Abstract
The incidence of twins in England and Wales is approximately 15.9/1000 maternities. Despite strategies to reduce the number of multiple births there has been very little reduction in numbers. Twin pregnancies are associated with increased maternal and neonatal morbidity. Monochorionic twins are even more complex in view of the shared placenta that may lead to such complications as twin-to-twin transfusion syndrome and selective fetal growth restriction. Early diagnosis and determination of chorionicity is imperative to plan antenatal management, ultrasound surveillance and timing and mode of delivery. In addition parents should be counselled regarding the risks of prematurity, as 60% will be delivered early, either spontaneously or as a result of obstetric intervention. Twin pregnancy should be managed in a multi-disciplinary setting ideally in a specialist obstetric clinic where complications may be recognised early and interventions employed in a timely manner. Twin deliveries can also be complicated and where possible a senior obstetrician should oversee the delivery who is trained to manage any potential complications. The largest numbers of litigation cases in twin pregnancies arise from babies suffering hypoxic ischaemic damage where CTG interpretation during labour has been an issue.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Kilby MD, Oepkes D. Multiple pregnancy. In: Edmonds K, editor. Dewhurst’s textbook of obstetrics & gynaecology. 8th ed. Chichester: Wiley Blackwell; 2012. isbn:13 9780470654576
El Toukhy T, Bhasttacharya S, Akande VA. RCOG Scientific Impact Paper (No. 22). Multiple pregnancies following assisted conception. 2017.
Nicolaides K. First trimester screening. Fetal medicine foundation. 2004.
McDonald R, Hodges R, Knight M, Teoh M, Edwards A, Neil P, Wallace EM, DeKoninck P. Optimal interval between ultrasound scans for the detection of complications in monochorionic twins. Fetal Diagn Ther. 2017;41(3):197–201.
NICE Guidance. Multiple pregnancy: antenatal care for twin and triplet pregnancies. National Institute of Care and Clinical Excellence Clinical guideline [CG129]. Published date Sep 2011.
Kilby MD, Bricker L. Monochorionic twin pregnancy, management (Royal College of Obstetrician and Gynaecologists Green-top Guideline No. 51). Published 16 Nov 2016.
Cheong-See F, Schuit E, Arroyo-Manzano D, Khalil A, Barrett J, Joseph KS, Asztalos E, Hack K, Lewi L, Lim A, Liem S, Norman JE, Morrison J, Combs CA, Garite TJ, Maurel K, Serra V, Perales A, Rode L, Worda K, Nassar A, Aboulghar M, Rouse D, Thom E, Breathnach F, Nakayama S, Russo FM, Robinson JN, Dodd JM, Newman RB, Bhattacharya S, Tang S, Mol BW, Zamora J, Thilaganathan B, Thangaratinam S, Global Obstetrics Network (GONet) Collaboration. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. BMJ. 2016;354:i4353.
D’Antonio F, Familiari A, Thilaganathan B, Papageorghiou AT, Manzoli L, Khalil A, Bhide A. Sensitivity of first-trimester ultrasound in the detection of congenital anomalies in twin pregnancies: population study and systematic review. Acta Obstet Gynecol Scand. 2016;95(12):1359–67.
Breathnach FM, McAuliffe FM, Geary M, Daly S, Higgins JR, Dornan J, Morrison JJ, Burke G, Higgins S, Dicker P, Manning F, Mahony R, Malone FD, Perinatal Ireland Research Consortium. Definition of intertwin birth weight discordance. Obstet Gynecol. 2011;118(1):94–103.
Stirrup OT, Khalil A, D’Antonio F, Thilaganathan B, Southwest Thames Obstetric Research Collaborative (STORK). Fetal growth reference ranges in twin pregnancy: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort. Ultrasound Obstet Gynecol. 2015;45(3):301–7.
Khalil A, Rodgers M, Baschat A, Bhide A, Gratacos E, Hecher K, Kilby MD, Lewi L, Nicolaides KH, Oepkes D, Raine-Fenning N, Reed K, Salomon L, Sotiriadis A, Thilaganathan B, Ville Y. ISUOG practice guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 2016;47(2):247–63.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Kilby, M.D., Thomson, P.J. (2018). Twins. In: Jha, S., Ferriman, E. (eds) Medicolegal Issues in Obstetrics and Gynaecology. Springer, Cham. https://doi.org/10.1007/978-3-319-78683-4_31
Download citation
DOI: https://doi.org/10.1007/978-3-319-78683-4_31
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-78682-7
Online ISBN: 978-3-319-78683-4
eBook Packages: MedicineMedicine (R0)