Preventative cerclage has not been shown to prevent

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preventative cerclage has not been shown to prevent preterm birth in twins or triplets. Tocolytic agents are medications that may slow or stop premature labor. These medications are given in hospital “emergency” settings in an attempt to stop premature labor. It is important to attempt to delay delivery to minimize the risks of premature delivery. Ultrasound examinations in the second trimester can identify some birth defects. Assessment of fetal growth by ultrasound every 3 to 4 weeks during the second half of pregnancy is commonly performed. Every multiple pregnancy should be considered at high risk, and obstetricians experienced with the management of multiple gestations should provide care. A neonatal intensive care unit nursery should be available to provide immediate and comprehensive support to premature newborns. Method of Delivery Vaginal delivery of twins may be safe in some circumstances. Many twins can be delivered vaginally if the lowest infant is in the head-first position. Most triplets will be delivered by cesarean section. Appropriate anesthesia and neonatal support are essential, whether delivery is performed vaginally or requires cesarean section. Delivery of multiples requires planning by the entire medical team and availability of full intensive-care support following birth.
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11 Psychosocial Effects of Multiples on a Family Although the majority of women with a multiple pregnancy do very well, their families may experience significant stress. If prolonged hospitalization is needed, arrangements must be made for work, home, and family care. Even when medical problems are overcome and the infants survive without disability, the effect of multiple births on family life is substantial. The impact of a multiple birth clearly affects the parents, but also the babies, other siblings, and the extended family. Financial stresses are common, due to the additional costs of feeding, clothing, housing, and caring for multiple children. Postpartum depression also is more common after delivery of multiple pregnancies in both the mother and the father and may be long-term. Psychological counseling and support groups may provide a lifeline for the parents of multiples, who may feel isolated or depressed. Most physicians can provide appropriate referrals to a mental health professional or a support group. For more information, see the ASRM Patient Fact Sheet titled Challenges of Parenting Multiples . CONCLUSION The objective of infertility treatment is the birth of a healthy child. In a small percentage of patients, treatment results in multiple pregnancy that may place the mother and the babies at increased risk for an unhealthy outcome. Since multiple pregnancies and their complications are an inevitable risk of fertility therapies, education about these risks is crucial prior to treatment. Ultimately, prevention is the key to reducing the risk of multiple pregnancy.
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12 GLOSSARY American Society for Reproductive Medicine (ASRM) . A professional
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  • reproductive medicine, American Society for Reproductive Medicine

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