Detection and Risk
Detecting multiples. In your mother's day, a woman discovered she was having multiples in the delivery room, when the doctor pulled out one baby and realized that the party wasn't over yet. Now ultrasounds show multiples as early as 6 weeks into pregnancy and can detect more than 95 percent of multiples by the beginning of the 2nd trimester. If you don't have an ultrasound, or if you have one later in your pregnancy, your doctor may suspect multiples after hearing more than one heartbeat. Multiples are also a possibility if you are gaining a lot of weight, if your uterus is much larger than your gestational age would suggest, or if you have severe morning sickness. Multiples may be in your future if you have abnormal results on the multiple marker screening test, also known as the quad marker screen; this blood test is done between weeks 15 and 20.
Risks and precautions. Women who are pregnant with multiples see their doctors more often. Their pregnancies are usually considered high-risk because they have a greater chance of miscarrying one or more of the fetuses. They're also at higher risk for premature labor, gestational diabetes, preeclampsia, iron deficiency anemia, and intrauterine growth restriction, which indicates that a fetus is growing poorly. Multiples usually arrive early: 60 percent of twins, 90 percent of triplets, and virtually all multiples greater than triplets are born preterm. Here's a quick rule: On average, singletons arrive at 40 weeks, twins at 36 weeks, triplets at 32 weeks, and quadruplets at 28 weeks.
Multiples are often born by cesarean delivery because premature babies are less likely to be vertex (in the head-down position). Almost all high-order multiples (three babies or more) are delivered by cesarean. Many twins may be delivered vaginally, especially if baby A (the baby that is presenting) is head down and baby B is smaller or the same size as baby A.
Originally published in You & Your Baby: Pregnancy.
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