MANAGEMENT CONUNDRUMS IN MULTIPLE PREGNANCIES WITH SELECTIVE REDUCTION, INTRAUTERINE FETAL DEATH OR SPONTANEOUS ABORTION

Abstract

There has been a marked increase in the prevalence of twins, triplets and higher-order multiple pregnancies over the last 20 years due, in part, to delayed childbearing, but more significantly associated with the widespread introduction of assisted reproductive techniques. Once viability is confirmed these pregnancies pose a series of unique challenges to the obstetrician as the dynamic of the maternal – fetal relationship changes when there are two, or more, fetuses to consider. With the exception of postmaturity, all obstetric complications are more common in multiple pregnancies. Australian data shows perinatal mortality rates of 7, 25 and 63 per 1,000 births for singleton, twin (RR 3.4) and triplet (RR 8.5) pregnancies respectively; with similar rates reported in the UK and USA. While multiple pregnancies account for only 2% of births, they account for 20% of neonatal admissions and 12% of perinatal deaths – with a 5-fold increase in deaths before 1 year of age.