COMPLICATIONS of

MULTIFETAL GESTATION
 COMPLICATIONS of MULTIFETAL
GESTATION
Monoamniotic twins
1% of monozygotic twins are
monoamniotic
 ABNORMAL TWINNING
Conjoined twins
Siamese Twins (Cahng and Eng Bunker
of Siam)
 ABNORMAL TWINNING
External Parasitic Twins
Heart and brain is absent
 ABNORMAL TWINNING
Fetus in Fetu
One embryo enfolded
inside its twin.
 Vascular Anastomoses between
Fetuses

Acardiac Twin
Twin reversed-arterial-perfusion (TRAP)
sequence.
 Vascular Anastomoses between
Fetuses
Twin-Twin Transfusion Syndrome
(TTTS)
Midpregnancy: donor fetus becomes
oliguric from decreased renal perfusion.
 DISCORDANT TWINS
- Placental vascular anastomoses-
>hemodynamic imbalance.
 TWIN DEMISE
Death of One Fetus
Fetus compresus: dead fetus is
identifiable; compressed appreciably.
Fetus papyraceous: dead fetus is
flattened remarkably.
 TWIN DEMISE
Impending Death of One Fetus

Death of Both Twin Fetuses

Monochromic placentation and
discordant fetal growth.
COMPLETE HYDATIDIFORM MOLE &
CO-EXISTING FETUS
Two different conceptuses.
 MANAGEMENT OF
MULTIFETAL GESTATTION
 ANTEPARTUM
Delivery of markedly preterm neonates be
prevented

Fetal-growth restriction be identified and afflicted

fetuses be delivered before they become
moribund

Fetal trauma during labor and delivery be avoided

Expert neonatal care be available.

 DIET
Increased calories, proteins, minerals, vitamins and
essential fatty acids.

Caloric consumption increased by 300kcal/day.

Weight gain be based in part of prepregnancy weight.

Triplets pregnancies: at least 50lbs.

Iron supplementation: 60-100mg/day

Folic Acid: 1mg/day

 HYPERTENSION
Fetal number and placental mass :
preeclampsia.

Hypertension: more often and earlier.

 ANTEPARTUM
SURVEILLANCE
Serial sonographic examinations: 3rd
trimester.

Amniotic Fluid Index (AFI)

Considered abnormal at 28-40th AOG
<8cm: below 5th percentile.
>24cm: above the 95th percentile.
 TESTS of FETAL WELL
BEING
Nonstress test or Biophysical Profile
 TESTS of FETAL WELL
BEING
Doppler Velocimetry
 PREVENTION of PRETERM
DELIVERY
Bed rest
Tocolytic therapy
Progesterone therapy
Corticosteroids for Lung Maturation
Cervical cerclage
INTRAPARTUM
MANAGEMENT
 Recommendations:
Continuous electronic fetal monitoring.
Blood made available for transfusion.
Infusion of IV fluids.
Prophylactic Antibiotics in preterm labor:
Ampicillin 2g Q6H IV
Modes of Delivery:
Vaginal: cephalic-cephalic.
Cesarean: noncephalic 1st twin, interlocking
twins, high order multifetal pregnancy