Complications of labour

• malpresentations e.g. in twins
  • 45% are cephalic/cephalic
  • 39% are cephalic/breech
  • 9% are breech/breech
  • 5% are cephalic/transverse
  • 2% are transverse/transve or breech/transverse
    
    
• postpartum haemorrhage - 2.5 fold increase over singleton rate to 10% (1)
  
  
• cord prolapse - often in association with malpresentation - increased 6 fold in twins (to 2.3%) (1)
  
  
• locked twins - extremely rare - aftercoming head of one twin locked with forthcoming head of the other - usually requires delivery by Caesarean section
  
  
• twin to twin transfusion - placental anastomoses may give rise to growth discordance or death of one or both twins
  
  
• antepartum haemorrhage - studies suggest an increased APH in multiple pregnancies but much of the APH is attributed to unknown origin; a few to placental abruption or placenta praevia

Reference:

• Chamberlain. ABC of Antenatal Care. Multiple pregnancy. BMJ 1991; 303: 111-115.