Multiple Gestation (Twins & Higher-Order)

A multiple gestation is a pregnancy with two or more fetuses, most often twins, and the overdistended uterus makes preterm labor its most common complication. Dizygotic twins come from two eggs and each has its own placenta; monozygotic twins come from one egg that splits and may share a placenta. Shared-placenta twins can develop twin-twin transfusion syndrome, in which the donor twin becomes small and anemic with low fluid while the recipient becomes polycythemic with excess fluid and heart strain, and twins who share one sac risk cord entanglement. Clues include a uterus larger than dates, a high hCG level and more intense nausea and vomiting. The mother faces more preeclampsia, gestational diabetes, anemia, hyperemesis gravidarum and postpartum hemorrhage, so care brings more frequent visits, serial ultrasounds, closer blood pressure checks and teaching about preterm labor signs and extra calories, protein, folic acid and iron. In labor the nurse monitors both fetal heart rates and confirms two distinct rates, prepares a resuscitation team for each baby, and after birth assesses fundal tone and bleeding closely.