Multiple Pregnancy / Twin Pregnancy – Complications:

Maternal

During pregnancy:

♠       nausea and vomiting occurs with increased frequency and severity

♠       Anemia is more common in twin pregnancy.

♠       Pre-eclampsia (25%) is increased three times over singleton pregnancy. Over distension of the uterus may be the possible explanation.

♠       Hydramnios (10%)  is more common in uniovular twins and usually involves the second sac. It is perhaps due to increased renal perfusion with consequent increased urinary output which may accompany the hypervolaemia in the larger twin. 

♠       Antepartum hemorrhage may occur with slight increased frequency. The increased incidence of placenta praevia is due to the bigger size of the placenta encroaching on to the lower segment. The separation of normally situated placenta may be due to – (i) increased incidence of P.I.H (ii) sudden escape of liquor following rupture of membranes of the hydramniotic sac, (iii) deficiency of folic acid and (iv) following delivery of the first baby due to sudden shrinkage of the uterine wall adjacent to the placental attachment.

♠       Malpresentation is more common in the second baby.

♠       Preterm labour (30%) frequently occurs and the mean gestational period for twins is 37 weeks. Over distension of the uterus, hydramnios and premature rupture of the membranes are responsible for preterm labour.

♠       Mechanical distress such as palpitation, dyspnoea, varicosities and hemorrhoids may be increased compared to a singleton pregnancy.

During labour

♠       Early rupture of the membranes and cord prolapse are likely to be increased due to increased prevalence of malpresentation. Cord prolapse is five times more common than in singleton pregnancy and is more common in relation to the second baby.

♠       Prolonged labour

♠       Increased operative interference

♠       Bleeding

♠       Postpartum hemorrhage is the real danger in twins: it is due to: (i) atony of the uterus. (ii) Infection (iii) bigger surface area of the placenta exposing  more uterine sinuses. (iv) Implantation of a part of the placenta in the lower segment which is less retractile.

 

During puerperium

♠       Sub-involution – because of bigger size of the uterus.

♠       Infection

 

Fetal

♠       Miscarriage rate is increased

♠       Premature rate (80%)

♠       IUGR

♠       IUD of one fetus

♠       Fetal anomalies

♠       Asphyxia and stillbirth