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SPECIAL
PREGNANCY
CASES
The following sections will help you with
understanding and coping with special pregnancy
cases such as obesity, ectopic pregnancy,
malpresentation, multiple gestation, grand
multipara and others.
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What are the Effects of Multiple Gestations on
Pregnancy?
The complication rate is higher for the mother and
the fetuses
Complications in the
mother
- Anemia - anemia in such cases is not only due to
higher iron demands but also folic acid deficiency leading
to meghaloblastic anemia.
- Hyper emesis when this happen, it can be very
severe in these mothers and the patient will also require
more rest than normal because of increased varicose
veins.
- Gestational hypertension and
preeclampsia this not only manifests
early but also in a more severe form.
- The incidence of atypical forms like HELLP SYNDROME and
placental abruption also increases.
- The large placenta of multiple fetuses also produces
varying degrees of placenta praevia in such mothers.
- Polyhydramnios is one more complication that these
mothers may face
The chances of gestational diabetes does not
increase with multiple gestation.
Fetal complications
- Perinatal mortality which is death of the fetus within
two weeks of delivery is six times higher in multiple
gestations.
- Vanishing twins- twins re more often conceived than
born- there can be an arrest of growth of one fetus in the
first trimester leading to its disappearance.
- Malformations-major congenital malformations occur
twice as often in multiple gestations as compared to
singletons especially in monozygotic twins. these can be
grouped in three categories -
- Anomalies unique to twins like conjoined and
acardiac twins
- Deformities because of mechanical or vascular
factors like foot deformities, asymmetry of skull,
dislocation of the hip etc., microcephaly, intestinal
Artesia, renal dysphasia, limb amputation and skin
malformations can occur because of vascular
compromise.
- Others like neural tube defects, facial clefts,
anterior abdominal wall defects etc are also seen.
- Chromosomal anomaly risk is also greater.
If an invasive procedure is needed in this pregnancy, one
has to be sure of chorionicity of the fetus. Because in
monochorionic twins, while it is important to take only one
sample from the sac, in dizygotic twins, samples will have to
be taken from both the sacs independently under ultrasound
guidance.
Single fetus demise may happen in 5 % of twin
pregnancies. And in 17% of triplets. This may lead to increased
chances of multiple organ damage in the surviving fetus and
also the chances of its survival decreases by 25%.
If this happens in the first trimester, the other fetus is
not much affected and the pregnancy can go on but if happens in
the second and third trimesters, the chorionicity would play a
major role.
In dichorionic twins, the second twin may remain unaffected
and the pregnancy can be continued till needed according to the
gestational age and monitoring with non stress tests and bio
physical profile.
In monochorionic twins, there may be circulatory problems in
the child and there might be multiple organ damage.
Other Effects of Multiple Gestations on
Pregnancy
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