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Intrapartum management of multiple gestations

C Houlihan1, R A Knuppel

  • 1Department of Obstetrics and Gynecology, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA.

Clinics in Perinatology
|March 1, 1996
PubMed
Summary

Managing multiple gestations during labor requires careful consideration of fetal presentation and weight. External cephalic version (ECV) is recommended for non-vertex second twins under 1700g, followed by cesarean if unsuccessful. For heavier non-vertex twins, ECV or assisted breech extraction is suitable.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Perinatology

Background:

  • Intrapartum management of multiple gestations remains a complex and debated topic in obstetrics.
  • Accurate ultrasonography plays a critical role throughout labor and delivery for multiple fetuses.

Purpose of the Study:

  • To review and provide recommendations for the intrapartum management of twin and triplet gestations.
  • To clarify the optimal delivery route based on fetal presentation, gestational age, and estimated fetal weight.

Main Methods:

  • Review of current literature and clinical practices regarding multiple gestation delivery.
  • Analysis of ultrasonographic findings in labor and delivery.
  • Evaluation of techniques such as external cephalic version (ECV) and assisted breech extraction.

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Main Results:

  • Specific recommendations are provided for the management of the non-vertex second twin based on estimated fetal weight.
  • External cephalic version (ECV) is advised for non-vertex second twins <1700g, with cesarean section if unsuccessful.
  • For non-vertex second twins >1700g, ECV or assisted breech extraction is appropriate; all triplet gestations are recommended for abdominal delivery.

Conclusions:

  • The optimal delivery route for multiple gestations requires individualized assessment based on various fetal parameters.
  • Further research is needed to refine management strategies, including the potential use of uterine relaxants like intravenous nitroglycerin.