DEFINITION

 The term "multiple births" refers to the delivery of

twins and higher-order multiples (ie, triplets,
quadruplets, etc)
 occur when multiple fetuses are carried during a
pregnancy with the subsequent delivery of
multiple neonates
 History
 Mostmultifetal pregnancies are prenatally
diagnosed.
 Maternal complaints of excessive weight gain,
hyperemesis gravidarum, the sensation of more
than one moving fetus, the use of ovulation-
inducing drugs, or a family history of dizygotic
twins should alert caregivers to the possibility of a
multifetal pregnancy.
Physical
May have a uterine size that is
inconsistently large for dates
May experience accelerated weight
gain
Upon auscultation, more than one
fetal heart rate may be heard.
 Causes
Risk factors for multifetal pregnancy can be
divided into natural and induced.
 Natural include advanced maternal age,
family history of dizygotic twins, and race.
 Induced occur following infertility treatment
via the use of ovulation-inducing agent,
multiple gamete/zygote transfer.
 Laboratory Studies
Obstetrical: Routine prenatal laboratory studies are
indicated.
Neonatal: A CBC count is obtained to evaluate for anemia
and polycythemia.
Neonatal arterial blood gas and cord blood gas: These are
measured to evaluate for respiratory distress, hypoxia,
acidosis, and perinatal depression.
Metabolic panel: Fluid status and electrolyte levels should be
evaluated and metabolic status should be determined,
including through screening for hypoglycemia and
hypocalcemia.
 Bilirubin level: This is obtained to screen for increased risk of
hyperbilirubinemia associated with prematurity and
polycythemia
Imaging Studies
Obstetrical: Prenatal ultrasonography
Fetal echocardiography: This is used to screen for
congenital heart disease in neonates.
Fetal MRI: This is used to screen for fetal anomalies.
Neonatal: Chest radiography is used to evaluate
respiratory distress.
Ultrasonography
Echocardiography: This is used to screen for congenital
heart disease.
 Medical Care
 Obstetric medical care is specific to the type of
multifetal pregnancy. The highest risk is in
monochorionic/monoamniotic pregnancies. An
inherent risk of other conditions (ie, preterm
labor, intrauterine growth retardation (IUGR),
hypertensive diseases)
 Many neonates require only routine newborn
care; others require neonatal intensive care
secondary to prematurity, low birth weight, and
their associated complications
Special concerns

Increased incidences of maternal

depression
poor parent satisfaction with
parenting
child abuse
sibling behavior problems