MULTIPLE BABIES IN NORTHWEST ARKANSAS

 

We are here to provide comprehensive perinatal care to patients with twins, triplets, and higher order multiple gestations to obtain the best maternal and neonatal outcomes.

 

Multiple Births

 

      The number of twin, triplet, and higher-order pregnancies has increased significantly in the last 30 years. Although multiple gestations account for only 3% of all births in the United States, infants of multiple gestations comprise almost 25% of very-low-birth-weight infants (<1500gms). Severe handicap can occur in 34 out of 1000 twins and 58 out of 1000 triplet survivors. Recent National Vital Statistics data from the United States indicate that twins and triplets are approximately 5 and 12 times more likely to die by their first birthday than singletons. Extensive research of multiple gestations has shown improved fetal outcomes such as decreased preterm delivery, increased newborn weight, and decreased time in the neonatal intensive care unit when Maternal-Fetal Medicine doctors are involved in the care of the pregnancy.

               

Genetic Testing

 

      Nuchal translcency (NT) screening in twins has a very high detection rate (>85%) for Down syndrome. If you present for consultation after 10 weeks of pregnancy, you have the option of cell free twin DNA screening. This is a simple blood test that can be useful for the detection of chromosomal abnormalities in one of the twins. Invasive genetic tests such as amniocentesis can be used to definitively diagnose chromosomal abnormalities in pregnancy. Also your specialized prenatal care will include a detailed ultrasound examination of your babies, usually performed between 18-20 weeks gestation. This evaluation is designed to look for structural defects that tend to occur more often in multiple than singleton pregnancies. Though not as sensitive for detecting the more common genetic diseases, on occasion ultrasound will find rare disorders that are not screened for using the tests.

 

Preterm Labor Surveillance

               

      One common complication of carrying multiples is preterm labor and delivery. The average length of pregnancy is 35 weeks for twins, 32 weeks for triplets, and 29 weeks for quadruplets. Even though 35 weeks is reassuring, twins are 10 times more likely, and triplets 30 times more likely, than singletons to deliver very premature (less than 32 weeks). It is this group of early babies that account for the majority of long term complications of premature delivery.

 

     One way to combat the complications of a premature delivery is early recognition of those pregnancies at highest risk for preterm delivery. Early recognition affords the opportunity to be prepared for, and sometimes prevent, premature delivery. If shortening of the cervix is identified or if presence of a special protein in vaginal fluid secretions (a substance call fetal fibronectin) is detected, multiple interventions, including steroid administration or administration of anti-contraction medications may be employed to prevent early delivery.

               

Fetal Growth Surveillance

 

      Approximately 15% to 25% of twin gestations, and over 35% of triplets, can have signs of poor fetal growth (intrauterine growth restriction) of one or more of the fetuses during pregnancy.

 

     One of the reasons for concern is that babies delivered at a low birth weight (<2500g) are 5 times more likely to die before their first birthday than their normally grown counterparts. Even more concerning is that very low birth weight babies (<1500g) are 99 times more likely to die before their first birthday than babies born of a normal weight. Because of the high incidence of growth restriction in multifetal pregnancies and its association with poor newborn outcome it is imperative for early detection and treatment of this high risk condition.

 

     As part of your specialized pregnancy care, we evaluate fetal growth in multiple pregnancies every 3-4 weeks with ultrasound and fetal growth charts designed specifically for multiple gestations. If we detect abnormalities in fetal growth, the growth patterns are examined even more frequently (typically every 1-2 weeks). In select cases of extreme growth restriction more intensive monitoring including hospitalization with daily fetal and maternal assessments may be employed to maximize newborn outcomes.

 

Neonatal Intensive Care Unit Services

 

      My partnership with Willow Creek Women’s Hospital NICU allows your babies to receive the best care possible in the event that your babies are delivered early. Our team includes experts at caring for multiples. Our neonatologists are available to meet with families before delivery and provide a tour of the NICU when it is anticipated that a baby will require extra care at birth.