Monitoring twins in labor

It is actually not difficult to electronically monitor twins in labor. This is, as long as the position of each baby is known. It is easy to confirm fetal position using ultrasound.

Monitoring transducers are then applied on the appropriate positions and each baby's heartbeat is monitored. Twins are almost always monitored continuously.

Second twin showing features of distress

If the second twin shows CTG features suggesting possible distress, it is not possible to verify this. If this occurs, the only solution is to perform a caesarean section and deliver the twins.

Quite often it turns out to have been a false scare but most people will agree that it is better to be safe than sorry.

Fetal scalp electrode

Part of the weakness of the conventional CTG is the inherent difficulty stemming from monitoring the fetal heart remotely, with the probe on the maternal abdomen. It is not unusual to pick the signal erratically or sometimes not at all. Sometimes one ends up picking the maternal heartbeat.

A fetal scalp electrode (FSE) is a simple device, which is a significant improvement on this state of affairs. The small probe is attached to the skin of the baby’s scalp and it directly monitors the heartbeat. An FSE is more accurate and more reliable.

With twins, it is normal practice to monitor Twin 1 with a scalp electrode and Twin 2 with an abdominal transducer. Of course, calling it "scalp" electrode is a slightly restrictive term. In breech presentation, if vaginal delivery is planned; the electrode can be placed on the fetal buttocks and it will function perfectly.

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