Multiple Gestations

  • Steven S. Schwalbe


A 23-year-old secundigravida with a known triplet gestation was admitted at 35 weeks gestation with rupture of membranes and mild uterine contractions. A previous pregnancy 2 years earlier had been delivered by cesarean section because of arrest of labor. The patient gave a history of occasional attacks of fainting during the last months of this pregnancy but could not give any details. Her physical examination and vital signs were normal; blood pressure was 126!62mmHg while sitting, heart rate was 96/ min and regular, and respiratory rate was 20/min. Sonography revealed three fetuses in breech presentations with estimated weights of approximately 2000gm each. Biophysical profile and nonstress tests showed good fetal responses. However, two transient episodes of maternal hypotension to 80/50mmHg occurred during the fetal surveillance; these appeared to be related to changes in maternal position.


Obstet Gynecol Multiple Gestation Breech Presentation Twin Gestation Uterine Relaxation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Benirschke K., Chung K.K.: Multiple pregnancy. N Engl J Med 1973, 288: 1276–84.PubMedCrossRefGoogle Scholar
  2. 2.
    Hawrylyshyn P.A., Barkin M., Bernstein A., Papsin F.R.: Twin pregnancies—a continuing perinatal challenge. Obstet Gynecol 1982, 59: 463–6.PubMedGoogle Scholar
  3. 3.
    McCarthy B., Sachs B.P., Layde P.: Epidemiology of neonatal mortality in twins. Am J Obstet Gynecol 1981, 141: 252–6.PubMedGoogle Scholar
  4. 4.
    Sassoon D.A., Castro I.C., Davis J.L., Hobel C.J.: Perinatal outcome in triplet versus twin gestations. Obstet Gynecol 1990, 75: 817–20.PubMedGoogle Scholar
  5. 5.
    Botting B.J., Davies I.M., Macfarlane A.J.: Recent trends in the incidence of multiple births and associated mortality. Arch Dis Child 1987, 62: 941–50.PubMedCrossRefGoogle Scholar
  6. 6.
    Ho S.K., Wu P.Y.K.: Perinatal factors and neonatal morbidity in twin pregnancy. Am J Obstet Gynecol 1975, 122: 979–85.PubMedGoogle Scholar
  7. 7.
    Duncan S.B., Ginz B., Wahab H.: Use of ultrasound and hormonal assays in the diagnosis, management and outcome of twin pregnancy. Obstet Gynecol 1979, 53: 367.PubMedGoogle Scholar
  8. 8.
    Keith L., Ellis R., Berger G.S., Depp R.: The Northwestern University Multihospital Twin Study. Am J Obstet Gynecol 1980, 138: 781–91.PubMedGoogle Scholar
  9. 9.
    Myrianthopoulos N.C.: Congenital malformations in twins: Epidemiologic survey. Birth Defects 1975, 11: 39–44.Google Scholar
  10. 10.
    Galea P., Scott J.M., Goel K.M.: Feto-fetal transfusion syndrome. Arch Dis Child 1982, 57: 781–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Shah D.M., Chaffin D.: Perinatal outcome in very preterm births with twin-twin transfusion syndrome. Am J Obstet Gynecol 1989, 161: 1111–3.PubMedGoogle Scholar
  12. 12.
    Medearis A.L., Jonas HJ., Stockbauer J.W.: Perinatal deaths in twin pregnancy. Am J Obstet Gynecol 1979, 134: 413–8.PubMedGoogle Scholar
  13. 13.
    Rovinsky J.J., Jaffin H.: Cardiovascular hemodynamics in pregnancy: 1. Blood and plasma volumes in multiple pregnancy. Am J Obstet Gynecol 1965, 93: 1–13.PubMedGoogle Scholar
  14. 14.
    James F.M.: Anesthetic considerations for breech or twin delivery. Clin Perinatol 1982, 9: 77.PubMedGoogle Scholar
  15. 15.
    Benson C.B., Doubilet P.M.: Sonography of multiple gestations. Radiol Clin North Am 1990, 28: 149–61.PubMedGoogle Scholar
  16. 16.
    Persson P.H., Kullander S.: Long term experience of general ultrasound screening in pregnancy. Am J Obstet Gynecol 1983, 146: 942–6.PubMedGoogle Scholar
  17. 17.
    Newman R.B., Hamer C., Miller M.C.: Outpatient triplet management: A contemporary review. Am J Obstet Gynecol 1989, 161: 547–53.PubMedGoogle Scholar
  18. 18.
    Patten R.M., Mack L.A., Nyberg D.A.. Filly R.A.: Twin embolization syndrome: Prenatal sonographic detection and significance. Radiology 1989, 173: 685–9.PubMedGoogle Scholar
  19. 19.
    Carlson N.J., Towers C.V.: Multiple gestation complicated by the death of one fetus. Obstet Gynecol 1989, 73: 685–9.PubMedGoogle Scholar
  20. 20.
    Bianchi M.T.: Triplet pregnancy with second trimester abortion and delivery of twins at 35 weeks’ gestation. Obstet Gynecol 1984, 64: 728–30.Google Scholar
  21. 21.
    Redwine F.O., Petres R.E.: Selective birth in a case of twins discordant for Tay Sachs disease. Acta Genet Med Gemellol (Roma) 1984, 33: 35–38.Google Scholar
  22. 22.
    Chervenak F.A.: The controversy of mode of delivery in twins: The intrapartum management of twin gestation (part 2). Semin Perinatol 1986, 10: 44–9.PubMedGoogle Scholar
  23. 23.
    Schwalbe S.S., Marx G.F., Meyers G.: Aortocaval compression revisited, in Abstracts of Annual Meeting of the Society for Obstetric Anesthesia and Perinatology. 1988, p 136.Google Scholar
  24. 24.
    Elstein I.D., Schwalbe S.S., Marx G.E: Cardiac output measurements during and after triplet gestation. Obstet Gynecol 1989, 74: 452–3.PubMedGoogle Scholar
  25. 25.
    Crawford J.S.: A prospective study of 200 consecutive twin deliveries. Anaesthesia 1987, 42: 33–43.PubMedCrossRefGoogle Scholar
  26. 26.
    James F.M. III, Crawford J.S., Davies P., Crawley M.: Lumbar epidural analgesia for labor and delivery of twins. Am J Obstet Gynecol 1976, 127: 176–80.Google Scholar
  27. 27.
    Daniels J.C., Hebre F.W.: Anesthetic considerations for complicated obstetrics: I. A retrospective study of 527 twin deliveries. Anesth Analg 1967, 46: 527–39.PubMedGoogle Scholar
  28. 28.
    Leighton B.: New advances in obstetric anesthesia. 41st Annual Refresher Courses Lectures. American Society of Anesthesiologists. Las Vegas, NV. October 1990, No. 172.Google Scholar
  29. 29.
    Munson E.S., Embro W.J.: Enflurane, isoflurane and halothane and isolated human uterine muscle. Anesthesiology 1977, 46: 11.PubMedCrossRefGoogle Scholar
  30. 30.
    Wheeler A.S., Patel K.F., Spain J.: Pulmonary edema during beta-2-tocolytic therapy. Anesth Analg 1981, 60: 695.PubMedCrossRefGoogle Scholar
  31. 31.
    Philpsen T., Erikson P.S., Lynggard F.: Pulmonary edema following rito-drine-saline infusion in premature labor. Obstet Gynecol 1981, 58: 304.Google Scholar
  32. 32.
    Elliott J.P.: Magnesium sulfate as a tocolytic agent. Am J Obstet Gynecol 1983, 147: 277.PubMedGoogle Scholar
  33. 33.
    DeVore J.S., Asrani R.: Magnesium sulfate prevents succinylcholine induced fasciculations in toxemic parturients. Anesthesiology 1980, 52: 76.PubMedCrossRefGoogle Scholar

Copyright information

© Birkhäuser Boston 1991

Authors and Affiliations

  • Steven S. Schwalbe

There are no affiliations available

Personalised recommendations