Management and outcome of twin pregnancies

The management of multiple pregnancies during gestation, labor and delivery, which has long been a key skill for the obstetrician, is never more important than in the current era. Multiple pregnancies are increasing globally, in keeping with lyfestyle changes, an increase in maternal age, and in the use of assisted reproductive techniques. However, multiple pregnancies contribute disproportionately to prematurity and perinatal mortality and morbidity. Whereas in the past multiple pregnancy often went undiagnosed until delivery, today improved antenatal management, including ultrasound and monitoring, allow a comprehensive and individualized plan for the mode and timing of each pregnancy control and delivery. Twin pregnancies are at increased risk for preterm birth, intrauterine growth restriction, and other conditions such as hypertensive disorders, gestational diabetes. Monochorionic twins have additional risks for death and morbidity, primarily because of the twin-to-twin transfusion syndrome and congenital abnormalities. In order to develop excellence in the antenatal and perinatal management of multiple pregnancies, it is important to consider several key points: chorionicity, fetus growth, adequate monitoring of pregnancy, fetus presentation, planned timing of delivery, planned place of birth offering the most appropriate intrapartum maternal and fetal monitoring.