Management

ยก2 mimetics are no longer used for tocolysis, given their cardiovascular side effects and in particular pulmonary oedema for which multiple pregnancy was a risk factor.

Although atosiban and nifedipine seem equally effective in delaying preterm labour [36], there is increasing concern in twin pregnancies about the adverse cardiovascular effects of nifedipine. Nine of the 14 reported cases of pulmonary oedema associated with tocolytic calcium channel blockers were in twins; therefore nifedipine should not be used in multiple pregnancies [37].

Glucocorticoids should be used in multiple pregnancies at risk of delivery < 34-36 weeks in the next 7-14 days. Meta-analysis of randomized trials in multiple pregnancies suggests a trend towards reduced respiratory distress syndrome, although as with other subgroups this falls short of significance (OR 0.72, 95% CI 0.35-1.68) [38]. This could be due to small numbers or to sub-therapeutic drug levels in twin pregnancies. Consistent with this, retrospective studies suggest that multiple pregnancy attenuates the beneficial effect of antenatal steroids. The possibility that a larger dose is required remains to be tested. Repeated prophylactic steroids are not recommended. First, retrospective data show that fortnightly steroids from 24 weeks did not reduce the incidence of respiratory problems in twins [39]. Second, there is concern that these may impair fetal growth and/or brain development. Finally, they may prevent indicated courses working, as only the first course has been shown to be beneficial.

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Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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