Seminars in perinatology
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The aim of this article is to review current information regarding the management of twin gestations and discuss optimal pregnancy length and considerations regarding route of delivery. Limited data are available on the timing and mode of delivery for twins. ⋯ Cesarean is recommended in twin gestations with monoamnionicity, noncephalic presenting fetus, and those at high risk for combined vaginal-abdominal delivery. The optimal management of twin deliveries is controversial, with timing and mode of delivery dependent on multiple factors, including chorionicity, amnionicity, provider experience, and fetal presentation.
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As the incidence of twin gestation increases, it is important to consider the maternal risks associated with carrying multiples. Compared with singleton gestation, there are increased risks to the mother during the antepartum, intrapartum, and postpartum periods. Certain pregnancy complications are more likely to occur during a twin gestation, including preeclampsia and other hypertensive disorders, antepartum hospitalization for preterm labor or abnormal bleeding, nutritional deficiencies, cesarean delivery, and postpartum hemorrhage. Women carrying twins may benefit from early education regarding these issues, close maternal monitoring as well as physical therapy sessions, and nutrition counseling during their pregnancies.
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Maternal mortality is an important indicator of adequacy of health care in our society. Improvements in the obstetric care system as well as advances in technology have contributed to reduction in maternal mortality rates. ⋯ Optimal management of the pregnant trauma victim requires a multidisciplinary team, where the obstetrician plays a central role. This review focuses on the incidence of maternal mortality due to trauma, the mechanisms involved in traumatic injury, the important anatomic and physiologic changes that may predispose to mortality due to trauma, and finally, preventive strategies that may decrease the incidence of traumatic maternal death.
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Seminars in perinatology · Feb 2012
Historical ArticleSaving Mothers' Lives: the continuing benefits for maternal health from the United Kingdom (UK) Confidential Enquires into Maternal Deaths.
The actions that have followed the recommendations of successive publications of the UK Confidential Enquiries into Maternal Deaths have helped save mothers' lives and reduced ill health and morbidity. Through the implementation of their recommendations, they have helped improve access to, and the quality of, the maternity care provided for all pregnant women in the United Kingdom. ⋯ This chapter provides a short summary of the positive contributions the successive reports on Confidential Enquiries into Maternal Deaths, "Saving Mothers' Lives," have made to maternal health outcomes in the United Kingdom for more than half a century. It also demonstrates why such systems continue to be beneficial around the world, including countries with very low maternal mortality rates.