MetroHealth Dialogue
Reducing risks with multi-fetal pregnancies
 MetroHealth's Division of Maternal-Fetal Medicine is the region's most diverse practice to specialize in caring for high-risk pregnancies, including multi-fetal gestations. The division is supported by MetroHealth's state-of-the-art NICU.
The maternal-fetal division has highly trained specialists and technological capabilities to care for problems which are more common for women carrying multiple fetuses. These include:
- Preterm labor
- Premature rupture of membranes
- Gestational hypertension or preeclampsia
- Gestational diabetes
- Anemia
- Thromboembolism
Delivery of more than one baby is also more complicated, with a greater risk of cesarean delivery and postpartum hemorrhage than with singletons. Preterm delivery also means there is a greater risk that the infant will have neurologic issues, including cerebral palsy.
MetroHealth’s perinatologists are highly experienced in managing potential problems which develop during multi-fetal gestations, as well as the delivery of these infants. In 2011, 1 in 35 babies born at MetroHealth was a twin or multiple born preterm. Currently, about 1 in 50 pregnancies in the U.S. is a twin gestation, and the complication rate during pregnancy with twins is about 40 percent.
“When carrying twins or high-order multifetal pregnancies, there is an increased likelihood of serious complications,’’ said Brian Mercer, MD, Chairman of OB/GYN and Director of Maternal-Fetal Medicine at The MetroHealth System. “People need to understand that having twins is a high-risk pregnancy.’’
The average delivery gestation for multifetal pregnancies is notably shorter than the standard 39 weeks: for twins, it’s 36 weeks; for triplets, 32 weeks; and for quadruplets, 30 weeks.
“So carrying more babies means more chance for early delivery of babies not ready to be born,” said Dr. Mercer.
Perinatal Center faculty members are available around the clock for consultation and transfer of patients with complicated pregnancies. “And if referring physicians want to continue to care for their patient in collaboration with us, we are happy to coordinate care with them,’’ said Dr. Mercer.
About 20 percent of the infants in MetroHealth’s NICU are very-low-birth-weight babies (less than 1,500 grams), which is a higher percentage than in other area NICUs, said Marc F. Collin, MD, Medical Director of the NICU. “That means we are extremely well-versed in taking care of them.’’
“We receive many transfers in obstetrics that are difficult cases,’’ said Dr. Collin. “The good news is that the babies we get from our high-risk obstetricians are coming from the best care possible.’’
John J. Moore, MD, Chief, MetroHealth’s Division of Neonatology, said that for all infants weighing under 1,500 grams (3 1/3 pounds) at birth, MetroHealth had among the best outcomes nationally in 2010 as tracked by the Vermont Oxford Network (VON).
The VON is a non-profit voluntary collaboration of healthcare professionals dedicated to improving the quality and safety of medical care for newborn infants and their families. The network is comprised of more than 900 NICUs from around the world.
For infants weighing 500 to 750 grams, the tiniest infants tracked by the VON network, MetroHealth had an 80 percent to 85 percent survival rate over the past three years. “When I was a resident, the survival in that group of the tiniest babies was about 25 percent,’’ said Dr. Moore, who has spent 30 years caring for patients in MetroHealth’s NICU.
In addition to care during hospitalization, Dr. Collin noted that NICU physicians follow their babies up to age 2 in MetroHealth’s Special Care Developmental Follow-up Clinic, which is coordinated by Debbie Lawson, LPN, the NICU discharge coordinator.
This allows continued screening of these babies for any developmental issues which are associated with premature or difficult births.
| Call the Maternal-Fetal Medicine Clinic Coordinator at 216-778-3882 |
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