Table I-8-2. Postconception Days to Identical Twin CleavageEmbryonic disk
Conjoined >12 days
EmbryoWith multiple gestation, hyperemesis gravidarum is common due to high
levels of β-hCG. Uterus is larger than dates. Maternal serum α-fetoprotein is
excessively higher than with one fetus.
Management.
Antepartum: Give mother iron and folate supplementation to prevent
anemia, monitor BP to detect preeclampsia, educate mother regarding preterm
labor symptoms and signs, and perform serial ultrasound examinations
looking for twin–twin transfusion (amniotic fluid discordance).
Intrapartum: Route of delivery is based on presentation in labor—vaginal
delivery if both are cephalic presentation (50%); cesarean delivery if first twin
in noncephalic presentation; route of delivery is controversial if first twin is
cephalic and second twin is noncephalic.
Postpartum: Watch for postpartum hemorrhage from uterine atony owing to
an overdistended uterus.