Nicholas M Fisk

With the decline in perinatal morbidity and mortality from other causes, multiple pregnancy now warrants special attention from obstetricians. First, they are common, having increased in incidence by 50% in developed countries over the last two decades. Second, they make a disproportionate contribution to perinatal morbidity and mortality, well in excess of that due to multiplication of singleton risks by fetal number. Next, almost every maternal and obstetric problem occurs more frequently in multiples. Finally, there are a number of intrapartum considerations, including manipulations no longer practised in singletons. Whereas previously maternal management was stressed, the modern approach to managing multiple pregnancy focuses on recognizing fetal risk as stratified by chorionicity, monitoring fetal growth and well-being by ultrasound and reducing risks of preterm delivery. Recognizing the specialized nature of multiple pregnancy management, the RCOG Study Group on Multiple Pregnancy has recommended that, like for diabetes, multiple pregnancies be managed within any one hospital by a single consultant-led multidisciplinary team [1].

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