Biomedical subjects

R B Newman

Publications and source records attributed to R B Newman.

At least 19 recordsLinked to original sources

PubMed1998

The importance of early weight gain in the intrauterine growth and birth weight of twins.

OBJECTIVE: It was our objective to evaluate the association between early maternal weight gain (before 20 weeks), midpregnancy weight gain (20-28 weeks), and late pregnancy weight gain (28 weeks to birth) with fetal growth and birth weight in twins. STUDY DESIGN: This historic cohort study was based on 1564 births of live twins >/=28 weeks' gestation from Baltimore, Maryland, Miami, Florida, Charleston, South Carolina, and Ann Arbor, Michigan. RESULTS: Early fetal growth was affected only by smoking and chorionicity. Factors in models of both mid and late fetal growth included maternal age, pregravid weight, parity, rates of early pregnancy and midpregnancy maternal weight gain, smoking, and pre-eclampsia. Increased midpregnancy fetal growth was associated with early maternal weight gain (10.91 g/wk per pound per week) and midpregnancy maternal weight gain (15.89 g/wk per pound per week). Increased late fetal growth was associated with early maternal weight gain (16.86 g/wk per pound per week) and midpregnancy maternal weight gain (23.88 g/wk per pound per week). Increased birth weight was associated with early (283.02 g per pound per week), mid (163.58 g per pound per week), and late (69.76 g per pound per week) maternal weight gains. CONCLUSIONS: These findings confirm the importance of early maternal weight gain in twin fetal growth and birth weight.

Adult↗

PubMed1998

Cost-effective delivery management of the vertex and nonvertex twin gestation.

OBJECTIVE: The aim of the study was to determine the most cost-effective delivery management of vertex and nonvertex twin pair gestations. STUDY DESIGN: Two hundred sixty-six consecutive twin gestations were followed up prospectively in a special antepartum Twins Clinic directed by the Maternal-Fetal Medicine Division. Maternal demographic, obstetric, and neonatal data were compiled prospectively. Information regarding 84 vertex and nonvertex twin pair gestations was extracted for review. Comparison groups included 41 twin pairs managed by spontaneous vaginal delivery and breech extraction (group A), 19 twin pairs managed by spontaneous vaginal delivery and external cephalic version (group B), and 24 twin pairs managed by primary cesarean delivery (group C). In-hospital financial data were retrieved and adjusted for inflation to 1996 constant dollars (data from a single institution allow comparison of charges). The Kruskal-Wallis chi2 test, the Fisher exact test, and analysis of variance were used for statistical analysis. RESULTS: The 3 groups did not differ with respect to maternal demographics, medical complications, gestational age, birth weight, fetal sex, or intrauterine growth restriction. Maternal and neonatal hospital charges were both significantly lower (P = .01 and P = .0001, respectively) in the breech extraction group A ($5890 +/- $2304 and $3526 +/- $5017, respectively) than in either group B ($8638 +/- $4175 and $11,754 +/- $15,457, respectively) or group C ($7,608 +/- $3,256 and $36,994 +/- $54,318, respectively). Although maternal morbidity was similar among the 3 groups, length of stay was shorter for mothers in group A. The infants delivered by spontaneous vaginal delivery and breech extraction (group A) had significantly lower rates of pulmonary disease (7% vs 24% vs 31% for groups A, B, and C, respectively; P = .002) and neonatal infectious disease (1% vs 0% vs 16%; P = .0005). These infants required the use of a ventilator less frequently (5% vs 12% vs 24%; P = .01), were more likely to be admitted to the normal newborn nursery (71% vs 51% vs 50%; P = .0001), and had a significantly shorter length of hospitalization (4.8 vs 12.4 vs 17.8 days; P = .0001). CONCLUSIONS: There is no medical consensus regarding delivery management for vertex and nonvertex presenting twin pairs. When hospital charges are examined with clinical data, however, breech extraction of the nonvertex second twin is the most cost-effective delivery management strategy.

Adult↗

PubMed1998

Fetal anomaly detection by second-trimester ultrasonography in a tertiary center.

OBJECTIVE: Our purpose was to determine the relative accuracy of indicated versus screening second-trimester ultrasonography for detection of fetal anomalies and to assess the cost effectiveness of anomaly screening. STUDY DESIGN: The study population consisted of 2031 pregnant women with singleton gestations who prospectively underwent ultrasonographic scanning between 15 and 22 weeks and received complete obstetric care at the Medical University of South Carolina between July 1, 1993, and June 30, 1996. Patients were divided into two groups: (1) indicated and (2) screening. The cost of screening ultrasonography was compared with the cost of newborn care for selected anomalous fetuses. RESULTS: Forty-seven fetuses (2.3%) were diagnosed by ultrasonography as having a major anomaly: 8.6% in the indicated group and 0.68% in the screening group (p=0.001). The sensitivity for detecting the anomalous fetus was 75.0% overall: 89.7% in the indicated group and 47.6% in the screening group (p=0.001). Of the 47 patients diagnosed with fetal anomalies, 11 (23.4%) chose pregnancy termination; of the 35 (74.5%) live-born anomalous infants, 29 (82.9%) were discharged alive. Projected newborn cost savings offset the cost of routine midtrimester screening. CONCLUSIONS: Detection of anomalous fetuses was significantly better in the indicated compared with the screening group. Nevertheless, routine ultrasonographic screening appeared cost-effective in our population.

Congenital Abnormalities↗

PubMed1998

Obstetric management of high-order multiple pregnancies.

High-order multiples are increasingly common as a result of assisted reproductive technologies and represent pregnancies at exceptional risk. This article discusses the antepartum management of high-order multiples, which has in general been highly individualized and poorly studied. Care for high-order multiples should include preterm birth prevention education, the frequent assessment of maternal symptoms and cervical status by a consistent provider, individualized modification of activity, attention to maternal nutrition, ultrasonography for the assessment of fetal anatomy and intra-uterine growth and anticipation of maternal complications. Interventions such as prophylactic cerclage, uterine activity monitoring, prophylactic tocolysis or hospitalization have not improved outcome when used routinely, and guidelines for selective use will be presented. Specialized care for high-order multiples should be directed at identifying congenital anomalies, maximizing fetal growth and preventing early preterm birth, the effect of which will be to improve perinatal outcome for these exceptional pregnancies.

Delivery, Obstetric↗

PubMed1997

Glucometer analysis of one-hour glucose challenge samples.

OBJECTIVE: Our purpose was to explore a cost-saving measure for diabetes screening by using glucometer testing on venous whole blood obtained after a 1-hour glucose challenge test. Glucometer results falling above an upper threshold would predict abnormal plasma values and mandate a glucose tolerance test; results below the lower threshold would predict normal plasma values and avoid further testing. Results between the thresholds would require traditional plasma analysis. STUDY DESIGN: We performed a prospective cohort study on 222 consecutive pregnant women. A standard 50 gm glucose screen was performed with venous blood drawn at 1 hour. We immediately removed a drop of whole blood from the venous sample and analyzed it on a portable glucometer, Accu-Chek III. The remaining sample was submitted immediately for routine plasma analysis. All values were obtained on the same glucometer, which was calibrated daily in our clinic laboratory. Regression analysis was performed on 129 samples to select the two thresholds. The selected thresholds were then applied prospectively to the next 93 consecutive samples for validation. RESULTS: Excellent correlation (r = 0.9045) exists between the glucometer and laboratory values. Glucometer threshold values of 110 mg/dl and 155 mg/dl were selected because they predicted plasma values < 135 mg/dl or > 135 mg/dl with 95% certainty, respectively. Prospectively, the thresholds were completely accurate in classifying the values. CONCLUSION: Venous whole blood assayed by glucometer can reliably predict an elevated or normal automated plasma glucose value. By applying thresholds, three fourths of all patients can immediately receive reassuring information, whereas the patients with poorest glucose tolerance are immediately identified and diagnostic testing is scheduled. Additionally, our model reduces the number of automated laboratory studies by 80% and reduces the cost of diabetic screening.

Blood Glucose↗

PubMed1997

The Preterm Prediction Study: association of cesarean delivery with increases in maternal weight and body mass index.

OBJECTIVE: Our purpose was to evaluate whether maternal weight and body mass index measured either before or during pregnancy are associated with an increased risk of cesarean delivery. STUDY DESIGN: Maternal weight and height were prospectively collected on 2929 women in the National Institutes of Health Maternal-Fetal Medicine Units Network Preterm Prediction Study. Prepregnancy and 27- to 31-week maternal weight and height were used to calculate the body mass index, and its contribution to the risk of cesarean delivery was determined. Women with prenatally diagnosed congenital anomalies (n = 89) and pregestational diabetes (n = 31) were excluded from analysis. RESULTS: Univariate analysis of risk factors for cesarean delivery in the 2809 eligible women revealed a decreased risk of cesarean delivery with maternal age < 18 years and multiparity; increased risk of cesarean delivery was noted with maternal age > 35 years and a male fetus. Increases in either prepregnancy or 27- to 31-week maternal weight (5-pound units) or body mass index (1.0 kg/m2 units) were significantly associated with an increased odds of cesarean delivery (p = 0.0001). Each unit increase in prepregnancy or 27- to 31-week body mass index resulted in a parallel increase in the odds of cesarean delivery of 7.0% and 7.8%, respectively. Multivariable stepwise logistic regression analysis confirmed the association of male fetus, age, nulliparity, and body mass index as significant variables contributing to cesarean delivery risk. CONCLUSIONS: The risk of cesarean delivery is associated with incremental changes in maternal weight and body mass index before and during pregnancy after adjustment for potential confounding factors. Prepregnancy counseling about optimizing maternal weight and monitoring weight gain during pregnancy to decrease the risk of cesarean delivery are supported by this study.

Adolescent↗

PubMed1997

Interobserver reliability of digital and endovaginal ultrasonographic cervical length measurements.

OBJECTIVE: Our purpose was to prospectively evaluate the interobserver reliability of digital and endovaginal ultrasonographic cervical length measurements. STUDY DESIGN: Forty-three women were recruited from our antepartum clinic to participate in this study. Two independent and blinded digital cervical examinations were performed by the first author and a second examiner. Instructions were given to estimate the cervical length in millimeters. After micturition endovaginal ultrasonographic cervical length measurements were performed by two independent, blinded registered diagnostic medical sonographers. Cervical lengths were compared with the Student t test and Pearson's correlation coefficient. A kappa statistic was calculated for interobserver reliability at three levels of agreement +/- 1 mm, +/- 4 mm, and +/- 10 mm. Data are expressed as means +/- SD. RESULTS: Digital cervical lengths were not different between the two examiners (18.7 +/- 4.8 mm, 20.5 +/- 6.2 mm) nor between the two ultrasonographic measurements (38.6 +/- 6.1 mm, 39.2 +/- 5.4 mm). The digital cervical lengths agreed (+/- 1 mm) 35% of the time (R2 0.10, p = 0.02). The endovaginal ultrasonographic measurements agreed (+/- 1 mm) 74% of the time with a stronger correlation (R2 0.53, p = 0.0001). The kappa statistic for interobserver variability was marginal for both digital and endovaginal cervical length measurements when agreement was defined as +/- 1 mm. Endovaginal ultrasonography was significantly more reliable than digital examination when agreement between examiners was defined as either +/- 4 mm or +/- 10 mm. CONCLUSION: Although both digital and endovaginal ultrasonographic cervical length measurements show correlation between examiners, endovaginal ultrasonography is significantly more reliable when agreement is defined as > or = +/- 4 mm. Serial cervical length measurements to predict preterm labor will be enhanced by the interobserver reliability of endovaginal ultrasonography.

Cervix Uteri↗

PubMed1997

The maternal and fetal effects of tuberculosis therapy.

Tuberculosis can cause significant morbidity in the pregnant woman, fetus, and members of the community. The first-line agents suggested by the CDC for use during pregnancy (isoniazid, rifampin, and ethambutol) seem to have minimal risk of induced congenital anomalies. Maternal morbidity associated with therapy does not seem increased above rates observed in the nonpregnant population. Education of the patient concerning the potential adverse side effects may decrease maternal morbidity. Therapy should be started as soon as the diagnosis of tuberculosis is confirmed (or when suspected in the HIV-infected woman) or after the first trimester in women younger than 35-years-old with recent TB tine test conversion. Monitoring for medication compliance during pregnancy is important to provide effective therapy and to decrease the development of resistant organisms.

AIDS-Related Opportunistic Infections↗

PubMed1997

Drug therapy in the nursing mother.

The benefits of breast-feeding on newborn and infant health and for the maternal-infant relationship are well established. It is a failing of health care providers that breast-feeding is too frequently interrupted because of unfounded concerns over the potential adverse effects of concurrent drug therapy in the nursing mother. An overwhelming minority of medications are contraindicated during lactation, while the vast majority are considered either safe to use or the risk versus benefit considerations clearly favor use with continuation of breast-feeding. For those drugs that may pose a potential concern to the newborn, there are practical suggestions and precautions that can be taken to minimize risk. These include such interventions as selection of alternative effective drug regimens with safer profiles in breast-feeding, timing of drug dosing to minimize accumulation in the breast milk, surveillance for newborn or infant symptomatology that may be a sign of toxicity, or even the determination of drug levels in the infant's circulation. With a commitment to the advantages of breast-feeding and the information contained both herein and elsewhere regarding the interaction of medical therapy, pharmacology, and lactation, it is hoped that the health care provider will be empowered both to encourage and counsel more effectively the parturient who wishes to breast-feed but is concerned about ongoing drug therapy during lactation.

Adult↗

PubMed1997

Correlation of antepartum uterine activity and cervical change in twin gestation.

OBJECTIVE: To determine the correlation between quantitative measurements of antepartum uterine activity and cervical change twin gestations. METHODS: Forty women from our Twin Clinic constituted the study group. Participants had a cervical examination each week between 20 and 37 weeks gestation and a cervical score (CS) was calculated as follows: CS = cervical length (cms)-cervical dilation (cms) at the internal os. The women also performed blinded home uterine activity monitoring (HUAM) for a mean of 7.0 + 3.0 hrs/wk (+SD). Uterine activity was expressed as mean number of contractions/hour/week gestation based on the average of three independent reviewers. CS was determined by a single clinician unaware of the HUAM recordings. A significant change in the CS was defined as a reduction of at least 0.5 from the preceding week. Correlation coefficients were used to determine the association between uterine activity and change in the cervical score. RESULTS: Twin pregnancy was characterized by a rise from 0.2 + .03 contractions/hr at 20 weeks to 3.2 + 2.4 contractions/hr at 37 weeks gestation. CS fell from a mean of 2.6 + 0.2 at 20 weeks to -2.1 + 0.9 at 37 weeks gestation. There was a significant negative correlation (-0.317, p < .0001) between increasing uterine activity and decreasing CS. There were significantly more (p < .002) contractions during the 7 days preceding a significant reduction in CS (3.3 + 3.5 contractions/hr) than when the CS was unchanged (1.6 +/- 1.5 contractions/hr). CONCLUSIONS: In twin gestations, an increasing frequency of uterine contractions is strongly correlated with quantifiable cervical change between 20-37 weeks gestation. Persistent daytime contraction frequencies of > 3/hr represent a risk factor for cervical dilation and/or effacement.

Adult↗

PubMed1996

Diphenhydramine overdose during pregnancy: lessons from the past.

A primigravid woman was seen for the first time in a disoriented and combative state, with regular, painful uterine contractions. Evaluation revealed a negative illicit drug screen, no evidence of preeclampsia, and a nonfocal neurologic examination. Further workup revealed urinary diphenhydramine levels suggesting drug overdose. This case serves as a reminder of the oxytocin-like effects of diphenhydramine.

Adult↗

PubMed1996

Hemodynamic effects of oral nifedipine in preeclamptic hypertensive emergencies.

OBJECTIVE: Our purpose was to evaluate the hemodynamic effects of oral nifedipine in preeclamptic hypertensive emergencies. STUDY DESIGN: A prospective observational study of the hemodynamic effects of oral nifedipine was conducted with severely preeclamptic patients receiving magnesium sulfate infusion during a hypertensive emergency. Patients were eligible for the study if systolic blood pressure was > or = 170 m Hg or the diastolic blood pressure was > or = 105 mm Hg on repeat measurements 15 minutes apart at > or = 24 weeks' gestation. Nifedipine was given with an initial dose of 10 mg orally followed by 20 mg orally every 20 minutes until systolic blood pressure was > 160 mm Hg and the diastolic blood pressure was < 100 mm Hg, or for a total of five doses. Patients were hemodynamically monitored in the lateral recumbent position by thoracic electrical bioimpedance before during, and after oral nifedipine dosing. Cardiac index, systemic vascular resistance index, mean arterial pressure, heart rate, and stroke index were all recorded at baseline and during treatment. Data were analyzed by analysis of variance for repeated measures (alpha 0.05) and paired t tests, baseline versus 15 minutes (alpha 0.01). RESULTS: Ten severely preeclamptic patients at 33.2 +/- 3.0 (mean +/- SD) weeks' gestation were enrolled in the study. Mean arterial pressure measurements taken at baseline, 0.25, 0.5, 1, and 4 hours were 133 +/- 10, 119 +/- 8, 109 +/- 8 89 +/- 12, and 100 +/- 13 mm Hg (mean +/- SD, p < 0.0001, analysis of variance repeated measures). Cardiac index increased over time (p = 0.0011, analysis of variance repeated measures). There was no significant effect on maternal heart rate or stroke index. No periodic fetal heart rate changes were noted. One patient had nausea. CONCLUSION: Oral nifedipine appears to be an effective antihypertensive agent in preeclamptic hypertensive emergencies. A steady decrease in mean arterial pressure, systemic vascular resistance, and a mirrored increase in cardiac index are noted.

Administration, Oral↗

PubMed1996

Prognostic significance of prior preterm twin delivery on subsequent singleton pregnancy.

OBJECTIVE: Our purpose was to determine whether preterm birth of twins is associated with an increased risk of preterm birth in a subsequent singleton pregnancy. STUDY DESIGN: The Medical University of South Carolina perinatal database was accessed to identify a cohort of patients who were delivered of twins followed by a singleton gestation (1981 to 1993). Maternal transports were excluded to minimize referral bias. Preterm birth was defined as < 37 weeks' gestation. Relative risks with 95% confidence intervals were calculated. RESULTS: One hundred forty-four patients were identified who were delivered of twins followed by a singleton gestation. Preterm delivery occurred in 86 (59.7%) of the twins and 21 (14.6%) of the subsequent singletons. Preterm birth of twins was associated with a significantly increased risk of preterm delivery in a subsequent singleton pregnancy (relative risk 2.87, 95% confidence interval 1.02 to 8.09). In the subset of women who were delivered of twins at < 30 weeks' gestation, 42% of the subsequent singletons were delivered preterm (relative risk 6.11, 95% confidence interval 2.07 to 18.02). The relative risk of preterm birth of a singleton after delivery of twins between 30 and 34 weeks' gestation was 3.63 (95% confidence interval 1.02 to 12.92). However, if the preceding twins delivered between 34 and 37 weeks' gestation, the relative risk of preterm birth of the subsequent singleton was not significantly increased (relative risk 1.42, 95% confidence interval 0.40 to 5.01). CONCLUSIONS: Preterm birth of twins before 34 weeks' gestation is associated with a significant risk for preterm delivery in a subsequent singleton pregnancy. The magnitude of risk increases with decreasing gestational age of the preceding twin delivery.

Adult↗

PubMed1996

The effects of hemodialysis on total intrauterine volume.

Our objective was to assess the effects of maternal fluid shifts during hemodialysis on the amniotic fluid volume. Ultrasound estimation of the total intrauterine volume before and after dialysis was performed between 23 and 26 weeks in a 30-year-old woman with progressive IgA glomerulonephropathy. The total intrauterine volume was reduced after each episode of dialysis. The mean decrease in the amniotic fluid volume was 116.6 ml (range 17.8-287.1 ml), which represented a 1.5-31.1% change in the total intrauterine volume (p = 0.004). The reduction was linearly related to the amount of maternal fluid removed during hemodialysis. The reduction in the total intrauterine volume was best estimated by the equation: -6.618 + (32.582) (weight loss in kilograms). Hemodialysis during pregnancy results in linear amniotic fluid shifts related to the amount of maternal fluid removed during dialysis. Given these findings, care must be taken to limit the volume of maternal fluid removed during hemodialysis, especially in pregnancies complicated by early gestation, intrauterine growth retardation, or oligohydramnios.

Adult↗

PubMed1995

Distance from an intrauterine hydrophone as a factor affecting intrauterine sound pressure levels produced by the vibroacoustic stimulation test.

OBJECTIVE: The purpose of this study was to determine whether intrauterine sound pressure levels produced by vibroacoustic stimulation were associated with distance from an intrauterine hydrophone in human parturients and to evaluate the effects of distance on the spectrum of the stimulus. STUDY DESIGN: Measurements of intrauterine sound were taken in eight volunteer parturients in normal active-phase labor by use of an intrauterine hydrophone. Vibroacoustic stimulation was performed on the maternal abdomen directly overlying the hydrophone; at distance of 5, 10, 15, 20, and 25 cm from the hydrophone; and at the maternal sternum. Intrauterine sound pressure levels were tape-recorded for later analysis. Fetal heart rate and fetal movement were assessed with each vibroacoustic stimulation. Spectral analyses were performed by taking the fast Fourier transform of the tape-recorded stimulation at each position. RESULTS: Analysis of variance with repeated measures indicated a statistically significant decrease (F = 4.1, p = 0.004) in the sound pressure levels as distance increased. Spectral analysis indicated large variability between and within subjects. CONCLUSION: Sound exposure of the fetal ear is on average decreased as the distance between the ear and the vibroacoustic stimulation is increased. The spectrum of the stimulus produced with vibroacoustic stimulation is highly variable.

Acoustic Stimulation↗

PubMed1995

Prospective determination of chorionicity, amnionicity, and zygosity in twin gestations.

OBJECTIVE: Our purpose was to determine the predictive accuracy of a composite ultrasonographic evaluation for chorionicity, amnionicity, and zygosity in a consecutive series of twins. STUDY DESIGN: One hundred ten consecutive twins were seen for ultrasonography beginning January 1992. Chorionicity, amnionicity, and, zygosity were prospectively assessed with a composite of ultrasonographic findings (placental number, fetal sex, membrane thickness, and "twin peak" sign). Clinical and pathologic confirmation of chorionicity, amnionicity, and zygosity was available on 100 of these twins. RESULTS: The 100 twins had 3.6 +/- 1.6 ultrasonographic scans each (mean +/- SD) with the first performed at 22.6 +/- 6.9 weeks. Chorionicity, amnionicity, and zygosity were each predicted with > or = 91% sensitivity and specificity. In 35 (35%) cases zygosity could not be determined by either ultrasonographic or clinical or pathologic assessment at delivery. CONCLUSION: Chorionicity, amnionicity, and zygosity have important implications for antepartum management and prognosis of twins. By use of a composite of ultrasonographic findings, chorionicity, amnionicity, and zygosity were predicted with excellent reliability when they were prospectively tested in a heterogeneous consecutive series of twins.

Amnion↗

PubMed1995

Favorable hemodynamic effects of magnesium sulfate in preeclampsia.

OBJECTIVE: Our purpose was to evaluate the hemodynamic effects of magnesium sulfate in preeclamptic and preterm labor patients. STUDY DESIGN: Fifteen preeclamptic patients at 32.4 +/- 3.3 (mean +/- SD) weeks' gestation and 11 preterm labor patients (31.3 +/- 2.8 weeks) were hemodynamically monitored in the lateral recumbent position by thoracic electrical bioimpedance (BoMed, Irvine, Calif.) before and during high-dose magnesium sulfate bolus and infusion. Cardiac index, systemic vascular resistance index, mean arterial pressure, heart rate, and stroke index were all recorded at baseline and during magnesium sulfate infusion. All patients received a standard crystalloid infusion. Data analysis continued until the patient received epidural placement or other antihypertensive therapy or was delivered. RESULTS: At baseline the systemic vascular resistance index was 2465 +/- 718 F.ohm/m2 and the cardiac index was 3.6 +/- 1.0 L/min/m2 for the preeclamptic patients. These were significantly different compared with the preterm labor patients, who had a systemic vascular resistance index of 1377 +/- 563 F.ohm/m2 and 4.6 +/- 1.2 L/min/m2. Magnesium sulfate infusion resulted in a rapid, sustained fall in systemic vascular resistance and a rise in cardiac index in the preeclamptic patient. This effect was evident at least 4 hours after initiation of the bolus and infusion. In the preterm labor patients the hemodynamic effects of magnesium sulfate were minimal and were noted only during the magnesium sulfate bolus. CONCLUSION: Magnesium sulfate infusion appears to have a prolonged hemodynamic effect in the preeclamptic patient. Sustained reduction in systemic vascular resistance and an increase in cardiac index is found in patients with preeclampsia but not in preterm labor.

Cardiac Output↗

PubMed1995

Antepartum management of the multiple gestation: the case for specialized care.

Multiple gestations are increasingly more common and represent one of the highest risk conditions faced in pregnancy. The population-attributable fetal and newborn risks of twin and triplet gestations are compelling. This article is dedicated to a discussion of the antepartum management of multiple gestations and a conclusion that specialized care can improve both perinatal morbidity and mortality in these pregnancies. Prenatal care for multiple gestations should be provided by an experienced and dedicated staff that can anticipate and manage the various and complex problems presented by the multifetal gestation. Specialized care for multiple gestations should include components such as consistent evaluation of maternal symptoms and cervical status by a single care-provider, intensive preterm birth prevention education, individualized modification of maternal activity, increased attention to nutrition, ultrasonography, tracking of clinic nonattenders, and a supportive clinical environment. This sort of specialization and individualization of antepartum care for multiple gestations provides the best opportunity to maximize intrauterine fetal growth, identify congenital anomalies, prevent extremely preterm or very low birth weight deliveries, and identify fetal or maternal complications that may necessitate more intensive fetal surveillance or even delivery to reduce adverse perinatal outcome.

Female↗