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    • Publisher:
      Cambridge University Press
      Publication date:
      15 January 2025
      30 January 2025
      ISBN:
      9781009526142
      9781009526104
      Dimensions:
      Weight & Pages:
      Dimensions:
      (229 x 152 mm)
      Weight & Pages:
      0.207kg, 134 Pages
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    Book description

    Multiple pregnancy affects 0.9-3.1% of births worldwide. Prevalence rates vary significantly due to differences in dizygotic twinning rates and use of assisted reproduction. Both maternal and fetal/neonatal complications are more common in multiple compared to singleton pregnancies, and there are specific problems for the fetuses related to monochorionicity. Multiple pregnancies require specialised and individualised care. Complicated multiple pregnancies should be managed in a tertiary care centre where there is additional expertise, such as the laser ablation needed to treat monochorionic monozygotic pregnancies with conjoined circulations. Cornerstones of management in pregnancy are the need for accurate fetal measurement to optimise dating of gestational age, and documentation of chorionicity. High-level ultrasound expertise is needed. The mothers need frequent assessment to detect hypertension and anemia, and early identification and management of preterm labour.

    Further Reading

    Farmer, N, Hillier, M, Kilby, MD, Hodgetts-Morton, V, Morris, RK. Outcomes in intervention and management of multiple pregnancies trials: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2021; 261: 178–92.
    Khalil, A, Rodgers, M, Baschat, A, et al. ISUOG practice guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 2016; 47: 247–63.
    Mackie, FL, Rigby, A, Morris, RK, Kilby, MD. Prognosis of the co-twin following spontaneous single intrauterine fetal death in twin pregnancies: a systematic review and meta-analysis. BJOG. 2019; 126: 569–78.
    di Mascio, D, Acharya, G, Khalil, A, et al. Birthweight discordance and neonatal morbidity in twin pregnancies: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2019; 98: 1245–57.
    d’Antonio, F, Odibo, A, Berghella, V, et al. Perinatal mortality, timing of delivery and prenatal management of monoamniotic twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2019; 53: 166–74.
    Khalil, A, Beune, I, Hecher, K, et al. Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure. Ultrasound Obstet Gynecol. 2019; 53: 4754.
    Royal College of Obstetricians and Gynaecologists (RCOG). Management of Monochorionic Twin Pregnancy, 2nd edn. Green-top Guideline No. 51. London: RCOG, 2016. www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg51/ (accessed 13 September 2024).
    Khalil, A, Gordijn, S, Ganzevoort, W, et al. Consensus diagnostic criteria and monitoring of twin anemia–polycythemia sequence: Delphi procedure. Ultrasound Obstet Gynecol. 2020; 56: 388–94.
    National Institute for Health and Care Excellence (NICE). Twin and Triplet Pregnancy. NICE Guideline NG137. London: NICE, 2024. www.nice.org.uk/guidance/ng137 (accessed 22nd October 2024).
    di Mascio, D, Khalil, A, Rizzo, G, et al. Risk of fetal loss following amniocentesis or chorionic villus sampling in twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2020; 56: 647–55.
    Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies: ACOG practice bulletin, number 231. Obstet Gynecol. 2021; 137: e145–62.
    Nicholas, L, Fischbein, R, Ernst-Milner, S, Wani, R. Review of international clinical guidelines related to prenatal screening during monochorionic pregnancies. J Clin Med. 2021; 10: 1128.
    Townsend, R, d’Antonio, F, Sileo, FG, et al. Perinatal outcome of monochorionic twin pregnancy complicated by selective fetal growth restriction according to management: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2019; 53: 3646.
    Marleen, S, Dias, C, Nandasena, R, et al. Association between chorionicity and preterm birth in twin pregnancies: a systematic review involving 29 864 twin pregnancies. BJOG. 2021; 128: 788–96.
    EPPPIC Group. Evaluating Progestogens for Preventing Preterm birth International Collaborative (EPPPIC): meta-analysis of individual participant data from randomised controlled trials. Lancet. 2021; 397: 1183–94.
    Romero, R, Conde-Agudelo, A, Rehal, A, et al. Vaginal progesterone for the prevention of preterm birth and adverse perinatal outcomes in twin gestations with a short cervix: an updated individual patient data meta-analysis. Ultrasound Obstet Gynecol. 2022; 59: 263–6.
    Li, C, Shen, J, Hua, K. Cerclage for women with twin pregnancies: a systematic review and meta-analysis. Am J Obstet Gynecol. 2019; 220: 543–55.
    Donepudi, R, Hessami, K, Nassr, AA, et al. Selective reduction in complicated monochorionic pregnancies: a systematic review and meta-analysis of different techniques. Am J Obstet Gynecol. 2022; 226: 646–55.
    di Mascio, D, Khalil, A, d’Amico, A, et al. Outcome of twin–twin transfusion syndrome according to Quintero stage of disease: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2020; 56: 811–20.
    Murgano, D, Khalil, A, Prefumo, F, et al. Outcome of twin-to-twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2020; 55: 310–17.

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