Published online by Cambridge University Press: 11 October 2022
The incidence of twin and higher order multiple pregnancies increased dramatically with the advent of Assisted Reproductive Technology (ART) in the 1970s, but practice guidelines have led to decreasing numbers from 2014 onwards. All types of twins have increased in incidence, but dizygous much more so than monozygous. Monochorionic placentation is peculiar to monozygotic pregnancies. Higher orders of chorionicity can occur in monozgotic pregnancies, but are much more common in gestations of plural zygosity. There are many factors that affect the incidence of multiple gestation: individual, genetic, and environmental. However, prudent ART management is the simplest and most effective way of reducing the incidence. Multifetal pregnancy reduction is an operative intervention that can reduce the unwanted medical and social sequelae of multiple pregnancy, counseling about such an intervention should be non-directional and carried out by a specialist.
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