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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Twins: Antepartum assessment and Intrapartum management
Sponsored by The Indian Health Service Clinical Support Center
5 Twin Pregnancy: Double Trouble?
Step 5. Complications: Preterm labor
CASE STUDY (continued)
Mrs. BP’s pregnancy progresses normally until 26 weeks when a routine growth ultrasound reveals that the B twin’s growth is lagging 2 weeks behind that of twin A. Her 26 week labs show that she does not have gestational diabetes, but her hematocrit is 27% with an MCV of 74.
Two weeks later she presents to Labor & Delivery complaining of uterine contractions occurring every 5 minutes. Her cervix is soft, mid position, 1 cm dilated, 50% effaced, with the presenting cephalic part of twin A at -3 station. Her vital signs are stable except for a blood pressure of 133/88; both fetal heart rates are reassuring.
- What is her current problem list?
- How should you address these issues?
COMPLICATIONS OF TWIN PREGNANCY
Preterm labor is definitely the most common complication of twin pregnancy.
Unfortunately, since we have no really effective intervention for preterm labor, being able to predict it is often frustrating. In the patient with a twin pregnancy who presents with preterm contractions, a cervico-vaginal fetal fibronectin and a transvaginal cervical length may be helpful to determine the likelihood of premature delivery, but such determinations in asymptomatic patients are not very helpful (see the Perinatologist’s Corner module on Preterm Labor and Preterm Premature Rupture of Membranes
)
Likewise, prophylactic cervical cerclage, prophylactic tocolysis,
home uterine activity monitoring, routine hospitalization,
or at home restriction of activities, have not been shown to reduce the incidence of preterm birth, low birth weight infants, or perinatal death in twin pregnancy. There have been four randomized control trials of bed rest in twins: two showed no benefit, and two showed worse outcomes in the bed rest groups! (Cockwell) ( Modena)
