Intrapartum management of multifetal pregnancies.

Over the past several decades advances in assisted-reproductive technologies have resulted in a dramatic increase in the number of multifetal gestations. Concomitant with this increase there has been a gradual rise in the overall preterm birth rate, as well as other pregnancy complications related to these pregnancies. Twin, triplet, and other high-order multifetal gestation pregnancies pose a number of important issues related to antepartum and intrapartum management. Antepartum issues include ultrasound determination of zygosity, management and prevention of preterm labor, maternal/fetal surveillance for complications, and specific interventions focused on prevention of adverse maternal and/or fetal outcomes. Intrapartum issues include those related to timing of delivery, labor management, anesthesia options, and determination of an optimal delivery modality. Clearly, these issues related to the management of multifetal pregnancies are of paramount importance to optimize pregnancy outcome. As many of the issues related to antepartum care for women with multifetal gestations have been reviewed elsewhere, we have restricted the focus of this article to intrapartum management. Thus, this article reviews salient issues related to the intrapartum management of multifetal gestations, including twins, triplets, and other high-order pregnancies.