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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

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