Multiple Pregnancy
Key Facts
- About 1 in 80 pregnancies at term
- incidence is rising with increasing maternal age and assisted conception.
- The second twin is at greater risk of intrapartum compromise.
- Vaginal birth is usually safely achievable where the presenting twin is in a cephalic vertex presentation.
- Caesarean section performed If the first twin presents by the breech or transverse.
Associated Complications
- abnormal fetal growth
- malpresentation
- CTG abnormalities
- cord prolapse
- need for emergency caesarean section in labour
- PPH.
Twins in Different Positions
Scenarios
The image illustrates four different scenarios of twins in various positions within the womb. The diagrams are labeled with key anatomical terms.
- The first diagram shows twins in unmarked positions.
- The subsequent diagrams are labeled with the following terms:
- Umbilical cord
- Placenta
- Baby in vertex presentation
- Baby in breech presentation
- Baby in transverse lie
- Uterus
- Cervix
Delivery of Twins
Steps
- Vaginal birth if the first twin is in a cephalic (vertex) presentation.
- Caesarean section performed If the first twin presents by the breech or transverse.(not cephalic)
- Delivery of the 2nd twin:
- After the delivery of the 1st twin:
- ✔ clamp the cord.
- ✔ Determine the position of the 2nd twin.
- ✔ Bring the nearest pole (breech or cephalic).
- ✔ Do ARM & give oxytocin iv.
Shoulder Presentation
Causes and Management
- Shoulder presentation occurs as the result of a transverse or oblique lie of the fetus.
- Causes include:
- placenta praevia.
- high parity.
- pelvic tumour.
- uterine anomaly.
- Delivery should be by caesarean section.
- Delay:
- cord prolapse.
- uterine rupture.
