Twins

 

Issues:

Maternal physiology

·      Airway: aspiration risk even worse

·      Breathing: diaphragm embarrassment even worse

·      Circulation: aortocaval compression even worse

·      Spinal/epidural: more difficult smaller dose

·      GA more difficult

Obstetric complications

·      Pre-eclampsia

·      Placenta praevia

·      Placental abruption

·      Malpresentation

·      Premature labour

·      Uterine atony / PPH

Neonatal complications

·      Premature

·      Growth restricted

·      Congenital abnormality

·      Intracranial haemorrhage

 

Management:

Antenatal

·      Obstetrician-led care

·      Big hospital with HDU and NICU

Peri-natal

Two of everything:

·      Anaesthetists

·      Obstetricians

·      Paediatricians

·      Midwives

·      Technicians

Other:

·      Don’t give oxytocin until second baby