Spontaneous twins occur in approximately 1 in 90 pregnancies Increased use of reproductive technology has significantly increased this rate
SECOND Cephalic
TWINS Breech
39
13
0.6
26
0.6
Other
0.5
Same resources as required for singleton with extra staffing (nursing, physician, midwives) Consider transier of labouring patient if resources unavailable locally
Consider the lie and presentation of each fetus Vaginal delivery is the goal unless there are specific contraindications Placenta should not be drained and cord bloods not taken until after delivery of second twins
Management of labour
Preterm labour common
- educate re : warning signs - steroids indicated as in singleton - use tocolytics judiciously (pulmonary edema) Induction as per singleton indications plus twin specific indications (e.g. EFW disparity) Augmentation as per singleton may be helpful following delivery of first twin