80 Obstetrics and Gynecology Board Review •••
❍ Has bed rest been shown to reduce the risk of preterm delivery in twins?
No.
❍ Should maternal dietary intake change in multifetal pregnancies?
Maternal dietary intake should increase by approximately 300 kcal above that for singleton gestations.
❍ What is the recommended weight gain for women carrying twins?
35 to 45 pound total weight gain at term.
❍ What complications of multiple gestations affect pregnancy outcome?
(1) Increased incidence of spontaneous abortion
(2) Increased incidence of malformations
(3) Intrauterine growth restriction
(4) Increased incidence of preterm birth
(5) Placenta previa is more frequently encountered because of large size of placenta or placentas
(6) Gestational hypertension. The risk is increased three to four times more in multiple gestations than in single
pregnancies
(7) Gestational diabetes
(8) Acute fatty liver
(9) Pruritic urticarial papules and plaques of pregnancy (PUPPS)
(10) Pulmonary embolus
(11) Uterine atony
(12) Abruption
(13) Malpresentation
❍ What is the recommended gestational age to deliver twins?
By 39 weeks.
❍ What is the most common cause of neonatal morbidity and mortality in twins?
Preterm delivery.
❍ What percentage of twins are born preterm (before 37 weeks’ gestation)?
Almost 50% of twin gestations are born preterm.
❍ What is the mean duration of gestation in twins and triplets and quadruplets?
Twins: 35 weeks, triplets: 32 weeks, and quadruplets: 29 weeks.
❍ What is the incidence of very premature delivery (before 32 weeks) in singletons, twins, and triplets?
Singletons: 1.6%, twins: 12%, triplets: 36%.