39. Multiple Gestations

  1. John T. Queenan MD3,
  2. Catherine Y. Spong MD4 and
  3. Charles J. Lockwood MD5
  1. Karin E. Fuchs MD1,2 and
  2. Mary E. D'Alton MD1,2

Published Online: 4 JAN 2012

DOI: 10.1002/9781119963783.ch39

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

How to Cite

Fuchs, K. E. and D'Alton, M. E. (2012) Multiple Gestations, in Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition (eds J. T. Queenan, C. Y. Spong and C. J. Lockwood), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119963783.ch39

Editor Information

  1. 3

    Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA

  2. 4

    Bethesda, MD, USA

  3. 5

    Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Author Information

  1. 1

    Department of Obstetrics and Gynecology, Columbia University Medical Center, NY, USA

  2. 2

    Columbia Presbyterian Hospital, New York, NY, USA

Publication History

  1. Published Online: 4 JAN 2012
  2. Published Print: 24 FEB 2012

ISBN Information

Print ISBN: 9780470655764

Online ISBN: 9781119963783



  • multiple gestations, and fetal complications;
  • multiple gestation, and delayed child bearing, ART, ovulation induction;
  • implication of multiple gestations, problems of preterm delivery;
  • antepartum management of multiple gestations;
  • patients with multiples, risk for adverse perinatal outcomes;
  • multiple gestation, risk for long-term neurologic impairment;
  • twin–twin transfusion syndrome (TTTS);
  • MPR, an ethical dilemma;
  • discordant anatomic abnormalities;
  • technologic advances, new insights into multifetal pregnancies


An epidemic of multiple gestations has occurred over the past two decades, attributed largely to an older patient population secondary to delayed child bearing and the rise in the use of assisted reproductive technology and ovulation induction. According to the National Vital Statistics Report for 2007, the twinning rate was 32.2 twin births per 1000 total livebirths with a 70% rise between 1980 and 2004. More impressive are the numbers of triplets and high-order multiples, which rose over 400% between 1980 and 1998 to a high of 193.5 per 100,000 births before declining again to a rate of 148.9 per 100,000 births in 2007. Perinatal complications have been strongly affected by the widespread prevalence of multiple gestations as these pregnancies account for a disproportionate share of adverse outcomes. The most profound implication of this epidemic of multiple gestations is the problem of preterm delivery, which remains the leading cause of hospitalization among pregnant women and the leading cause of infant death. In addition to prematurity, multiple pregnancy is known to be associated with a greater number of other maternal and fetal problems including gestational hypertension, placental abruption, operative delivery, low birthweight, and adverse neurologic outcomes. The overall increased perinatal risks associated with multiple gestations compared with singleton pregnancies are well documented, and these high-risk pregnancies have a profound effect on medical expenditures and public health. This chapter reviews multiple gestations and the current strategies for managing these complex pregnancies.