Care and Management of Multiple Pregnancy
Management of multiple pregnancy:
Specific management for multiple pregnancy will be determined by your physician based on:
your pregnancy, overall health, and medical history
the number of fetuses
your tolerance for specific medications, procedures, or therapies
expectations for the course of the pregnancy
your opinion or preference
Management of multiple pregnancy may include the following:
increased nutrition
Mothers carrying two or more fetuses need more calories, protein, and other nutrients, including iron. Higher weight gain is also recommended for multiple pregnancy. The American College of Obstetricians and Gynecologists recommends women carrying twins gain at least 35 to 45 pounds.
more frequent prenatal visits
Multiple pregnancy increases the risk for complications. More frequent visits may help detect complications early enough for effective treatment or management. The mother's nutritional stutus and weight should also be monitored more closely.
referrals
Referral to a maternal-fetal medicine specialist, called a perinatologist, for special testing or ultrasound evaluations, and to coordinate care of complications, may be necessary.
increased rest
Some women may also need bedrest - either at home or in the hospital depending on pregnancy complications or the number of fetuses. Higher-order multiple pregnancies often require bedrest beginning in the middle of the second trimester.
maternal and fetal testing
Testing may be needed to monitor the health of the fetuses, especially if there are pregnancy complications.
tocolytic medications
Tocolytic medications may be given, if preterm labor occurs, to help slow or stop contractions. These may be given orally, in an injection, or intravenously. Tocolytic medications often used include terbutaline and magnesium sulfate.
corticosteroid medications
Corticosteroid medications may be given to help mature the lungs of the fetus. Lung immaturity is a major problem of premature babies.
cervical cerclage
Cerclage (a procedure used to suture the cervical opening) is used for women with an incompetent cervix. This is a condition in which the cervix is physically weak and unable to stay closed during pregnancy. Some women with higher-order multiples may require cerclage in early pregnancy.
How are multiple pregnancies delivered?
Delivery of multiples depends on many factors including the fetal positions, gestational age, and health of mother and fetuses. Generally, in twins, if both fetuses are in the vertex (head-down) position and there are no other complications, a vaginal delivery is possible. If the first fetus is vertex, but the second is not, the first fetus may be delivered vaginally, then the second is either turned to the vertex position or delivered breech (buttocks are presented first). These procedures can increase the risk for problems such as prolapsed cord (when the cord slips down through the cervical opening). Emergency cesarean birth of the second fetus may be needed. Usually, if the first fetus is not vertex, both babies are delivered by cesarean. Most triplets and other higher-order multiples are born by cesarean.
Vaginal delivery may take place in an operating room because of the greater risks for complications during birth and the need for cesarean delivery. Cesarean delivery is usually needed for fetuses that are in abnormal positions, for certain medical conditions of the mother, and for fetal distress.
86. Sound Advice for a Healthful Pregnancy
So, you're having a baby! Once the shock of that news begins to wear off, it's important to think about your lifestyle and health habits during pregnancy.
Following these guidelines can help keep you and your developing child healthy in the months to come:
Visit your health care provider regularly throughout your pregnancy.
Don't take any medications without your doctor's OK. Both prescriptions and over-the-counter medications can cause birth defects.
Don't smoke. Mothers who smoke have an increased risk of delivering prematurely and having a child with significant health problems.
Don't drink alcohol. It can cause birth defects associated with fetal alcohol syndrome.
Don't take illegal drugs. Doing so can cause birth defects and developmental delays in your child.
Avoid exposure to toxic substances and chemicals, such as cleaning solvents, lead, mercury, some insecticides, paint thinners and paint removers.
Eat a nutritious and balanced diet. You'll need extra protein, calcium, iron and zinc. If you were at your ideal weight before you become pregnant, you need about 300 additional calories a day from nutritious foods. If you were overweight or underweight before pregnancy, ask your health care provider how many extra calories a day you need.
Take 400 mcg of folic acid daily. Folic acid is a B vitamin that helps protect your unborn child from brain and spinal-cord birth defects.
Stay physically active unless your doctor suggests otherwise. Exercise can help you feel better, reduce discomfort and fatigue, and promote a faster recovery after delivery. Walking and swimming, in particular, are recommended. Avoid strenuous sports or activities in which you could fall, such as horseback riding, roller-skating and downhill skiing.
Avoid saunas, steam baths and hot tubs. High heat can harm your baby.
When to call the doctor
The following symptoms could indicate a potential health problem. If they occur, call or see your health care provider:
Excessive vomiting or diarrhea.
Swelling in your face, fingers and feet.
Bleeding or leaking of fluid from the vagina.
Strong cramps.
A headache, backache or stomachache that doesn't go away.
Blurred vision or spots in front of your eyes.
Pain or burning when you urinate.
Less movement by the baby than usual.