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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Twins: Antepartum assessment and Intrapartum management
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6 Twin Pregnancy: Double Trouble?
Step 6. Other maternal complications
Women with twin pregnancies who experience preterm labor may receive tocolytic agents, but, because of their increased blood volume, and their associated heightened physiologic changes of pregnancy, they are at increased risk of pulmonary edema. This is especially true for beta agonists and magnesium sulfate, but may also be seen with non-steroidal anti-inflammatory agents. Scrupulous intake and output records are critical in managing these patients in this situation. Corticosteroids for fetal lung maturation are just as effective in twins as singletons. The dose does not have to be increased because of the twins, and the initial course should not be repeated.
The incidence of preeclampsia is approximately three and a half times higher in twins than in singletons. This may be due to the greater placental mass and an increased production of whatever “substance X” is that results in the preeclampsia syndrome. It may occur earlier and be more severe. The incidence is not different between monochorionic and dichorionic twins. (See the Perinatologist Corner, Hypertension in Pregnancy modules: Part 1: Mild preeclampsia, Part 2: Severe preeclampsia, Part 3 Gestational Hypertension and Chronic Hypertension in Pregnancy
Gestational diabetes is also increased in twins, again presumably because of a larger placental mass producing more hormonally-induced insulin resistance.Consequently it is suggested thatpatients with twin pregnancy receive glucose challenge screening at their first visit, 24 -28 weeks, and again at 32 weeks. (See the Perinatologist Corner, Diabetes in Pregnancy modules: PART 1: Screening and Diagnosis or PART 2: Management, delivery, and postpartum)
Hyperemesis and “pseudo-hyperthyroidism” (see the Perinatologist Corner modules on “ Nausea and Vomiting in Pregnancy”, and Thyroid Disorders in Pregnancy) also occur with a heightened frequency in twins, probably as a result of increased beta HCG levels.
Anemia is very common in women with twin pregnancies because of the double fetal demand for iron. On the other hand, the increased blood volume expansion seen with twins may dilute the hematocrit more dramatically, giving the false impression of more severe anemia. Because of uterine over distention, post partum uterine atony and hemorrhage are also more common in twin pregnancy, further contributing to chronic anemia.
Women having twins are also at greater risk of cesarean birth because of malpresentation and other intrapartum complications (see Labor & Delivery section below).
