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Multiple Pregnancy


Twins

  • 1 in 70-80 pregnancies
  • increases complication rates
    • pregnancy-induced hypertension from 5% → 15%
    • anaemia 3-5% → 15%
    • polyhydramnios <2% → >5%
    • pre-term labour <5% → >25%
    • perinatal mortality 0.9% → 5.6%
  • various presentations
  • morbidity and mortality higher for second twin

    • uterine contraction may shear placenta

  • often small / premature

    • overdistended uterus

  • risk maternal haemorrhage

    • atony of overdistended uterus

  • may be delivered vaginally or by Caesarean depending on presentation

  • if no complication can be delivered vaginally

    • cephalic : cephalic 45%

    • cephalic : breech 37%

  • LSCS

    • breech : cephalic

    • breech : breech 10%

    • cephalic : transverse 5%

    • breech : transverse 2%

    • transverse : transverse 0.5%

  • First twin delivered normally

  • 2nd twin converted to longitudinal lie if possible

  • may need syntocinon drip if contractions fade

  • if compound presentation, cord prolapse then may need emergency Caesarean section

  • Delivery 2nd twin within 15-20 mins of first

Triplets and above

  • almost always result of fertility treatment

  • should be delivered by Caesarean Section

 


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