July 2007 · Vol. 19, No. 07Managing risk—to mother and fetuses—in a twin gestation
Begin by determining chorionicity. Discuss the risks of a multiple gestation, prepare parents for premature delivery, and monitor fetal growth as indicated.
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Fast Track
First step in managing a multiple gestation? Determine chorionicity, early, by ultrasonography
To evaluate a monochorionic gestation for TTTS, perform a detailed anatomic survey and serial US every 2 weeks
On the basis of maternal age alone, invasive prenatal Dx can be offered to women who will be 31 years or older at estimated due date
The risk of preterm delivery is low in a woman who has a cervical length measurement of >35 mm at 24 to 26 weeks’ gestation
US surveillance is indicated if abnormal fetal growth or amniotic fluid is detected in a monochorionic multiple gestation
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Victoria
Belogolovkin,
MD;
Joanne
Stone,
MDDr. Belogolovkin is a fellow and Dr. Stone is associate professor in the Department of Maternal–Fetal Medicine, Mount Sinai School of Medicine, New York, NY
Multiple gestations are far more common today than they once were—up 70% since 1980.1 Today, every 1,000 live births include 32.3 sets of twins, a 2% increase in the rate of twin births since 2004. Why this phenomenon is occurring is not entirely understood but, certainly, the trend toward older maternal age and the emergence of assisted reproduction are both part of the explanation.
Multiple gestations are of particular concern to obstetricians because, even though they remain relatively rare, they are responsible for a significant percentage of perinatal morbidity and mortality.
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