Obstetric Aspects of Multiple Pregnancy

  • Virginia J. Baldwin


Pregnancy is a dynamic process of an evolving interaction of three complex biologic entities—mother, fetus, and placenta—that includes autonomous characteristics of each entity as well as systems of interactions in three dyads and one triad, as well as external and unknown sources of influence1 (Fig. 4.1a). This way of considering the events during pregnancy can be used not only for the normal structural changes and functional processes, but also for abnormalities of structure and function, and for the consequences of these abnormalities on the other components of the triad. It may also help clarify just what is being assessed during antenatal, intrapartum, and postnatal testing. The presence of more than one fetus at a time adds another dimension to these interactions. As the types of twins become less and less separate, the potential for distortion of first the placental component, and then the fetal component, can be represented by the altered shapes needed to represent the interactions as in Fig. 4.1b, e and Fig. 4.1d, e respectively. These representations serve to remind us not only of the potential for feto-fetal interaction, particularly in monoamniotic twinning, but also of the maternal-fetal interaction system. Aspects of fetoplacental and maternoplacental interactions were described in Chapter 3, and the implications of monochorionicity are presented in Chapters 8, 9, and 10. This chapter highlights maternal-fetal and maternal-fetal-placental associations as they relate to the pathology of multiple pregnancy.


Obstet Gynecol Multiple Pregnancy Twin Pregnancy Perinatal Asphyxia Multiple Gestation 
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Copyright information

© Springer-Verlag New York Inc 1994

Authors and Affiliations

  • Virginia J. Baldwin
    • 1
  1. 1.Department of PathologyBritish Columbia’s Children’s HospitalVancouverCanada

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