Which of the following is the most common cause of morbidity in multiple gestation?

Explanation

1. Core Concept: Multiple gestations (twins, triplets, etc.) carry a significantly higher risk of obstetric and neonatal complications compared to singleton pregnancies due to uterine overdistension and placental insufficiency.

2. Clinical Presentation:

• Preterm labor, preterm premature rupture of membranes (PPROM), preeclampsia, gestational diabetes, and fetal growth restriction.

3. Diagnosis:

• First-line: Early obstetric ultrasound to determine chorionicity and amnionicity.
• Gold Standard: Serial ultrasounds to monitor fetal growth, amniotic fluid volume, and cervical length.

4. Management:

• Acute: Close maternal and fetal surveillance, nutritional optimization, and administration of corticosteroids if preterm delivery is imminent.
• Definitive: Prematurity (spontaneous preterm birth) is by far the most common cause of perinatal morbidity and mortality in multiple gestations, leading to complications like respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis.