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.)
