Chapter-09 Multifetal Pregnancy

BOOK TITLE: Management of High-Risk Pregnancy—A Practical Approach

1. Reena
Publishing Year
Author Affiliations
1. Lady Hardinge Medical College and SSK Hospital, New Delhi, India, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi
Chapter keywords


Multifetal pregnancy is a high-risk pregnancy with increased maternal and perinatal risk. Over the past few decades there is a 40% increase in rate of twinning and a three-to-four fold increase in higher order births. This increase is largely due to increased application of assisted reproductive techniques. Early ultrasonography for dating and determining chronicity is important and detailed USG at 18–20 weeks of gestation to rule out congenital anomalies is indicated. Early signs and symptoms of preeclampsia, preterm labor, intrauterine growth restriction should be detected. Hospitalization is indicated if any complications develop. Delivery should be done preferably at a tertiary level hospital. Watchful expectancy for the patient to go into spontaneous labor is indicated if there are no complications. Expert obstetrician, pediatrician and anesthesiologist should be available at the time of delivery. Continuous electronic monitoring of all fetuses should be done if possible. Elective cesarean section is done for non-cephalic leading twin, monoamniotic twins, triplets and higher order births. Vaginal delivery is allowed if leading twin is cephalic. Assess the lie and presentation of second twin by abdominal and per vaginal examination after the delivery of the first baby. Cesarean section for second twin is done only if the second twin is larger than the first or it is in transverse lie and obstetrician is not skilled in IPV or the cervix contracts and thickens or nonreassuring fetal heart rate develops. Oxytocin infusion should be started after delivery of all fetuses to reduce the risk of postpartum hemorrhage.

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