Management of Multiple Pregnancy: Labor and Delivery

Abstract

After completion of this article, the reader should be able to describe the effects of the rising rate of multiple pregnancies on perinatal morbidity and mortality, to recall the complications of diagnosing and treating abnormalities of multiple pregnancies and to list the different safe options in managing labor in a multiple gestation.

Trends in twin pregnancies and mode of delivery during the last 30 years: inconsistency between guidelines and clinical practice

“…Based on the limited level 1 evidence, there are no absolute indications or contraindications concerning chorionicity or presentation and mode of delivery. Practice guidelines are based on current evidence and expert opinions [4,12,40]. In general, vertex presentation for both twins is considered to be the ideal setting for a trial of labor; VD may be appropriate for vertex-non-vertex presentation under certain circumstances, whereas CS is generally suggested as the appropriate route of delivery in cases of breech first twin.…”

“…In general, vertex presentation for both twins is considered to be the ideal setting for a trial of labor; VD may be appropriate for vertex-non-vertex presentation under certain circumstances, whereas CS is generally suggested as the appropriate route of delivery in cases of breech first twin. There is an overall agreement that a trial of labor always requires some prerequisites, including fetal heart rate monitoring of both twins, available blood and blood component products, ultrasound equipment in the delivery room, anesthesiologist and regional anesthesia, personnel for the resuscitation of both fetuses, the facility for performing an immediate CS if necessary and the presence of an obstetrician with experience in the active management of delivery [2,4,12]. The recommendations of scientific organizations are also general and not definite.…”

Vaginal twin delivery: a survey and review of location, anesthesia coverage and interventions

“…Epidural anesthesia has many advantages for VTD including superior analgesia during delivery, attenuation of the 'bearing-down' reflex, inhibition of early pushing, pelvic floor relaxation facilitating internal podalic version or breech extraction, and the ability to extend the block for cesarean delivery. 10,15,16 However, epidural catheter placement does not eliminate the occasional need for general anesthesia for emergency cesarean delivery, particularly if there is concern for fetal well being or if the epidural top-up fails. Epidural anesthesia may also increase motor block and prolong the second stage of labor.…”

“…9,15,16 In 1988, Redick stated that the anesthesiologist should be present and prepared for all circumstances during VTD. 9 Despite this recommendation, one third of California anesthesiologists report that their facilities perform VTD in the patient's labor room with nearly 50% of respondents stating anesthetic coverage was not required.…”

Humangenetische Beratung bei Mehrlingsschwangerschaften

“…Hauptgründe für den Anstieg von Mehrlingsschwangerschaften sind der zunehmende Gebrauch von ovulationsstimulierenden Medikamenten und die Verbreitung assistierter Reproduktionstechniken [1,2] .…”