All the following are complications of twin pregnancy EXCEPT

Appeared in: JIPMER Nursing Officer-2017

Explanation

Post-maturity, or post-term pregnancy (beyond 42 weeks), is the correct answer because it is not a recognized complication of twin pregnancies.
Due to uterine overdistension, twin pregnancies have a very high likelihood of preterm labor and delivery.
The average gestational age for twin delivery is 35-36 weeks, making post-term delivery extremely rare.
Elective delivery is often planned between 37 and 38 weeks for uncomplicated twin pregnancies to minimize other risks, further preventing post-maturity.

Option A: Spontaneous abortion is a known and more frequent complication in twin pregnancies compared to singleton pregnancies. This includes the 'vanishing twin syndrome' where one fetus is lost.
Option C: Low birth weight is one of the most common outcomes in twin pregnancies, primarily due to the high rate of preterm birth and potential for intrauterine growth restriction (IUGR).
Option D: The incidence of congenital malformations is significantly increased in twin pregnancies, approximately doubling the risk compared to singletons. The risk is even higher for monozygotic (identical) twins.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Multiple Gestation (Twin Pregnancy) as background academic context rather than a clinical decision trigger.
Recognizing the common complications of twin pregnancy is crucial for nurses to provide appropriate antenatal counseling, monitoring, and care.
Nurses must be prepared for the high probability of preterm labor, the need for neonatal intensive care for low-birth-weight infants, and increased maternal risks like preeclampsia and postpartum hemorrhage.
What if the pregnancy was a singleton? In that case, post-maturity becomes a more common and monitored complication, often requiring induction of labor after 41 weeks to prevent risks associated with an aging placenta.

How to Approach the Question

First, identify the keywords in the question: 'complications,' 'twin pregnancy,' and the negative lead-in 'EXCEPT.'
The word 'EXCEPT' means you are looking for the option that is NOT a complication of twin pregnancy.
Evaluate each option against your knowledge of multiple gestations.
Ask yourself for each option: 'Is [option] a known complication of twin pregnancy?'
Abortion (Yes), Low birth weight (Yes), Congenital malformations (Yes).
Post maturity (No, the opposite is true; prematurity is the complication). The option that does not fit is the correct answer.

Concept Tested & Keywords

Concept Tested: Complications of Multiple Gestation (Twin Pregnancy)
Stem keywords: complications, twin pregnancy
Lead-in keywords: EXCEPT
Negative lead-in flag: This question uses negative framing ('EXCEPT'), requiring you to identify the option that is NOT a complication of twin pregnancy.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 1049-1051, 1048-1050

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