Several therapies have been used including serial amnioreduction and laser coagulation of the communicating vessels. [22, 23] The rate of stillbirth has been estimated at 44.4 per 1000 births for monochorionic twin pregnancies versus 12.2 per 1000 births in dichorionic twin pregnancies. Multifetal pregnancies reach a nadir of perinatal mortality earlier than singleton pregnancies. One twin may obstruct the delivery of both fetuses in locked twins. This leads to increased blood flow to one fetus (recipient fetus) and reduced blood flow to the other fetus (donor fetus). 2015 Sep. 126 (3):e31-7. Prenat Diagn. Obstet Gynecol. [Medline]. 1996 May 8. Other indications for primary cesarean section include (but are not limited to) compound or monoamniotic twins and probable twin-twin transfusion syndrome (gross disparity in fetal size) and placenta previa. 144: Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. N Engl J Med. [Medline]. A few retrospective studies of nonstress testing and fetal biophysical profiles have been shown to detect compromised twin and triplet pregnancies. Monochorionic, diamniotic twins have been shown to have increased perinatal mortality throughout pregnancy, even at term, compared with dichorionic, diamniotic twins. release of more eggs than expected. During World War II, the incidence of non-identical twinning decreased in Europe when food was not readily available. [Medline]. Nearly all (> 85%) triplets warrant cesarean section delivery. 1997-1998 Winter. Memphis Fertility Laboratory, Inc. 80 Humphreys Center, Suite 307, Memphis, TN 38120-2363. copyright=new Date(); [Medline]. ACOG recommends the following in terms of timing of delivery: [28] Monozygotic twins have twice the incidence of congenital abnormalities compared with dizygotic twins. Multiple Pregnancy is much more common today than they were in the past. If estimated fetal weight suggests fetal well being, it is not necessary to deliver twin B within 30 minutes. Recent literature suggests that total breech extraction may be preferable to external cephalic version of twin B. [Medline]. [38] Single-nucleotide polymorphism-based noninvasive prenatal testing (NIPT) appears to be able to identify triploid, unrecognized twin, and vanishing twin pregnancies. [26] A trial of labor is generally accepted in this situation with delivery occurring in a setting that allows efficient conversion to cesarean section for the second twin if indicated. [Medline]. 1998 Oct 25. Goodnight W, Newman R,. increases multiple pregnancy is the use of infertility treatment, but there are other factors. It can be the most common twins or even triplets and quadruplets. Your race, age, heredity, or history of prior pregnancy does not increase your chances of having Source: Kamath et al. The main factor that single embryo, created by the union of a sperm and egg, divides into two embryos. [Medline]. According to Obstetrician / Gynecologists, 2001 J Matern Fetal Neonatal Med. Prospective evidence regarding optimal timing of delivery for twins is also lacking. Cut the cord as far outside the vagina as possible so that it can hang loose to permit vaginal examination or manipulation. [Medline]. Hogle KL, Hutton EK, McBrien KA, Barrett JF, Hannah ME. Routine, continuous electronic fetal heart rate monitoring is recommended. Pediatrics. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Today, superovulation accounts for most of the high order multiples. This may be related more to nutrition than to body size alone. 123 (5):1118-32. Multiple gestation: clinical characteristics and management. Malone FD, D'Alton ME. Learn more. • It is of two types: 1. Perform a vaginal examination immediately after delivery of twin A to note the presentation of the second twin, the presence of a second sac, an occult cord prolapse, or cord entanglement. Obstet Gynecol. 1994 Feb 28-Mar 2. This is generally accomplished by external version of twin B immediately after the delivery of twin A. Maternal mortality associated with multiple births is 2.5 times that for singleton births. Obstet Gynecol. 1986 Jun. [10] The overall post procedure pregnancy loss rate is estimated at approximately 6-12%, depending on gestational age.
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