High-risk of twins and multiples

David Miller, MD, Chief of Maternal Fetal Medicine, Children's Hospital Los Angeles, discusses the common risks associated with twin pregnancies
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High-risk of twins and multiples

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What are the specific risks that come along with twin pregnancy or multiple gestation? As a perinatologist and a father of twins, I am very familiar with the potential risks of a twin pregnancy, and again, they come in maternal risks and fetal risks. Some of the maternal risks of twin pregnancy include things like excessive weight gain, diabetes, pre-eclampsia, and some of the fetal risks of multiple gestation are even greater than that. We can start with some of the simple things like twins are at a higher likelihood of delivering early, twins on average deliver at about 35 weeks compared to singleton pregnancies, in which nine out of ten deliver at at least 37 weeks. If you have triplets, that number drops to 32 weeks, and if you have quadruplets it drops to about 29, and if you have quintuplets, that is five, it drops to about 27 weeks. So early delivery is one of the very well recognized risks of twin pregnancy. Some of the other risks are a little bit more complicated, and they have to do with the twins not growing evenly, or not sharing their blood supply evenly, in identical twins who have a common blood supply at the level of the placenta. That can lead to differential growth, but it can even lead to a condition that's fairly complicated, called twin transfusion syndrome in which one twin literally acts as a donor, a blood donor, and another twin acts as a blood recipient. That condition has an extremely high rate of fetal loss. In some circumstances the procedure that can be used to treat twin transfusion syndrome can result in survival of both twins in as many as 70% of cases, and in survival of one twin in more than 90% of cases.

David Miller, MD, Chief of Maternal Fetal Medicine, Children's Hospital Los Angeles, discusses the common risks associated with twin pregnancies

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David Miller, MD

Chief of Maternal Fetal Medicine, Children's Hospital Los Angeles

David A. Miller, MD, is Professor of Obstetrics, Gynecology, and Pediatrics at the Keck School of Medicine of the University of Southern California and Children's Hospital Los Angeles.  He is the Chief of Maternal Fetal Medicine at Children’s Hospital Los Angeles and the Director of the CHLA-USC Institute for Maternal Fetal Health, a unique alliance of medical leaders from Children's Hospital Los Angeles and USC, specializing in interdisciplinary diagnosis and treatment of complex fetal abnormalities.  Dr. Miller graduated from USC, attended medical school at the University of Arkansas, did his internship and residency at Vanderbilt University Medical Center and came back to USC for fellowship training in Maternal-Fetal Medicine (Perinatology).  He has been a researcher, clinician and educator at USC for more than 20 years.  Dr. Miller has published extensively in the area of Maternal-Fetal Medicine and has won numerous awards and honors including Best Doctors in America from 2001-present.

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