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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