The most important piece of information regarding your multiple gestation is the number of placentas (chorions). This is best determined by an ultrasound in the first trimester (before 14 weeks gestation).  

Because pregnancies with multiples have a higher risk of complications, you will have an increased number of prenatal visits and more frequent ultrasound evaluations. The frequency of visits increases in the second half of pregnancy. Closer monitoring may allow early detection of any problems if they do develop.  

Visit frequency and timing is determined by:

• Number of fetuses
• Number of placentas
• Fetal growth

For more information or to schedule an appointment, call 734-763-6295. 

Consultations We Offer

For all high-risk pregnancies, University of Michigan Health Maternal-Fetal Medicine (MFM) specialists are available for consultation, working with other members of the U-M Health team or with your outside provider. The MFM specialists provide primary prenatal care for some patients depending on individual patient needs. 

For those multiple gestations with known complications including twin-to-twin transfusion syndrome, selective intrauterine growth restriction (sIUGR), or fetal anomalies in one or more of the fetuses, our specialized multidisciplinary team is available for consultation or to provide additional care. We provide the full range of comprehensive services, with excellence in prenatal evaluation and the full range of fetal therapies and neonatal care. 

General diet recommendations exist for all pregnant patients but carrying more than one fetus increases nutritional requirements. Patients will need more calories, additional protein and especially more iron (to prevent development of anemia).  Specific weight gain recommendations will depend on your starting weight as well as the number of fetuses. Some patients find it helpful to consult with a dietitian to optimize their diet during the pregnancy.

Activity

There is no evidence that bedrest improves outcome for typical multiple gestations. Many patients, especially with triplets or more, are unable to continue their normal activities into the third trimester due to the changes in their bodies. This may require some planning for patients related to work or other responsibilities. Specific activity guidelines can be reviewed with your caregiver.

Preterm delivery is common for multiples. The median gestational age for twins is just under 36 weeks gestation. Triplets are more likely to deliver around 31-32 weeks gestation. Even for those who do not have preterm labor or delivery, the recommended timing of delivery will be before the due date you were given. This is related to the higher risk of still birth in a multiple gestation. The exact timing, in terms of how many weeks before your due date, will depend on the number of fetuses, how the babies are growing and the number of placentas.

For twins, vaginal delivery may be possible if the first baby is presenting headfirst (vertex). If the first baby is not head down, if the babies share the same amniotic sac (monoamniotic), or if there are triplets or more, the recommendation is usually for a cesarean birth. 

Most multiple gestations will have a healthy outcome for you and your babies. The individualized risks for you, based on your history, will be explained by your clinician. For all patients with multiple gestations, there is a higher risk of:

• Gestational diabetes
• High blood pressure including preeclampsia
• Preterm birth
• Cesarean delivery

Screening and monitoring during the pregnancy will help optimize the outcome. There may be a benefit from taking baby aspirin during the pregnancy to reduce the risk of preeclampsia or high blood pressure. If there are signs of preterm labor or early rupture of membranes, it is important to seek care immediately as there are treatments that can improve the outcome for you and your babies.