TY - CHAP M1 - Book, Section TI - Twin Delivery A1 - Li, Yunping A2 - Hess, Philip E. A2 - Li, Yunping A2 - Kowalczyk, John J. A2 - Stiles, Justin K. PY - 2023 T2 - Obstetric Anesthesia: Quick References & Practical Guides AB - The incidence of multifetal gestations has increased dramatically in the United States due to:Advanced maternal age when multifetal gestations are more likely to occur naturally (Odds Ratio = 4.5) compared to younger women.Increased use of assisted reproductive technology.1Major perinatal complications are increased with multiple gestations, including preterm birth, fetal anomalies, preeclampsia, and gestational diabetes. The risk of stillbirth begins to increase significantly at approximately 38 weeks of gestational age.Types of twin pregnancy include monochorionic/monoamniotic twins, monochorionic/diamniotic twins, and dichorionic/diamniotic twins.Based on standard obstetric nomenclature, Twin A is the presenting twin.The optimal route and timing of delivery in women with multifetal gestations depend on multiple factors, including the type of gestation, fetal presentations, fetal weight, gestational age, and the experience of the obstetricians.1Delivery timing: uncomplicated dichorionic twins 37 to 38 weeks gestation; uncomplicated monochorionic diamnionic twins 34 to 36 weeks gestation; uncomplicated monochorionic monoamniotic twins 32 to 34 weeks gestation.Vaginal delivery is a reasonable option.2 However, monoamniotic twins are delivered by cesarean between 32 and 34 weeks of gestation to avoid an umbilical cord complication.Options for delivery of the second nonvertex presenting twin include:Breech extraction.Internal podalic version with breech extraction.Internal cephalic version.Cesarean delivery.Possible cesarean delivery could be called during twin delivery for one or both twins. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/03/28 UR - obgyn.mhmedical.com/content.aspx?aid=1199674075 ER -