We are witnessing more and more frequently multiple pregnancy in this world. Multiple pregnancies are increasing globally, in keeping with lifestyle changes (consistently increasing overweight and obesity in women of reproductive age almost everywhere), an increase in maternal age at first pregnancy (especially in high income countries), and with the widespread use of medically assisted reproductive techniques (ART). Although obstetric risks related to ART are significantly elevated independently from multifetality, there is an increasing trend of twinning in infertile patients, in the obese and in those with the polycystic ovary syndrome.
This outlines a worrying picture.
In fact, twin pregnancy threatens the health or life of the mother and her fetuses and is associated with high rates of maternal complications and fetal mortality and morbidity. The major clinical problem concerns prematurity, since almost half of twins are delivered in early gestational ages, particularly in pregnancies resulting from ART compared to spontaneous ones. Prematurity often means that babies need intensive care for long periods of time with consistent increase in neurodevelopmental and growth disorders and high cost for the health systems and families and impairments for individual adult life. The management of multiple pregnancies during gestation, labor, and delivery, which has long been a key skill for the obstetricians, is never more important than in the current era.
Prevention of multiple pregnancy plays a fundamental role and a high priority, due to the iatrogenic nature of any complication. However, in the event of failure of a single conception, the obstetrician should manage multiple pregnancy in referral centers in order to reduce the consistent morbidities. To develop excellence in the antenatal and perinatal management of multiple pregnancies, it is important to consider several key points, particularly the early detection of chorionicity-amnionicity, the limits, risks, and pitfalls of prenatal diagnosis, the slower growth of twins, especially during the third trimester, the requirements of maternal nutrition and the need of micronutrients supplementation, and the potential to resort to a fetal surgery center and to neonatal intensive care provided maternity unit to face the major challenging morbidities, especially in monochorionic twinning, present specific problems caused by the shared placenta with interfetal anastomoses, etc.
Although the clinical choices must be individualized as much as possible, international guidelines and advice, meetings, and congresses on this topic address the major problems and solutions in order to homogenize our professional attitudes and care in this particular high risk type of pregnancy. Medical assistance to twin pregnancy is and should stay individualized and based on an interpersonal relationship which is irreplaceable.
Edited By Yang Pan