Signs of multiple pregnancy.
- Uterus larger than expected for dates.
- Excessive maternal weight that is not explained by edema or obesity.
- Polyhydramnios manifested by uterine size out o proportion to the calculated duration of gestation.
- Ballottement of more than one fetus.
- Multiplicity of small parts.
- Simultaneous recording of different fetal heart rate.
- Complications of pregnancy that is anemia and lower limb edema are more marked.
- Vascular pressure signs such as hemorrhoids and varicose veins may be seen.
- Fetal activity is more persistent and greater detected on ultrasonography.
Complications during pregnancy.
- Spontaneous abortion
There is increase in frequency of spontaneous abortion in pleural pregnancy due to polyhydramnios and chromosomal abnormalities.
- Premature labor and delivery.
The over distended uterus seems to reach limits of tolerance and results in uterine contractions with premature rupture of membrane or both.
- Antepartum hemorrhage.
Placenta previa may be responsible for APH.
- Hypochromic microcytic anemia
It is 2-3 times more common in multiple pregnancies due to increased demand.
- Urinary tract infection.
UTI is more frequent in multiple pregnancies owing to increased uterine pressure on uterus.
- Preeclampsia and eclampsia
Uterine distention, impairment of uteroplacental circulation and nutritional deficiency has been postulated as causes.
- Postpartum hemorrhage
Occurs as a result of placenta previa or abruptio placentae.
- Exacerbations of minor disorders o pregnancy.
These include edema, varicose veins, thrombosis, weight gain, hyperemesis and morning sickness.
- Lumbar lordosis and backache.
The additional weight gain causes enhanced pressure on lumbar vertebrae leading to lordosis and backache.
Complications during labor.
- Postpartm hemorrhage.
Occurs as a result of placenta previa, the frequency of these conditions is double because of relatively larger placental mass and consequent greater risk of encroachment of the lower segment.
- Premature separation of placenta.
It occurs due to rupture of first bag of uterus and initiation of strong uterine contractions
- Uterine atony
A thinned uterine wall is associated with the hypotonic uterine contractions and longer latent stag of labor .uterine atomy is often accompanied by excess lose of blood owing to inability of the overdistended uterus to contract.
- Death /distress of second twin.
Premature separation of the placenta before delivery by the 2nd twin may cause death or distress of2nd twin by hypoxia.
- Obstructed labor.
One twin may obstruct the delivery of both fetuses in locked twins. First is always a breech and second a vertex presentation. Conjoined twins usually result in obstructed labor.
Malpresentation is common ad at the onset of labor is only 40 % of cases do both fetuses presented by he head.
- Dysfunctional pattern of uterine contractions
These are attributed to uterine over distension.
- Cord prolapse.
Associated with malpresentation
- Cord enlargement.
The umbilical cord of one fetus may present in front of 2nd fetus during its delivery resulting in a cord compression and hypoxic distress or death of first fetus.