Multiples in Pregnancies

Are all pregnancies when we are talking about twins, triplets or multiples considered high risk?

Multiple pregnancies are generally considered higher risk pregnancies because they have a higher risk of having adverse outcomes when you compare them to just a singleton pregnancy or just carrying one baby. These pregnancies have a higher risk of developing hypertensive disorders. They have a higher chance of having gestational diabetes, anemia, and a higher chance of getting blood clots; so in general they are considered higher risk pregnancies.

So at what point does a mother who is pregnant with multiples decide she needs to see a Maternal Fetal Specialist?

We consider at least twins. We consider them dichorionic, and monochorionic. Dichorionic means they have two placentas. They tend to be lower risk twin pregnancies. We manage these pregnancies sometimes but often times a low risk obstetrician will see these patients and we will see them for their ultrasounds for anatomy just to ensure that they don’t have a structural malformation. The monochorionic twins, when they share a placenta, they generally see a high risk specialist. They see us throughout their pregnancy. Generally triplets and quads and any higher order multiples will generally come to maternal fetal medicine and we provide two different kinds of care for multiple pregnancies. Sometimes we take care of them all throughout their pregnancy because mom may have some other co-existing medical disorder or sometimes we co-manage them with a general obstetrician.

How do mom and dad find out if the babes are identical or fraternal twins?

Sometimes we can tell on ultrasound. When babies share a placenta, the monochorionic pregnancies, are generally identical pregnancies. When they don’t share a placenta and they have two placentas, what we call dichorionic pregnancies, these are generally harder to determine even if they have the same sex, two boys or two girls. Sometimes these are fraternal. So 20 percent of these will be identical and 80 percent will be fraternal. Sometimes we can tell but sometimes, post-delivery, we have to do some DNA testing to tell. However, generally the monochorionic twins are identical.

I hear a lot about ladies with multiple pregnancies that are on bed rest. Can bed rest reduce the risk of delivering pre-term twins?

That has actually been well-studied and bed rest does not appear to increase the gestational age at delivery so we don’t tend to carry these pregnancies longer because of bed rest. Bed rest can sometimes complicate a pregnancy. It can increase the chance of having a blood clot so in general we do not recommend bed rest because it has not really been shown to increase the baby’s gestational age.

The other thing we hear lot about are Caesarean sections and that if you are carrying twins, triplets or multiples it’s inevitable that you are going to have to have a C-section. Is that true?

That is not true since 40 percent of twins will both be head down and these are great candidates for having a vaginal delivery. We generally let babies that are both head down deliver vaginally. The ones that are not presenting head down these babies we never let labor. We’ll have a C-section, but a lot of our twins are good candidates for having a vaginal delivery.

What about mom? Does she need to double up her caloric intake during pregnancy with twins or how much weight should she be expecting to gain because again she is carrying two instead of one?

A single pregnancy we will have them increase their caloric intake by 300 kilocalories in a day so we do ask them to double this for twins. Therefore, we will ask them to increase their daily caloric intake by 600 kilocalories for two babies. What we end up finding is that when they reach around 20 weeks they will probably start gaining one and  half pounds a week They also need to increase their iron intake and their folic acid. We recommend their weight gain based on their body mass index which is the measure of their weight versus height. If they are of normal weight, they are expected to gain somewhere around 54 pounds. If they are overweight, sometimes that weight gain is a little lower but it is a significant amount of weight when you have twins.

Doctor, if folks want to contact you and get hold of you, how will they do that?

They can call us at 314-454-8181.

Okay or they can always go to the BJC or Progress West websites to get more information and be directed on how to locate you guys, but it is great information. Dr. Roxane Rampersad, I appreciate it and take care.

Thank you.

.