Multiple Gestation

At least 1 in 80 births is a twin gestation. With assisted reproductive technologies, this rate has now increased to almost 1 in 50 to 60. Approximately two thirds to three quarters of twins are dizygotic.

Twin gestation presents unique challenges. Monozygotic twins have twice the anomaly rate of dizygotic twins or singletons. Women with a twin gestation are more likely to miscarry early in gestation and more likely to deliver prematurely. Half of mothers of twins experience premature labor. Bed rest is often recommended after 5 months of gestation to aid in preterm-labor prevention. Education regarding associated signs and symptoms is important in this group. The average gestational age of delivery for a twin gestation is 36 menstrual weeks.

Women with a twin gestation are also at higher risk for chronic hypertension, pyelonephritis, gestational diabetes, and placenta previa. They should take supplemental iron, particularly in the latter trimesters, even if they are not iron deficient. Growth discordance can also occur, from twin-twin transfusion syndrome or more often simply from different placental implantation and different accessibility to nutrients. Serial ultrasound studies for growth approximately every 6 weeks is recommended. Twin fetuses with growth discordance should have antenatal testing.

The majority of twins will present both head first, cephalic-cephalic (Fig. 21-6, A), or first one cephalic, second one breech (cephalic-breech, 21-6, B). Any other combination can be seen, although cephalic-transverse (21-6, C), and breech-cephalic are the most likely in this remaining group. Once well into the third trimester, the first presenting fetus most often stays in its position; the second fetus often changes position, occasionally even during early labor. Twins who are cephalic-cephalic can be delivered vaginally. Those who are cephalic-breech and cephalic-transverse can also be attempted vaginally by skilled operators in carefully chosen women. When the first fetus is presenting other than cephalic, delivery is often best accomplished by cesarean section. Breastfeeding has been successful in many women with twins and should be encouraged.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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