Multifetal (multiple) pregnancy occurs in up to 1 of 30 deliveries.
Risk factors for multiple pregnancy include
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Ovarian stimulation (usually with clomiphene or gonadotropins)
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Assisted reproduction (eg, in vitro fertilization)
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Prior multifetal pregnancy
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Advanced maternal age
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West African descent
Complications
Multifetal pregnancy increases the risk of
The overdistended uterus tends to stimulate preterm labor, causing preterm delivery. Average gestation is
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.
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).
Diagnosis
Treatment
Cesarean delivery 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.
Key Points
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In multifetal pregnancies, the overdistended uterus tends to stimulate preterm labor, resulting in preterm delivery.
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Check for other possible complications, such as preeclampsia and gestational diabetes, and prepare for preterm delivery, cesarean delivery, and postpartum hemorrhage.
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If the uterus is large for gestational age, do ultrasonography.
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For most multifetal pregnancies, deliver by cesarean unless the presenting twin is in vertex presentation.
Drugs Mentioned In This Article
| Drug Name | Select Trade |
|---|---|
clomiphene |
CLOMID |
