Facts About Twins

The facts about twins and their formation.
I. Incidence: Approximately 1 in 80 pregnancies. Accounts for 20% of babies born < 1500 grams.

II. Risk Factors:

A. Size greater than dates
B. Elevated maternal serum alpha-fetoprotein
C. Strong maternal family history
D. Fertility Drugs.

III. Diagnosis: Ultrasound required for definitive diagnosis.

IV. Perinatal Morbidity & Mortality:

A. Overall perinatal mortality (PNM) 10 x higher than singletons
B. PNM for dichorionic twins is 9%
C. PNM for monochorionic twins is 26%
D. PNM for nonamniotic twins is 50%
E. Increased morbidity and mortality due to:

1. Prematurity: 50% of twins weigh less than 2500 gm.
2. IUGR: 30-50% incidence

Virtually all obstetric complications (with the notable exception of post-datism) are increased with multiple gestation.

V. Complications:


1. Premature labor
2. Congenital malformations - twice as high as singletons
3. Higher spontaneous abortion rate
4. Higher incidence of IUGR
5. Higher incidence of maternal anemia
6. Twin-to-twin transfusion syndrome
7. Pregnancy induced hypertension
8. Hydramnios


1. Placenta previa
2. Abruptio placenta
3. Vasa previa
4. Dysfunctional or prolonged labor
5. Abnormal fetal presentation
6. Cord prolapse
7. Higher incidence of cesarean section


1. Greater incidence of maternal blood transfusions
2. Postpartum hemorrhage/uterine atony

VI. Antepartum Management:

A. All pregnancies complicated by multiple gestation are Ahigh risk@ and need specialized antepartum, intrapartum, and postpartum care and management.

B. Encourage bed rest beginning at 20 weeks with twins, earlier with triplets.

C. Patients must be instructed as to signs and symptoms of premature labor, premature rupture of membranes and preeclampsia.

D. Screen for diabetes (1 hour glucola) at time of diagnosis and repeat at 26-28 weeks. May screen earlier and more often with positive family history.

E. Serial ultrasounds (q 4 weeks) for fetal growth and to detect discordancy. When suboptimal fetal growth or discordancy is suspected, (> 25% difference in estimated fetal weight) then perform ultrasounds at increased intervals.

F. Antepartum fetal surveillance NST/Biophysical profiles beginning approximately 32 weeks or earlier if indicated by superimposed problems (discordant growth, IUGR, Hydramnios, hypertension, etc).

VII. Intrapartum Management:

A. Delivery should occur at a hospital with the appropriate level of care (Obstetric and Pediatric). In preterm gestations (< 37 weeks) maternal transport to Tertiary Center for delivery should be considered.

B. Two obstetricians should be available for delivery.

C. Anesthesia personnel should be available in the Delivery Room.

D. Appropriate personnel skilled in neonatal resuscitation should be present in the Delivery Room (one pediatrician and one nurse for each neonate).

E. Continuous fetal monitoring must be employed on all fetuses, preferably with an internal catheter, an electrode on Twin A and external monitor (ultrasound) on Twin B or other fetuses.

F. Cesarean section is advisable for all breech-vertex and other abnormal presentations (interlocking twins) and for all pregnancies with three or more fetuses.

G. Be prepared for postpartum hemorrhage, i.e. oxytocin use postpartum, large-bore IV=s in place, blood available for transfusion.

H. Placenta and membranes should be examined and sent to Pathology.


recommended for you


FerOt May 25, 2015
Xanax And Dose Prescription Xanax 16 . Xanax Next Day During Pregnancy Lortab Cause Insomnia Xanax Without Prescription Lortab Xanax Addiction Define The Withdrawal Symptoms Of Xanax Xanax Cause Constipation Withdrawal Symptoms Xanax Sprite . Xanax Cns Depressant Xanax With Percocet Drug Interaction No Prior Prescription Xanax Bars [url=http://www.netvibes.com/xanax2mg ]buy alprazolam online[/url]. Xanax Withdrawal Schedule Benzodiazepines Mixer Effexor And Xanax Xanax Adverse Reactions Side Effects Xanax And Oxycocet .
carpinteyrocmu November 17, 2014
锘縯hat, setting up Thursday, he will be going head to head with all the well known early morning exhibit of the stereo place of which shot them around The spring of following 15 years.

But that does not he is not getting excited about the opposition and a get back to the speak present beginnings.

this industry, there are been recently dismissed from your job but, you're, explained Whitened, who had been one of the re-writing hosts associated with WGL AM's software ahead of becoming a member of WOWO, 1190 Was. zero vengeance listed here. Precisely the fortune of the Lord, Whitened extra.

That's got been for a while WOWO's niche market, however , White-colored proclaimed he could be self-assured his / her show will perform well resistant to the indicate published simply<a href=http://rhand.org.tt/Uploads/nike/nike18088.html>nike air max 90 outlet usa</a> by WOWO's Charly Grocer, which features regular segments of reports, temperatures along with sporting events, interspersed utilizing limited selection nonetheless very few show goers telephone calls.

Featuring its functionality establ<a href=http://rhand.org.tt/Uploads/nike/nike19418.html>air max 90 pink and purple</a>ished offers, Bright proclaimed his particular commitment could be worthy of of what this individual was producing from WOWO. He stated WGL called your pet basically a couple weeks once he previously eventually left WOWO. Actually is well liked viewed as web hosting service a show for any Bluffton based FM train station.

Bright white explained lots of her aged WOWO marketers have accepted support his brand new display, and hubby is expecting that will help WGL close up the very competitive difference with the sta who has for ages happen to be a undisputed alpha dog throughout nearby talk radio station.閿樼笅at White's airwaves move creates time fight

Some sort of subdued talk present showdown will probably success phones used to merely media Tuesday whenever Wally White's visible on WGL proceeds towards the day slot which will Wally Burns these days satisfies about WOWO a section that terminated White previous The spring of soon after Age 14 ages. exhibit began within May in WGL, 1250 Have always been. Whilst White colored said her display improved the particular station's scores during that period, are simply diverse. Folk have to arrive at work and have they prepared for varsity. Each day what you're really telling is definitely, the actual java pan?Woul becoming quickly dismissed, Whitened claimed police officers at WOWO, 1190 Have always been, shared with the pup some people wanted to make afternoon demonstrate some other way much more Dash Limbaugh together with other old-fashioned indicates for the station which might be dominated by governmental issues.

through precisely what For a nice and explained to, many people usually are not happy with what they've got already been listening to (about

<a href=http://rhand.org.tt/Uploads/nike/nike24594.html>air jordan 11 pink snakeskin 2013</a>
<a href=http://rhand.org.tt/Uploads/nike/nike24177.html>air jordan 4 fire red gs</a>
<a href=http://rhand.org.tt/Uploads/nike/nike23616.html>air jordan 11 23 logo fix</a>
<a href=http://rhand.org.tt/Uploads/nike/nike22865.html>nike free run 3 coral ebay</a>
<a href=http://rhand.org.tt/Uploads/nike/nike16447.html>nike air max thea camo blue</a>