by cesarean regardless of presentation.

In multifetal pregnancies, the overdistended uterus tends to stimulate preterm labor, resulting in preterm delivery.
Check for other possible complications, such as preeclampsia and gestational diabetes, and prepare for preterm delivery, cesarean delivery, and postpartum hemorrhage.
If the uterus is large for gestational age, do ultrasonography.
For most multifetal pregnancies, deliver by cesarean unless the presenting twin is in vertex presentation.

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clomiphene	CLOMID

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Multifetal Pregnancy

Complications

Diagnosis

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