Twins and multiple gestation: Antepartum Care, Labor and Delivery

The Epidemic of Multiples

Causes of epidemic

Artificial reproductive technologies (ART) twin delivery, prenatal care

In vitro fertilization

Aging mothers

Extent of changes, 1979-1989

Twins increased: 102%

Triplets increased: 133%

Racial differences, 1989 data

Whites increased: 166%

Blacks increased: 215%

Effect of ART on higher order multiples

Natural risk factors for twins

Maternal age

Race

Family history

Nutritional status

Pregravid weight

Body mass index

Risks of Multiple Pregnancy

Basic premises

All multiples high risk

Multiples account for 8-10% of perinatal morbidity/mortality

B. Twins model major problems, 1985 data

1. Low birthweight. 9.1 vs 0.9

2. Preterm delivery 11.4 vs 1.6%

C. Duration of pregnancy

1. Twins: 37 weeks

2. Triplets: 33 weeks

3. Quadruplets: 28-29 weeks

4. Quintuplets: 26-27 weeks

D. Maternal medical risks

1. Anemia

2. Polyhydrammos

3. Toxemia

4. Postpartum hemorrhage

5. Preterm labor

6. Operative delivery

E. Fetal risks

1. Morbidity/mortality relative risk (RR): two to five times singles

2. Monozygotic morbidity/mortality RR: two to three times dizygotic

3. Monozygotic/maternal mortality: 50%

4. Congenital anomalies