ACOG educational bulletin. Special problems of multiple gestation. Number 253, November 1998 (Replaces Number 131, August 1989). American College of Obstetricians and Gynecologists.

The incidence of twins, triplets, and higher-order multiple gestations has increased dramatically because of widespread use of ovulation-inducing drugs and advanced assisted reproductive techniques. There is considerable perinatal/maternal morbidity and mortality associated with multifetal gestations. The practicing obstetrician managing these high-risk patients should be familiar with their special antepartum and intrapartum problems. The obstetrician-gynecologist unaccustomed to caring for patients with a multifetal gestation should consult with maternal-fetal medicine specialists who have expertise in managing these pregnancies. Better use of infertility modalities, early diagnosis of the multiple pregnancy, prevention of preterm birth, close fetal surveillance, and atraumatic labor and delivery can improve perinatal outcome in the multifetal gestation.