Multiple Gestation in the Finger Lakes Region

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Multiple Gestation in the Finger Lakes Region

• Chris Glantz, MD, MPH

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FLR 1998 - 2003

• 91722 Total Deliveries
• 1613 (1.8) multiple gestations
• 1535 Twins 1.7 (95 of multiples)
• 73 Triplets 0.1 (4.5 of multiples)
• 5 Quads .01 (
• Rates rose in the 1990s
• Assisted reproductive technology (ART)

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Infertility and Multiple Gestation

• 18 with infertility history (11 IVF)
• 2 and 0.3 if singleton
• 17 - 44 - 100 for twins-triplets-quads
• Assisted Reproductive Technology associated with
  Multiple Gestation

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Who Has Multiple Gestations?

• 30y.o. G4P2
• 28y.o. G3P1 if singleton
• Median parity increases with higher order
• 88 High school graduate
• 84 if singleton
• 24 Medicaid
• 30 if singleton
• 25-7-0 for twins-triplets-quads

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Where Do They Deliver?

• Level III
• AO (2.8) 11/73 triplets 1/5 quads
• SMH (3.0) 56/73 triplets 4/5 quads
• Level II
• RGH (1.4) 4/73 triplets
• Level I
• (0 - 1.6) 2/73 triplets
• Twins
• 49 at Level III, 15 at Level II, 36 at Level
  I
  

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Obstetrical Complications
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Preterm Delivery

• Preterm Delivery in 54
• 7 if singleton
• Multiple Gestation is one of the strongest
  predictors of preterm delivery
  
• Preterm labor versus planned preterm delivery
• Mean gestational age at delivery
• Twins 36 weeks (range 24 - 41)
• Triplets 33 weeks (range 24 - 38)
• Quadruplets 32 weeks (range 28-34)

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Gestational Age at Delivery
5 14 54 100 Cumulative Perce
nt
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Proportion of Total Deliveries at GA Intervals
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Low Birth Weight

• Low Birth Weight (
• Mostly from preterm delivery
• 50 - 84 - 100 for twins-triplets-quads
• 6 in singletons
• Very Low Birth Weight (
• 8 - 29 - 40 for twins-triplets-quads
• 1 in singletons

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Malpresentation
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Delivery Considerations

• Cesarean Delivery in 58 of multiples
• Malpresentation and heart rate abnormalities
• Associated with fetal weight, high blood
  pressure, education, and BMI

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NICU Care
NICU Admit associated with birth weight , high
blood pressure, preterm delivery, and diabetes
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Birth Defects
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Level I versus Level II III

• Gestational age 37 vs. 35 weeks
• Mean Birthweight 2624 vs. 2259 grams

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Strong versus Transfer

• Gestational age 35 vs. 30 weeks
• Mean Birthweight 2349 vs. 1512 grams

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Management

• Limitation of activity
• Cervical assessment
• Awareness of warning signs
• Phone Home
• Medical treatment of preterm labor
• Ultrasounds for growth
• Blood pressure and diabetes screening
• Fetal heart rate monitoring?

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Parting Thought

• Be aware of increased risks, but most multiple
  gestations have successful outcomes