Multifetal Gestation

  • Gabriella Pridjian
  • Chin-Chu Lin


Cohabitation of the uterus produces more than one high-risk fetus. Each fetus is subject not only to the potential complications of a singleton fetus, but to a unique array of complications peculiar to sharing of the intrauterine environment. This chapter deals first with the incidence, cause, and diagnosis of multiple gestations as well as the associated concerns and potential complications. The latter are discussed on the time frame as they arise, that is, first trimester, second trimester, third trimester, intrapartum, and postpartum.


Obstet Gynecol Twin Pregnancy Multiple Gestation External Cephalic Version Twin Gestation 
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  1. 1.
    Benirschke K, Kim CK. Multiple pregnancy, 1. N Engl J Med. 1973;288:1276–1284.PubMedCrossRefGoogle Scholar
  2. 2.
    Lamont JA. Twin pregnancies following induction of ovulation: A literature review. Acta Genet Med Gemellol. 1982;31:247–253.PubMedGoogle Scholar
  3. 3.
    Schneider L, Bessis R, Simonnet T. The frequency of ovular resorption during the first trimester of twin pregnancy. Acta Genet Med Gemellol. 1979;28:271–272.PubMedGoogle Scholar
  4. 4.
    Newman RB, Hamer C, Clinton Miller M. Outpatient triplet management: A contemporary review. Am J Obstet Gynecol. 1989; 161:547–555.PubMedGoogle Scholar
  5. 5.
    James WH. A hypothesis on the declining dizygotic twinning rates in developed countries. Prog Clin Biol Res. 1978;24B:81–88.Google Scholar
  6. 6.
    Nylander PPS. The twinning incidence in Nigeria. Acta Genet Med Gemellol. 1979; 28:261–263.PubMedGoogle Scholar
  7. 7.
    Nylander PPS. The factors that influence twinning rates. Acta Genet Med Gemellol. 1981; 30:189–202.PubMedGoogle Scholar
  8. 8.
    Webster F, Elwood JM. A study of the influence of ovulation stimulants and oral contraception on twin births in England. Acta Genet Med Gemellol. 1985;34:105–108.PubMedGoogle Scholar
  9. 9.
    Jones KL, Benirschke K. The developmental pathogenesis of structural defects: The contribution of monozygotic twins. Semin Perinatal. 1983;7:239–243.Google Scholar
  10. 10.
    Benirschke K. Twin placenta in perinatal mortality. NY State J Med. 1961;61:1499.Google Scholar
  11. 11.
    Derom C, Vlietinck R, Derom R, Van den Berghe H, Thiery M. Population-based study on sex proportion in monoamniotic twins. N Engl J Med. 1988;319:119–120.PubMedCrossRefGoogle Scholar
  12. 12.
    Benirschke K, Kim CK. Multiple pregnancy, 2. N Engl J Med. 1973;288:1329–1336.PubMedCrossRefGoogle Scholar
  13. 13.
    Maggio M, Callan NA, Hamod KA, Sanders RC. The first-trimester ultrasonographic diagnosis of conjoined twins. Am J Obstet Gynecol. 1985;152:833–835.PubMedGoogle Scholar
  14. 14.
    Blum E, Pearlman M, Graham D. Early second-trimester sonographic diagnosis of thoracopagus twins. J Clin Ultrasound. 1986; 14:207–208.PubMedCrossRefGoogle Scholar
  15. 15.
    Sakala EP. Obstetric management of conjoined twins. Obstet Gynecol. 1986;67:21S-25S.PubMedGoogle Scholar
  16. 16.
    Diaz JH, Furman MB. Perioperative management of conjoined twins. Anesthesiology. 1987;67:965–973.PubMedCrossRefGoogle Scholar
  17. 17.
    Razavi-Encha F, Mulliez N, Benhaiem-Sigaux N, et al. Cardiovascular abnormalities in thoracopagus twins: Embryological interpretation and review. Early Hum Dev. 1987;15:33–44.PubMedCrossRefGoogle Scholar
  18. 18.
    Bucholz RD, Yoon KW, Shively RE. Temporoparietal craniopagus. Case report and review of the literature. J Neurosurg. 1987;66:72–79.PubMedCrossRefGoogle Scholar
  19. 19.
    Severn CB, Holyoke EA. Human acardiac anomalies. Am J Obstet Gynecol. 1973; 116:358–365.PubMedGoogle Scholar
  20. 20.
    Napolitani FD, Schrieber I. The acardiac monster: A review of the world’s literature and presentation of 2 cases. Am J Obstet Gynecol. 1960;80:582–589.PubMedGoogle Scholar
  21. 21.
    Pretorius DH, Leopold GR, Moore TR, Benirschke K, Sivo JJ. Acardiac twin: Report of Doppler sonography. J Ultrasound Med. 1988;7:413–16.PubMedGoogle Scholar
  22. 22.
    Van Allen MI, Smith DW, Shepard TH. Twin reversed arterial perfusion (TRAP) sequence: A study of 14 twin pregnancies with acardius. Semin Perinatol. 1983;7:285–293.PubMedGoogle Scholar
  23. 23.
    Platt LD, DeVore GR, Bieniarz A, Benner P, Rao R. Antenatal diagnosis of acephalus acardia: A proposed management scheme. Am J Obstet Gynecol. 1983;146:857–859PubMedGoogle Scholar
  24. 24.
    DeLia JE, Cruikshank P, Keye WR. Fetoscopic neodymium: Yag laser occlusion of placental vessels in severe twin transfusion syndrome. Presented at the 10th Annual Meeting of the Society of Perinatal Obstetricians, Houston, Texas, 1990.Google Scholar
  25. 25.
    Redford DHA, Whitfield CR. Maternal serum alpha fetoprotein in twin pregnancies uncomplicated by neural tube defect. Am J Obstet Gynecol. 1985;152:550–553.PubMedGoogle Scholar
  26. 26.
    Kallen B. Hyperemesis during pregnancy and delivery outcome: Registry study. Eur J Obstet Gynecol Reprod Biol. 1987;26:291–302.PubMedCrossRefGoogle Scholar
  27. 27.
    Vandederckhove F, Dhont M, Thiery M, Derom R. Screening for multiple pregnancy: Determination of human chorionic gonadotropin, alpha-fetoprotein, and human placental lactogen in blood during the second trimester of pregnancy. Acta Genet Med Gemellol. 1984;33:571–574.Google Scholar
  28. 28.
    Adams MJ, Windham GC, James LM, et al. Clinical interpretation of maternal serum alpha fetoprotein concentrations. Am J Obstet Gynecol. 1984;148:241–254.PubMedGoogle Scholar
  29. 29.
    Hughey MJ, Olive DL. Routine ultrasound scanning for the detection and management of twin pregnancies. J Reprod Med. 1985;30:427–430.PubMedGoogle Scholar
  30. 30.
    Grennert L, Persson P, Gennser G. Benefits of ultrasonic screening of a pregnant population. Acta Obstet Gynecol Scand. 1978;8(suppl):5–14.CrossRefGoogle Scholar
  31. 31.
    Breckwoldt M, Geisthovel F, Neulen J, Scihillinger H. Management of multiple conceptions after gonadotropin-releasing hormone analog/ human menopausal gonadotropin/human chorionic gonadotropin therapy. Fertil Steril. 1988;49:713–715.PubMedGoogle Scholar
  32. 32.
    Farquharson DF, Wittmann BK, Hansmann M, Yuen BH, Baldwin VJ, Lindahl S. Management of quintuplet pregnancy by selective embryocide. Am J Obstet Gynecol. 1988; 158:413–416.PubMedGoogle Scholar
  33. 33.
    Itskovitz J, Boldes R, Thaler I, Bronstein M, Erlik Y, Brandes JM. Transvaginal ultrasonography-guided aspiration of gestational sacs for selective abortion in multiple pregnancy. Am J Obstet Gynecol. 1989;160: 215–217.PubMedGoogle Scholar
  34. 34.
    Berkowitz RL, Lynch L, Chitkara U, et al. Selective reduction of multifetal pregnancies in the first trimester. N Engl J Med. 1988; 318:1043–1047.PubMedCrossRefGoogle Scholar
  35. 35.
    Lipitz S, Reichman B, Paret G, et al. The improving outcome of triplet pregnancies. Am J Obstet Gynecol. 1989;161:1279–1284.PubMedGoogle Scholar
  36. 36.
    Evans MI, Fletcher JC, Zador IE, Newton BW, Quigg MH, Struyk CD. Selective first-trimester termination in octuplet and quadruplet pregnancies: Clinical and ethical issues. Obstet Gynecol. 1988;71:289–296.PubMedGoogle Scholar
  37. 37.
    Hall MH, Campbell DM, Davidson RJL. Anemia in twin pregnancy. Acta Genet Med Gemellol. 1979;28:279–282.PubMedGoogle Scholar
  38. 38.
    Rovinsky JJ, Jaffin H. Cardiovascular hemodynamics in pregnancy. II. Cardiac output and left ventricular work in multiple pregnancy. Am J Obstet Gynecol. 1966;95:781–786.PubMedGoogle Scholar
  39. 39.
    MacGillivray I, Campbell D, Duffus GM. Maternal metabolic response to twin pregnancy in Primigravidae. J Obstet Gynaecol Br Commonw. 1971;78:530–534.PubMedCrossRefGoogle Scholar
  40. 40.
    Robson SC, Hunter S, Boys RJ, Dunlop W. Hemodynamic changes during twin pregnancy. Am J Obstet Gynecol. 1989;161:1273–1278.PubMedGoogle Scholar
  41. 41.
    Green JJ, Hobbins JC. Abdominal ultrasound examination of the first trimester fetus. Am J Obstet Gynecol. 1988;159:165–175.PubMedGoogle Scholar
  42. 42.
    Benacerraf BR, Lister JE, DuPonte BL. First-trimester diagnosis of fetal abnormalities. A report of three cases. J Reprod Med. 1988;33:777–780.PubMedGoogle Scholar
  43. 43.
    Robinson HP, Caines JS. Sonar evidence of early pregnancy failure in patients with twin conceptions. Br J Obstet Gynaecol. 1977; 84:22–25.PubMedCrossRefGoogle Scholar
  44. 44.
    Varma TR. Ultrasound evidence of early pregnancy failure in patients with multiple conceptions. Br J Obstet Gynaecol. 1979;86:290–292.PubMedCrossRefGoogle Scholar
  45. 45.
    Jeanty P, Rodesch F, Verhoogen C, Struyven J. The vanishing twin. Ultrasons. 1981;2:25–31.Google Scholar
  46. 46.
    Landy HJ, Keith L, Keith D. The vanishing twin. Acta Genet Med Gemellol. 1982;31:179–194.PubMedGoogle Scholar
  47. 47.
    Landy HJ, Weiner S, Corson SL, Batzer FR, Bolognese RJ. The “vanishing twin”: Ultrasonographic assessment of fetal disappearance in the first trimester. Am J Obstet Gynecol. 1986;155:14–19.PubMedGoogle Scholar
  48. 48.
    Ghosh A, Woo JS, Rawlinson HA, Ferguson-Smith MA. Prognostic significance of rasied serum alpha feto-protein levels in twin pregnancies. Br J Obstet Gynaecol. 1982;89:817–820.PubMedCrossRefGoogle Scholar
  49. 49.
    Letchworth AT, Gordon YB, Leighton PC, Kitau MJ. Raised amniotic fluid concentrations of alpha fetoprotein in a twin pregnancy. Br Med J. 1977;1:689.PubMedCrossRefGoogle Scholar
  50. 50.
    Lange AP, Hevjorn S, Moth I, et al. Twin fetus papyraceus and alpha fetoprotein: A clinical dilemma. Lancet. 1979;2:636. Letter.PubMedCrossRefGoogle Scholar
  51. 51.
    Streit JA, Peick GD, Williamson RA, Weiner CP, Benda JA. Prolonged elevation of alphafetoprotein and detectable acetylcholinesterase after death of an anomalous twin fetus. Prenat Diagn. 1989;9:1–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Bass HN, Oliver JB, Srinivasan M, Petrucha R, Ng W, Lee J. Persistently elevated AFP and AChE in amniotic fluid from a normal fetus following demise of its twin. Prenat Diagn. 1986;6:33–35.PubMedCrossRefGoogle Scholar
  53. 53.
    Winsor EJ, Brown BS, Luther ER, Heifetz SA, Welch JP. Deceased co-twin as a cause of false positive amniotic fluid AFP and AChE. Prenat Diagn. 1987;7:485–489.PubMedCrossRefGoogle Scholar
  54. 54.
    Yen S, MacMahon B. Genetics of anencephaly and spina bifida. Lancet. 1968;2:623–626.PubMedCrossRefGoogle Scholar
  55. 55.
    Holbrook RH JR, Krovoza AM, Schelley S, Ferguson JE II. Biamnial elevated alpha-fetoprotein and positive acetylcholinesterase in twins, one with anencephaly. Prenat Diagn. 1987;7:653–655.PubMedCrossRefGoogle Scholar
  56. 56.
    Stiller RJ, Lockwood CJ, Belanger, K, Baumgarten A, Hobbins JC, Mahoney MJ. Amniotic fluid alpha fetoprotein concentrations in twin gestations: Dependence on placental membrane anatomy. Obstet Gynecol. 1988; 158:1088–1092.Google Scholar
  57. 57.
    Wald NJ, Cuckle HS, Peck S, Stirrat GM, Turnbull AC. Maternal serum alpha fetoprotein in relation to zygosity. Br Med J. 1979;1:455.PubMedCrossRefGoogle Scholar
  58. 58.
    Walker EM, Patel NB. Maternal serum alpha fetoprotein, birthweight and perinatal death in twin pregnacy. Br J Obstet Gynaecol. 1986;93:1191–1193.PubMedCrossRefGoogle Scholar
  59. 59.
    Redford DHA, Whitfield, CR. Maternal serum alpha fetoprotein in twin pregnancies uncomplicated by neural tube defect. Am J Obstet Gynecol. 1985;152:550–553.PubMedGoogle Scholar
  60. 60.
    Donnenfeld AE, Glazerman LR, Cutillo DM, Librizzi RJ, Weiner S. Fetal exsanguination following intrauterine angiographic assessment and selective termination of a hydrocephalic, monozygotic co-twin. Prenat Diagn. 1989; 9:301–308.PubMedCrossRefGoogle Scholar
  61. 61.
    Aberg A, Mitelman F, Cantz M, Gehler J. Cardiac puncture of fetus with Hurler’s disease avoiding abortion of unaffected twin. Lancet. 1978;1:990–991.CrossRefGoogle Scholar
  62. 62.
    Rodeck CH, Mibashan RS, Abramowicz J, Campbell S. Selective fetocide of the affected twin by fetoscopic air embolism. Prenat Diagn. 1982;2:189–194.PubMedCrossRefGoogle Scholar
  63. 63.
    Pijpers L, Jahoda MGJ, Vosters RPL, Niermeijer MF, Sachs ES. Genetic amniocentesis in twin pregnancies. Br J Obstet Gynaecol. 1988;95:323–326.PubMedCrossRefGoogle Scholar
  64. 64.
    Elias S, Gerbie A, Simpson JL, Nadler HL, Sabbagha RE, Scholnik A. Genetic amniocentesis in twin pregnancies. Am J Obstet Gynecol. 1980;138:169–174.PubMedGoogle Scholar
  65. 65.
    Bovicelli L, Michelacci L, Rizzos N, et al. Genetic amniocentesis in twin pregnancy. Prenat Diagn. 1981;3:101–106.CrossRefGoogle Scholar
  66. 66.
    Librach CL, Doran TA, Benzie RJ, Jones JM. Genetic amniocentesis in seventy twin pre-gnancies. Am J Obstet Gynecol. 1984;148:585–591.PubMedGoogle Scholar
  67. 67.
    Palle C, Andersen JW, Tabor A, Lauritsen JG, Bang J, Philip J. Increased risk of abortion after genetic amniocentesis in twin pregnancies. Prenat Diagn. 1983;3:83–89.PubMedCrossRefGoogle Scholar
  68. 68.
    Cox WL, Forestier F, Capella-Pavlovsky M, Daffos F. Fetal blood sampling in twin pregnancies. Fetal Ther. 1987;2:101–108.PubMedCrossRefGoogle Scholar
  69. 69.
    Lage JM, Vanmarter LJ, Mikhail E. Vascular anastomoses in fused, dichorionic twin placentas resulting in twin transfusion syndrome. Placenta. 1989;10:55–59.PubMedCrossRefGoogle Scholar
  70. 70.
    Bebbington MW, Wittmann BK. Fetal transfusion syndrome: Antenatal factors predicting outcome. Am J Obstet Gynecol. 1989;160:913–915.PubMedGoogle Scholar
  71. 71.
    Schneider KT, Vetter K, Huch R, Huch A. Acute polyhydramnios complicating twin pregnancies. Acta Genet Med Gemellol. 1985;34:179–184.PubMedGoogle Scholar
  72. 72.
    Wittmann BK, Farquharson DF, Thomas WDS, Baldwin VJ, Wadsworth LD. The role of fetocide in the management of severe twin transfusion syndrome. Am J Obstet Gynecol. 1986;155:1023–1026.PubMedGoogle Scholar
  73. 73.
    De Lia J, Emery MG, Sheafor SA, Jennison TA. Twin transfusion syndrome: Successful in utero treatment with digoxin. Int J Gynaecol Obstet. 1985;23:197–201.PubMedCrossRefGoogle Scholar
  74. 74.
    Brown DI, Benson CB, Driscoll, Doubilet PM. Twin-twin transfusion syndrome: Sonographic findings. Radiology. 1989;170:61–63.PubMedGoogle Scholar
  75. 75.
    D’Alton ME, Dudley K. The ultrasonographic prediction of chorionicity in twin gestation. Am J Obstet Gynecol. 1989;160:557–561.PubMedGoogle Scholar
  76. 76.
    Barss VA, Benacerraf BR, Frigoletto FD. Ultrasonographic determination of chorion type in twin gestation. Obstet Gynecol. 1985; 66:779–783.PubMedGoogle Scholar
  77. 77.
    Townsend RR, Simpson GF, Filly RA. Membrane thickness in ultrasound prediction of chorionicity of twin gestations. J Ultrasound Med. 1988;7:327–332.PubMedGoogle Scholar
  78. 78.
    Hagay ZJ, Mazor M, Leiberman JR. Multiple pregnancy complicated by a single intrauterine fetal death. Obstet Gynecol. 1985;66:837–838. Letter.PubMedGoogle Scholar
  79. 79.
    Weekes ARL, Menzies DN, de Boer CH. The relative efficacy of bed rest, cervical suture, and no treatment in the management of twin pregnancy. Br J Obstet Gynaecol. 1977; 84:161–164.PubMedCrossRefGoogle Scholar
  80. 80.
    Sinha DP, Nandakumar VC, Brough Ak. Relative cervical incompetence in twin pregnancy. Acta Genet Med Gemellol. 1979;28:327–331.PubMedGoogle Scholar
  81. 81.
    Newman RB, Gill PJ, Katz M. Uterine activity during pregnancy in ambulatory patients: Comparison of singleton and twin gestations. Am J Obstet Gynecol. 1986;154:530–531.PubMedGoogle Scholar
  82. 82.
    Clark SL, Cotton DB, Lee W, et al. Central hemodynamic assessment of normal third trimester pregnancy: A simultaneous comparison of Fick principle, thermodilution, continuous wave Doppler, pulsed Doppler and electrical impedance measurements of cardiac ouput, and effects of position changes on hemodynamics and oxygen delivery. Presented at the ninth annual meeting of the Society of Perinatal Obstetricians, New Orleans, Louisiana, February 1989: Abstract 33.Google Scholar
  83. 83.
    Misenhimer HR, Kaltreider DF. Effects of decreased prenatal activity in patients with twin pregnancy. Obstet Gynecol. 1978;51:692–694.PubMedGoogle Scholar
  84. 84.
    Thompson SA, Lyons TL, Makowski EL. Outcomes of twin gestations at the University of Colorado Health Sciences Center, 1973–1983. J Reprod Med. 1987;32:328–329.PubMedGoogle Scholar
  85. 85.
    Gilstrap LC, Hauth JC, Hankins GD, Beck A. Twins: Prophylactic hospitalization and ward rest at early gestational age. Obstet Gynecol. 1987;69:578–581.PubMedGoogle Scholar
  86. 86.
    O’Connor MC, Murphy H, Dalrymple IJ. Double blind trial of ritodrine and placebo in twin pregnancy. Br J Obstet Gynecol. 1979;86:706–709.CrossRefGoogle Scholar
  87. 87.
    Marivate M, De Villiers KO, Fairbrother P. Effect of prophylactic outpatient administration of fenterenol on the time of onset of spontaneous labour and fetal growth rate in twin pregnancy. Am J Obstet Gynecol. 1977; 128:707–708.PubMedGoogle Scholar
  88. 88.
    O’Leary JA. Prophylactic tocolysis of twins. Am J Obstet Gynecol. 1986;154:904–905.PubMedGoogle Scholar
  89. 89.
    Rayburn W, Piehl E, Schork MA, Kirscht J. Intravenous ritodrine therapy: A comparison between twin and singleton gestations. Obstet Gynecol 1986:67:243–248.PubMedCrossRefGoogle Scholar
  90. 90.
    Stubblefield PG. Pulmonary edema occurring after therapy with dexamethasone and terbutaline for premature labor: A case report. Am J Obstet Gynecol. 1978;132:341–342.PubMedGoogle Scholar
  91. 91.
    Elliott JP, O’Keefe DF, Greenberg P, Freeman RK. Pulmonary edema associated with magnesium sulfate and betamethasone administration. Am J Obstet Gynecol. 1979; 134:717–719.PubMedGoogle Scholar
  92. 92.
    Spellacy WN, Cruz AC, Buhi WC. Amniotic fluid L/S rations in twin gestation. Obstet Gynecol. 1977;50:68–70.PubMedGoogle Scholar
  93. 93.
    Sims CD, Lowan DB, Parkinson CE. The L/S ratio in twin pregnancies. Br J Obstet Gynaecol. 1976;83:447–451.PubMedCrossRefGoogle Scholar
  94. 94.
    D’Alton ME, Dudley DKL. Ultrasound in the antenatal management of twin gestation. Semin Perinatol. 1986;10:30–38.PubMedGoogle Scholar
  95. 95.
    Dwyer PL, Oats JN, Walstab JE, et al. Glucose tolerance in twin pregnancy. Aust NZ J Obstet Gynaecol. 1982;22:131–134.CrossRefGoogle Scholar
  96. 96.
    Naidoo L, Jailal I, Moodley J, Desai R. Intravenous glucose tolerance tests in women with twin pregnancy. Obstet Gynecol. 66:500–502.Google Scholar
  97. 97.
    Naeye RL, Benirschke K, Hagstrom JWC, Marcus CC. Intrauterine growth of twins as estimated from liveborn birth-weight data. Pediatrics. 1966;37:409–416.PubMedGoogle Scholar
  98. 98.
    Socol ML, Tamura RK, Sabbagha RE. Diminished biparietal diameter and abdominal circumference growth in twins. Obstet Gynecol. 1984;64:235–238.PubMedGoogle Scholar
  99. 99.
    Grumbach K, Coleman BG, Arger PH, Mintz ML, Gabbe SG, Mennuti MT. Twin and singleton growth patterns compared using ultrasound. Radiology. 1986;158;237–241.PubMedGoogle Scholar
  100. 100.
    Crane JP, Tomich PG, Kopta M. Ultrasonic growth patterns in normal and discordant twins. Obstet Gynecol. 1980;55:678–683.PubMedGoogle Scholar
  101. 101.
    Yarkoni S, Reece EA, Holford T, O’Connor TZ, Hobbins JC. Estimated fetal weight in the evaluation of growth in twin gestations: A prospective longitudinal study. Obstet Gynecol. 1987;69:636–639.PubMedGoogle Scholar
  102. 102.
    Simon NV, Deter RL, Hassinger KK, Levisky JS, Stefos T, Shearer DM. Evaluation of fetal growth by ultrasonography in twin pregnancy: A comparison between individual and cross-sectional growth curve standards. J Clin Ultrasound. 1989;17:633–640..PubMedCrossRefGoogle Scholar
  103. 103.
    Stefos T, Deter RL, Hill RM, Simon N. Individual growth curve standards in twins: Growth in the second trimester. J Clin Ultrasound. 1989;18:641–646.CrossRefGoogle Scholar
  104. 104.
    Storlazzi E, Vintzileos AM, Campbell WA, Nochimson DJ, Weingaum PJ. Ultrasonic diagnosis of discordant fetal growth in twin gestations. Obstet Gynecol. 1987;69:363–367.PubMedGoogle Scholar
  105. 105.
    Brown CE, Guzick DS, Leveno KJ, Santos-Ramos R, Whalley PJ. Prediction of discordant twins using ultrasound measurements of biparietal diameter and abdominal perimeter. Obstet Gynecol. 1987;70:677–681.PubMedGoogle Scholar
  106. 106.
    Chitkara U, Berkowitz GS, Levine R, et al. Twin pregnancy: Routine use of ultrasound examinations in the prenatal diagnosis of intrauterine growth retardation and discordant growth. Am JPerinatol. 1985;2:49–54.CrossRefGoogle Scholar
  107. 107.
    Devoe LD. Simultaneous, antepartum testing of twin fetal heart rates. South Med J. 1985;78:380–383.PubMedCrossRefGoogle Scholar
  108. 108.
    Lodeiro JG, Vintzileos AM, Feinstein SJ, Campbell WA, Nochimson DJ. Fetal biophysical profile in twin gestations. Obstet Gynecol. 1986;67:824–827.PubMedCrossRefGoogle Scholar
  109. 109.
    Gerson A, Johnson A, Wallace D, Bottalico J, Weiner S, Bolognese R. Umbilical arterial systolic/diastolic values in normal twin gestation. Obstet Gynecol. 1988;72:205–208.PubMedGoogle Scholar
  110. 110.
    Nimrod C, Davies D, Harder J, et al. Doppler ultrasound prediction of fetal outcome in twin pregnancies. Am J Obstet Gynecol. 1987; 156:402–406.PubMedGoogle Scholar
  111. 111.
    Quigley JK. Monoamniotic twin pregnancy. Am J Obstet Gynecol. 1935;29:354–362.Google Scholar
  112. 112.
    Timmons JD, DeAlvarez RR. Monoamniotic twin pregnancy. Am J Obstet Gynecol. 1963; 86:875–881.PubMedGoogle Scholar
  113. 113.
    Lumme RH, Saarikoski SV. Monoamniotic twin pregnancy. Acta Genet Med Gemellol. 1986;35:99–105.PubMedGoogle Scholar
  114. 114.
    Rodis JF, Vintzileos AM, Campbell WA, et al. Antenatal diagnosis and management of monoamniotic twins. Am J Obstet Gynecol. 1987;157:1255–1257.PubMedGoogle Scholar
  115. 115.
    Townsend RR, Filly RA. Sonography of non-conjoined monoamniotic twin pregnancies. J Ultrasound Med. 1988;7:665–670.PubMedGoogle Scholar
  116. 116.
    McLeod FN, McCoy DR. Monoamniotic twins with an unusual cord complication. Case report. Br J Obstet Gynecol. 1981;88:774–775.CrossRefGoogle Scholar
  117. 117.
    Carlson NJ, Towers CV. Multiple gestation complicated by the death of one fetus. Obstet Gynecol. 1989;73:685–689.PubMedGoogle Scholar
  118. 118.
    Melnick M. Brain damage in survivor after in utero death of monozygous co-twin. Lancet. 1977;2:1287. Letter.PubMedCrossRefGoogle Scholar
  119. 119.
    Duenhoelter JH, Wells CE, Reisch JS, Santos-Ramos R, Jimenez JM. A paired controlled study of vaginal and abdominal delivery of the low birth weight breech fetus. Obstet Gynecol. 1979;54:310–313.PubMedGoogle Scholar
  120. 120.
    Kauppila O, Gronroos M, Paavo A, Aittoniemi P, Kuoppala M. Management of low birth weight breech delivery: Should cesarean section be routine? Obstet Gynecol. 1981;57:289–293.PubMedGoogle Scholar
  121. 121.
    Scialli AR. Intrapartum management of twin gestation. Obstet Gynecol. 1986;67:149–150. Letter.PubMedGoogle Scholar
  122. 122.
    Karp LE, Doney JR, McCarthy T, Meis PJ, Hall M. The premature breech: Trial of labor or cesarean section? Obstet Gynecol. 1979; 53:88–92.PubMedGoogle Scholar
  123. 123.
    Chervenak FA, Johnson RE, Berkowitz RL, Grannum P, Hobbins JC. Is routine cesarean section necessary for vertex-breech and vertex-transverse twin gestations? Am J Obstet Gynecol. 1984;148:1–5.PubMedGoogle Scholar
  124. 124.
    Blickstein I, Schwartz-Shoham Z, Lancet M, Borenstein R. Vaginal delivery of the second twin in breech presentation. Obstet Gynecol. 1987;69:774–776.PubMedGoogle Scholar
  125. 125.
    Rabinovici J, Barkai G. Reichman B, Serr DM, Mashiach S. Randomized management of the second nonvertex twin: Vaginal delivery or cesarean section. Am J Obstet Gynecol. 1987;156:52–56.PubMedGoogle Scholar
  126. 126.
    Laros RK, Dattel BJ. Management of twin pregnancy: The vaginal route is still safe. Am J Obstet Gynecol. 1988;158:1330–1338.PubMedGoogle Scholar
  127. 127.
    Acker D, Lieberman M, Holbrook RH, James O, Phillippe M, Edelin KC. Delivery of the second twin. Obstet Gynecol. 1982;59:710–711.PubMedGoogle Scholar
  128. 128.
    Doyle LW, Hughes CD, Guaran RL, Quinn MA, Kitchen WH. Mode of delivery of preterm twins. Aust NZ J Obstet Gynecol. 1988;28:25–28.CrossRefGoogle Scholar
  129. 129.
    Ranney B. The gentle art of cephalic version. Am J Obstet Gynecol. 1973;116:239–251.PubMedGoogle Scholar
  130. 130.
    Strickland N, Saneman P. Locked twins. Report of 3 cases. Obstet Gynecol. 1967;29:211–212.PubMedGoogle Scholar
  131. 131.
    Sevitz H, Merrell DA. The use of a beta-sympathomimetic drug in locked twins. Case report. Br J Obstet Gynaecol. 1981;88:76–77.PubMedCrossRefGoogle Scholar
  132. 132.
    Martimbeau P, Jorgensen E, O’Connell EJ. Locked twins. An unusual method of delivery. Obstet Gynecol. 1976;47:609–610.PubMedGoogle Scholar
  133. 133.
    Saint L, Maggiore P, Hartmann PE. Yield and nutrient content of milk in eight women breastfeeding twins and one woman breastfeeding triplets. Br J Nutr. 1986;56:49–58.PubMedCrossRefGoogle Scholar
  134. 134.
    Leonard LG. Breast-feeding twins: Maternal-infant nutrition. J Obstet Gynecol Nurs. 1982;11:148–153.CrossRefGoogle Scholar
  135. 135.
    Stables J. Breastfeeding twins. Nurs Times. 1980;76:1493–1494.PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York Inc. 1993

Authors and Affiliations

  • Gabriella Pridjian
  • Chin-Chu Lin

There are no affiliations available

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