Parents expecting more than one bundle of joy are typically thrilled and sometimes a little surprised. In between picking out names, nursery colors and trying to comprehend double diaper duty, expectant moms of multiples should be sure to ask their OB-GYN several key questions. While a gestation of two (or more) is a wonderful experience, these pregnancies are considered high risk. But take heart, many complications that may occur with multiples can be successfully corrected with early detection and treatment.
Karen Moise, RN, at Texas Children’s Fetal Center offers details on the top 5 questions expectant moms of multiples should ask their OB-GYN.
1. Should I see an MFM (Maternal-Fetal Medicine specialist, perinatologist) during my pregnancy?
Women with high-risk pregnancies should speak with their doctors to determine whether they should be referred to a perinatologist, often called a high-risk OB-GYN. Maternal-fetal medicine (MFM) is a subspecialty of OB-GYN focusing on the diagnosis, treatment and care of women with high-risk pregnancies. These physicians have undergone three years of additional training after a standard residency in obstetrics and gynecology. Because no “one size fits all” in the care of a high-risk pregnancy, women should speak candidly with their OB-GYN to create a management plan, including scheduled MFM visits, that is suited to their particular pregnancy.
2. Does each baby have its own placenta and amniotic sac?
Twins are created when the embryo randomly splits between 8 to 12 days after conception. Many multiples will have independent placentas (one for each fetus). This occurs in all fraternal twins and in one-third of identical twins. However, in some twin pregnancies the babies will share a single placenta (called a monochorionic gestation). This occurs in two-thirds of identical twins. Monochorionic twins can experience a rare but serious condition called twin-twin transfusion syndrome (TTTS) in which one of the fetuses does not have enough blood and one has too much. Left untreated, severe TTTS can result in the loss of both fetuses in up to 90% of pregnancies.
Sometimes in twin pregnancies, the fetuses may share a single placenta but remain in the same amniotic sac. This is known as a monoamniotic pregnancy. In these cases there is a greater concern that the babies’ umbilical cords will become entangled. Generally, it is recommended that these mothers be hospitalized at 24 weeks of pregnancy for special fetal monitoring of the babies until they are born.
3. Are my babies the same size?
If one of the fetuses appears to be growing less rapidly than the other, this may be an indication that there are signs of chronic distress in the smaller fetus. By closely monitoring their size, issues can be addressed in a timely manner.
4. Are the amniotic fluid levels balanced?
It is important to have your doctor check the amount of amniotic fluid in each baby’s sac. One sign of TTTS is that there is too much amniotic fluid in one sac and too little in the other.
5. What is my cervical length?
Make sure your cervix is checked periodically. This is something that is all too often overlooked by many doctors and is extremely important for women expecting multiples. A cervix which is thinning and shortening to 2cm by ultrasound can be a tell tale sign of a problematic pregnancy.