High Risk Pregnancy & Multiple Gestations

Multiple Pregnancy

A twin, triplet, or higher-order pregnancy (four or more babies) is called multiple pregnancy. If more than one egg is released during the menstrual cycle and each is fertilized by a sperm, more than one embryo may implant and grow in your uterus. This type of pregnancy results in fraternal twins (or more). When a single fertilized egg splits, it results in multiple identical embryos. This type of pregnancy results in identical twins (or more). Identical twins are less common than fraternal twins.

Early in a multiple pregnancy, an ultrasound  exam is done to find out whether each baby has its own chorion (chorionicity) and amniotic sac (amnionicity). 

These are the types of twin:

–     Dichorionic – diamniotic – twins have their own chorions and amniotic sacs. They typically do not share a placenta and can be fraternal or identical.

–     Monochorionic – diamniotic – twins who share a chorion but have separate amniotic sacs. They share a placenta and are identical.

–     Monochorionic – monoamniotic – twins who share one chorion and one amniotic sac. They share a placenta and are identical.

Monochorionic babies have a higher risk of complications than those with separate placentas. One problem that can occur in monochorionic – diamniotic babies is twin–twin transfusion syndrome (TTTS). In TTTS, the blood flow between the twins becomes unbalanced. One twin donates blood to the other twin. The donor twin has too little blood, and the recipient twin has too much blood. The earlier TTTS occurs in the pregnancy, the more serious the outcomes for one or both babies.

Although monochorionic – monoamniotic babies are rare, this type of pregnancy is very risky. The most common problem is an umbilical cord complication. Women with this type of pregnancy are monitored more frequently and are likely to have their babies by cesarean delivery.


Women with multiple pregnancy may have more severe morning sickness or breast tenderness than women who are pregnant with singleton baby. They could also gain weight more quickly. Multiple pregnancies are often discovered during an ultrasound examination.


The chance of needing a cesarean delivery is higher with multiples. In some cases, twins can be delivered by vaginal birth.

How your babies are born depends on the following:

–     Number of babies and the position, weight, and health of each baby.

–     Your health and how your labor is going.

–     Your obstetrician’s experience.

Gestational Hypertension / Pregnancy-Induced Hypertension

Gestational Hypertension is high blood pressure that first occurs in the second half (after 20 weeks) of pregnancy. Although gestational hypertension usually goes away after childbirth, it may increase the risk of developing hypertension in the future. Gestational hypertension can lead to a serious condition called preeclampsia, also referred to as toxemia. Hypertension during pregnancy affects about 6-8% of pregnant women.

There are 3 common types of gestational hypertension:

Chronic Hypertension – Women who have high blood pressure (over 140/90) before pregnancy, early in pregnancy (before 20 weeks), or continue to have it after delivery.

Gestational Hypertension  High blood pressure that develops after week 20 in pregnancy and goes away after delivery.

Preeclampsia – Both chronic hypertension and gestational hypertension can lead to this severe condition after week 20 of pregnancy. Symptoms include high blood pressure and protein in the urine. This can lead to serious complications for both mom and baby if not treated quickly.

Risk Factors:

A woman is more likely to develop PIH if she:

–     Is under age 20 or over age 35

–     Has a history of chronic hypertension

–     Has a previous history of PIH

–     Has a female relative with a history of PIH

–     Is underweight or overweight

–     Has diabetes before becoming pregnant

–     Has an immune system disorder, such as lupus or rheumatoid arthritis

–     Has kidney disease

–     Has a history of alcohol, drug, or tobacco use

–     Is expecting twins or triplets


–     Rapid or sudden weight gain

–     High blood pressure

–     Protein in the urine

–     Swelling (face, upper & lower extremities). Some swelling is normal during pregnancy but if the swelling doesn’t go away and is accompanied by some of the stated symptoms, please see your provider right away.

–     Other symptoms includes severe headache, change in reflexes, spots before your eyes, reduced urine output, dizziness, excessive nausea and vomiting, right upper quadrant pain.

Gestational Diabetes Mellitus

Gestational diabetes is diabetes mellitus that develops in women for the first time during pregnancy. Some women found to have gestational diabetes actually may have had mild diabetes before pregnancy that was not diagnosed.

Gestational diabetes is caused by a change in the way a woman’s body responds to insulin during pregnancy. Insulin is a hormone. It moves glucose out of the blood and into the body’s cells where it can be turned into energy. During pregnancy, a woman’s cells naturally become slightly more resistant to insulin’s effects. This change is designed to increase the mother’s blood glucose level to make more nutrients available to the baby. The mother’s body makes more insulin to keep the blood glucose level normal. In a small number of women, even this increase is not enough to keep their blood glucose levels in the normal range. As a result, they develop gestational diabetes.

Gestational diabetes increases the risk of having a very large baby (a condition called macrosomia) and possible cesarean birth. High blood pressure and preeclampsia are more common in women with gestational diabetes.

If you have gestational diabetes, you will need to keep your blood glucose level under control. Controlling your blood glucose level may require daily tracking of your glucose level, eating healthy foods, exercising regularly, and sometimes taking medications.

For most women, gestational diabetes goes away after childbirth. However, they remain at high risk of having diabetes later in life. For women who had mild diabetes before pregnancy, it is a lifelong condition.

Will I be tested for GDM?

All pregnant women are screened for gestational diabetes.  At around 24-28 weeks of gestation, pregnant moms are scheduled to do the 2 hr glucose tolerance test to screen for GDM. Result is available in 1-2 days and will be communicated to you by the doctor.

Risk Factors:

Gestational diabetes is more likely in women who:

–     are older than 25 years

–     are overweight

–     have had gestational diabetes before

–     have had a very large baby

–     have a close relative with diabetes

–     have had a stillbirth in a previous pregnancy

–     are African American, American Indian, Asian American, Hispanic, Latina or Pacific Islander