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Multiple pregnancy
Current Obstetrics & Gynaecology (1998) 8, 125 © 1998 Harcourt Brace & Co. Ltd
Editorial
Multiple pregnancy
M. Whittle
pregnancy exists in the first place. The identification of chorionicity is almost certainly crucial, although no data exist. Without doubt the outcome, both immediate and late, is better for dichorionic pregnancies, so that it seems important to be aware of chorionicity early on; it may be much harder to determine later in pregnancy. The methods of delivery remain controversial, but the additional problems of managing labour, the need for excellent delivery facilities and immediate neonatal support, cannot be overemphasized. Finally, the outcome of multiple pregnancy is so dependent on gestational age at delivery that the added, rather silent, problem of apparently unexplained cerebral palsy, has only relatively recently been recognized. This problem does seem to be a feature of monochorionic pregnancies and it is a significant concern.
Multiple pregnancy represents not only a considerable obstetric and neonatal challenge, but also the birth of more than one baby creates unique problems for families as a whole. The incidence of multiple births is rising as a result of assisted conception and this is having considerable impact on services in general, both in and out of hospital. The contributors to this mini-symposium have kindly agreed to address a number of issues. The importance of epidemiology is apparent and there is a significant difference between the rates of multiple pregnancies in different ethnic groups, which is something of a puzzle. The antenatal management of multiple pregnancy, and the preferred methods have never been assessed, but the review suggests uncertainty about the best approach. Probably the most important factor is to identify that a multiple
Professor Martin Whittle, Department of Fetal Medicine, Birmingham Maternity Hospital, Edgbaston, Birmingham B15 2TG, UK
125
Editorial
Multiple pregnancy
M. Whittle
pregnancy exists in the first place. The identification of chorionicity is almost certainly crucial, although no data exist. Without doubt the outcome, both immediate and late, is better for dichorionic pregnancies, so that it seems important to be aware of chorionicity early on; it may be much harder to determine later in pregnancy. The methods of delivery remain controversial, but the additional problems of managing labour, the need for excellent delivery facilities and immediate neonatal support, cannot be overemphasized. Finally, the outcome of multiple pregnancy is so dependent on gestational age at delivery that the added, rather silent, problem of apparently unexplained cerebral palsy, has only relatively recently been recognized. This problem does seem to be a feature of monochorionic pregnancies and it is a significant concern.
Multiple pregnancy represents not only a considerable obstetric and neonatal challenge, but also the birth of more than one baby creates unique problems for families as a whole. The incidence of multiple births is rising as a result of assisted conception and this is having considerable impact on services in general, both in and out of hospital. The contributors to this mini-symposium have kindly agreed to address a number of issues. The importance of epidemiology is apparent and there is a significant difference between the rates of multiple pregnancies in different ethnic groups, which is something of a puzzle. The antenatal management of multiple pregnancy, and the preferred methods have never been assessed, but the review suggests uncertainty about the best approach. Probably the most important factor is to identify that a multiple
Professor Martin Whittle, Department of Fetal Medicine, Birmingham Maternity Hospital, Edgbaston, Birmingham B15 2TG, UK
125