Is Your Pregnancy High Risk?

Your pregnancy may be treated as high risk if :

1. you are over 35 years old and are therefore at increased risk of giving birth to a child with a chromosomal anomaly;
2. you are under 17 and are therefore at increased risk of experiencing intrauterine growth restriction;
3. you are carrying more than one baby and are therefore at risk of experiencing a number of pregnancy-related complications, including preterm labor;
4. you have a chronic health condition such as diabetes, heart problems, or a blood-clotting disorder that has the potential to affect your pregnancy;
5. you have a history of gynecological problems such as pelvic inflammatory disease (PID), endometriosis, or large symptomatic fibroids;
6. you have a history of miscarriage, ectopic pregnancy, stillbirth or premature birth;
7. you have an STD, including HIV, that could be transmitted to your baby during pregnancy or at the time of birth;
8. you are pregnant as a result of assisted reproductive technologies (something that may put you at increased risk of having a multiple pregnancy);
9. you have had two or more second-trimester abortions (which may increase your chances of having problems with an incompetent cervix);
10. your mother took DES during her pregnancy (which may increase your odds of having difficulty carrying a pregnancy to term);
11. you conceived while using an IUD (something that increases your chances of experiencing a miscarriage);
12. you have a child with a genetic disorder or are a carrier for a genetic disorder (something that may increase your risk of giving birth to a child with that particular genetic disorder).

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Preterm birth

Preterm birth is the leading cause of neonatal death in multiples. Although the mere fact that you are carrying multiples puts you at increased risk of experiencing a pre-term birth, there are other factors that add to your risk. You’re at increased risk if

■ you have had abdominal surgery during the current pregnancy (for example, an appendectomy);

■ you have an abnormal uterine structure;

■ you have fibroids (benign uterine tumors);

■ you are experiencing emotional or physical stress;

■ you have high blood pressure;

■ you develop a high fever during pregnancy;

■ you have a kidney infection;

■ you are outside of the optimal age range (that is, if you are under 16 or over 35);

■ you are a DES daughter (your mother took diethylstilbestrol — DES — when she was pregnant with you);

■ you have been diagnosed with placenta pre-via;

■ you have been diagnosed with poly hydramnios;

■ you haven’t gained enough weight;

■ you have previously experienced premature labor or delivery;

■ you have been experiencing unexplained vaginal bleeding;

■ you are a smoker.

Although cerclage (a surgical procedure in which the cervix is stitched shut to prevent it from dilating prematurely) was once considered to be an effective means of preventing premature labor, most doctors no longer agree with its routine use in women carrying multiples. These days, cerclage is performed only on women with weak cervixes — a condition that the medical profession charmingly refers to as cervical incompetence. (As you probably realize, this is just a less-than-diplomatic way of saying that the cervix is unable to withstand the weight of the developing fetus, or fetuses, and opens prematurely.)

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

What causes a multiple birth

Twin pregnancies result from either the fertilization of two separate eggs by two separate sperm (a process that results in dizygotic, or fraternal, twins) or the separation of a single fertilized egg into two fetuses (a process that results in monozygotic, or identical, twins). Higher-order multiple pregnancies involve fraternal twins, identical twins, or a combination of both types of twins.

Here are some basic facts about multiples:

■ Twins occur naturally in 1 out of every 90 births; triplets in 1 out of every 10,000 births; and quadruplets in 1 out of every 650,000 births.

■ Fraternal twins occur more often in certain families and in certain ethnic groups (the rates are 1 in 70 in African Americans and 1 in 300 for women of Chinese descent with whites falling in between). The incidence of fraternal twins also increases with maternal age, weight, height, and parity (that is, the number of pregnancies a woman has had).

■ Identical twins occur in approximately 4 out of every 1,000 births and are unrelated to maternal age, race, or parity.

■ Fraternal twins typically look no more alike than any other pair of siblings. They can be either of the same sex or one of each sex.

■ Identical twins have identical features: hair, eye color, blood type, and so on. If, however, one twin developed more rapidly in uterus than the other one, they may not look identical at birth.

■ Identical twins have similar handprints and footprints, but they do not share the same fingerprints. (This was good news to one family of identical twins who had to rush their babies off to FBI headquarters to get them re-fingerprinted so that they could figure out who was who!)

■ Some identical twins are known as “mirror twins” because one is virtually a mirror image of the other (for example, a birthmark that appears on the left arm of one appears on the right arm of the other, one is left-handed and the other is right-handed, and so on).

■ Identical triplets can also occur, but they are extremely rare.

■ It is possible for fraternal twins to be conceived by two different fathers, a process known as super fecundation.

■ Scientists believe that approximately one in eight natural pregnancies starts out as a twin pregnancy — even though only 1 out of every 90 births results in the birth of twins. This is one reason why many caregivers routinely do ultrasounds to confirm that there are no other viable fetuses left in the uterus when they suspect that a patient is miscarrying.

■ It is possible to miscarry one multiple and go on to carry the others to term. It is also possible to have a combination ectopic and uterine pregnancy (that is, one or more babies implant in the fallopian tubes and the others in the uterus). Fortunately, this is rare.

■ Although most twins are born within minutes of one another, sometimes days — even months — can elapse between the births of twins.

■ Often, it isn’t immediately obvious at birth whether same sex twins are identical or fraternal. If the parents want to know for medical reasons, blood from the umbilical cord is drawn and analyzed for type, Rh factor, and so on. If the results are still inconclusive, parents can choose to opt for DNA testing — highly accurate.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004