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Chapter 18 - Maternal Complications in Multiple Pregnancy

Published online by Cambridge University Press:  11 October 2022

By
Sarah Rae Easter  and
Mike Foley
Edited by
Leanne Bricker ,
Julian N. Robinson  and
Baskaran Thilaganathan
Leanne Bricker
Affiliation:
Corniche Hospital, Abu Dhabi
Julian N. Robinson
Affiliation:
Brigham & Women's Hospital, Boston
Baskaran Thilaganathan
Affiliation:
St George's Hospital Medical School, University of London
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Summary

Epidemiologic studies consistently demonstrate an increased risk of severe maternal morbidity and mortality in multiple as opposed to singleton pregnancies. The exaggerated cardiovascular adaptation required to support more than one fetus may explain some of this morbidity while incorporating physiology into clinical management decisions may mitigate some of the risk. Balancing maternal risk with neonatal outcomes is central to obstetric management decisions including delivery timing and mode of delivery. Encouraging vaginal birth for women with cephalic-presenting first twins may reduce the risk of maternal morbidity but requires the involvement of an obstetrician with comfort with twin vaginal birth including breech extraction. Dedicated attention to maternal psychosocial state—particularly in the postpartum period—is an essential component of optimizing maternal outcomes in multifetal pregnancies. A uniform approach to management followed by tailored risk-appropriate care as clinical complexities arise is essential to optimize maternal outcomes in multifetal pregnancy.

Type
Chapter
Information
Management of Multiple Pregnancies
A Practical Guide
 , pp. 188 - 200
Publisher: Cambridge University Press
Print publication year: 2022

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References

Committee on Practice Bulletins – Obstetrics, Society for Maternal–Fetal Medicine. ACOG Practice Bulletin No. 169: Multifetal gestations: twin, triplet and higher-order multifetal pregnancies. Obstet Gynecol 2016 Oct;128(4):e131–e146.Google Scholar
Santana, DS, Cecatti, JG, Surita, FG et al. Twin pregnancy and severe maternal outcomes: the World Health Organization multi-country survey on maternal and newborn health. Obstet Gynecol 2016;127(4):631–41.Google Scholar
Ghi, T, Kuleva, M, Youssef, A et al. Maternal cardiac function in complicated twin pregnancy: a longitudinal study. Ultrasound Obstet Gynecol 2011;38:581–5.Google Scholar
Ghi, T, Esposti, D, Montaguti, E et al. Maternal cardiac evaluation during uncomplicated twin pregnancy with emphasis on the diastolic function. Am J Obstet Gynecol 2015;213(3):375.e1–e8.Google Scholar
Korb, D, Schmitz, T, Seco, A et al. Risk factors and high-risk subgroups of severe acute maternal morbidity in twin pregnancy: A population-based study. PLoS One 2020;15(2):e0229612.CrossRefGoogle ScholarPubMed
Roberge, S, Bujold, E, Nicolaides, KH. Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis. Am J Obstet Gynecol 2018;218(3):287–93.Google Scholar
Fox, NS, Rebarber, A, Roman, AS, Klauser, CK, Peress, D, Saltzman, DH. Weight gain in twin pregnancies and adverse outcomes: examining the 2009 IOM guidelines. Obstet Gynecol 2010;116(1):100–6.CrossRefGoogle Scholar
SMFM Research Committee, Grantz, KL, Kawakita, T et al. SMFM special statement: state of the science on multifetal gestations: unique considerations and importance. Am J Obstet Gynecol 2019 Aug;221(2):B2–B12.Google Scholar
Crowther, CA, Han, S. Hospitalisation and bed rest for multiple pregnancy. Cochrane Database Syst Rev 2010 (7). Art. No.: CD000110. https://doi.org/10.1002/14651858.CD000110.pub2Google Scholar
D’Alton, ME, Friedman, Am, Smiley, RM et al. National Partnership for Maternal Safety: consensus bundle on venous thromboembolism. Obstet Gynecol 2016;128(4):688–98.Google Scholar
American Association of Birth Centers; Association of Women’s Health, Obstetric and Neonatal Nurses; American College of Obstetricians and Gynecologists et al. Obstetric Care Consensus #9: Levels of Maternal Care. Am J Obstet Gynecol 2019;221(6):B19–B30.Google Scholar
Hutton, EK, Hanna, ME, Ross, S et al. Maternal outcomes at 3 months after planned caesarean section versus planned vaginal birth for twin pregnancies in the Twin Birth Study: a randomized controlled trial. BJOG 2015;122(12):1653–62.Google Scholar
Easter, SR, Robinson, JN, Lieberman, E, Carusi, D. Association of intended route of delivery and maternal morbidity in twin pregnancy. Obstet Gynecol 2017;129(2):305–10.Google Scholar
Main, EK, Goffman, D, Scavone, BM et al. National Partnership for Maternal Safety: consensus bundle on obstetric hemorrhage. Obstet Gynecol 2015 Jul;126(1):155–62.Google ScholarPubMed
American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 736: optimizing postpartum care. Obstet Gynecol 2018;131(5):e140–e150.Google Scholar

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