Multiple Gestation: Maternal and Fetal Risks

Introduction

Multiple gestation, defined as pregnancy involving two or more fetuses, poses significant maternal and fetal risks. With advancements in assisted reproductive technologies, the incidence of multiple pregnancies has increased. While twin pregnancies are relatively common, higher-order multiples present more complex challenges.

Maternal Risks

• Gestational Hypertension and Preeclampsia: The risk of hypertensive disorders increases due to heightened placental load.
• Preterm Labor: Nearly 50% of twin pregnancies and an even higher proportion of triplets or more result in preterm birth.
• Gestational Diabetes: Altered metabolic demands elevate the likelihood of impaired glucose tolerance.
• Postpartum Hemorrhage: Uterine overdistension in multiple pregnancies predisposes mothers to excessive bleeding post-delivery.

Fetal Risks

• Prematurity: Shortened gestational duration contributes to low birth weight and neonatal complications.
• Intrauterine Growth Restriction (IUGR): Competition for nutrients often leads to restricted fetal development.
• Twin-to-Twin Transfusion Syndrome (TTTS): Monochorionic twin pregnancies risk abnormal vascular connections, leading to uneven blood flow.
• Congenital Anomalies: Increased risk compared to singleton pregnancies.

Management Strategies

Optimal management involves early prenatal care, close monitoring with ultrasound assessments, and appropriate delivery planning. Targeted interventions, such as corticosteroid administration for fetal lung maturity and meticulous intrapartum surveillance, improve outcomes.

Conclusion

Multiple gestation presents heightened maternal and fetal risks, necessitating proactive obstetric care and multidisciplinary management for favorable perinatal outcomes.