Professional Documents
Culture Documents
Pregnancy
Multiple Pregnancy
• 3% of all pregnancies
• Induction of ovulation
– Increases both mono & dizygotic twining
– Gonadotropins - risk 20-40%
– Clomiphine - risk 7% twins, 0.5% triplets,
0.3 quadruplets
Risk Facotrs
• Race
– Blacks > White
– Africans
• Heredity
– Maternal transmission is stronger than paternal.
• Maternal Age & Parity
• Maternal size
Determination of Zygosity
• Why important?
– Guiding management
– Increased contractility
Maternal Adaptation
• Uterus may reach a volume of 10 L or more and weigh in
excess of 9 K especially if polyhydramnios is present.
• Incidence unestablished
– 1/60,000 births
Cephalic-breech
27%
Intrapartum Management
• Mode of delivery
– Vaginal for cephalic-cephalic
– Controversial for cephalic-non cephalic especially if
prematurity is a concern
– Increased rate of CS for second twin
– Controversial for breech-cephalic because of rare risk
of Locked twins
Intrapartum Management
• Delivery of the second twin
– Interval can be prolonged more than 30 minutes if
continuous fetal monitoring is employed
– Cesarean delivery rate is increased if interval is > 15
minutes
– External cephalic version
– Internal podalic version
External Cephalic Version
Internal Podalic Version
Triplets or More
• Increased maternal physiological adaptation &
complications
• Survival improved for triplets (>95%)
• Higher risk of prematurity
• Risk of vaginal delivery
• Cesarean is recommended