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Multiple Pregnancy Management

Multiple gestations, including twins, triplets or more, are high-risk pregnancies as they account for a disproportionate share of both maternal and fetal complications and adverse pregnancy outcomes.  The risks for women with multifetal pregnancies include preterm labor, premature rupture of membranes, gestational hypertension or preeclampsia, gestational diabetes, anemia, and thromboembolism.   Delivery of more than one baby is also more complicated, with a greater risk of cesarean delivery and postpartum hemorrhage.  Because of the high rate of preterm delivery in multiple gestations, these babies are at greater risk for adverse neurologic outcomes, such as cerebral palsy, compared with a singleton pregnancy.  Additionally, fetuses in multiple gestations have a greater risk of chromosomal and structural abnormalities.

Specialized Clinic

Because of these increased maternal and fetal risks, we have developed a clinic dedicated to caring for women with multiple gestations.  In addition to providing consultations, the clinic provides multidisciplinary care in a coordinated and convenient manner with the overall goal of improving both maternal and fetal outcomes.  We focus on optimizing maternal health, identifying and managing risk for preterm delivery, optimizing care of the fetuses, and providing the most favorable and safest environment for delivery.  We also have a state-of-the-art neonatal ICU (NICU), if needed, to provide excellent care for the babies after delivery.
 
The clinic is staffed with experienced Maternal-Fetal Medicine specialists, or Perinatologists, who have a special interest in caring for women with multiple gestations.  These dedicated caregivers are experienced in managing the numerous potential complications encountered in the prenatal management and delivery of multiple gestations.   Our team also includes genetic counselors from our Prenatal Diagnosis and Treatment Center. A variety of prenatal screening tests are available, including first and second trimester screening, and a state-of-the-art ultrasound unit is on-site.  When indicated or requested, our physicians perform chorionic villus sampling (CVS) and amniocentesis. We also offer counseling on multifetal pregnancy reduction and perform the procedure in our facility.  Other integral personnel include a dedicated nursing team, nutritionists, lactation consultants, and social workers.  All care, including specialized ultrasound, fetal testing, nutrition, and lactation consultations, are scheduled during the prenatal visit to increase convenience for the patient. 

Specialized Care

Specialized coordinated care for multiple gestations includes early ultrasound to determine the type of placentation (if fetuses share the same placenta or amniotic sac), as this impacts the risk of complications, and more frequent prenatal visits, as needed.  Ultrasounds for growth are typically performed monthly.  In certain situations, every other week or more frequent ultrasounds are performed.  Fetal surveillance, including fetal heart rate monitoring, biophysical profiles, and umbilical cord Doppler measurements, is available when indicated.

If complications occur, we coordinate and refer patients to the appropriate consultants who will ultimately care for the baby, including pediatric cardiologists, surgeons, neurosurgeons, urologists, and neonatologists.   If needed prior to delivery, consultations with anesthesiologists or other medical specialists are coordinated.

 

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