eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology

Multiple Births: Differential Diagnoses & Workup

Author: Garth E Fletcher, MD, Assistant Professor of Pediatrics and Staff Neonatologist, Joint Division of Newborn Medicine, University of Nebraska Medical Center and Creighton University
Coauthor(s): Terence Zach, MD, Department Vice-Chair, Professor, Department of Pediatrics, Section of Newborn Medicine, Creighton University; Arun K Pramanik, MD, MBBS, Professor of Pediatrics, Director of Neonatal Fellowship, Louisiana State University Health Sciences Center; Susannah P Ford, MD, Fellow, Department of Pediatrics
Contributor Information and Disclosures

Updated: Jul 8, 2009

Workup

Laboratory Studies

The evaluation of a multifetal pregnancy involves routine prenatal and postnatal care, as well as specific evaluation directed by the type of multiple pregnancy and neonatal complications. Guidelines for complicated multifetus pregnancies have been established by American College of Obstetricians and Gynecologists.7

  • Obstetrical: Routine prenatal laboratory studies are indicated.
  • Neonatal: A CBC count is obtained to evaluate for anemia and polycythemia.
  • ABG and cord blood gas (CBG): These are measured to evaluate for respiratory distress, hypoxia, acidosis, and perinatal depression.
  • Metabolic panel: Fluid and electrolyte levels should be obtained and metabolic status should be determined, including screening for hypoglycemia and hypocalcemia.
  • Bilirubin level: This is obtained to screen for increased risk of hyperbilirubinemia associated with prematurity and polycythemia.

Imaging Studies

  • Obstetrical: Prenatal ultrasonography is used to confirm multifetal pregnancy and to monitor intrauterine fetal growth.
  • Fetal echocardiography: This is used to screen for congenital heart disease in neonates.
  • Fetal MRI: This is used to screen for fetal anomalies.
  • Neonatal: Chest radiography is used to evaluate respiratory distress.
  • Ultrasonography: This is used to screen for intraventricular hemorrhage, periventricular leukomalacia, and abdominal abnormalities.
  • Echocardiography: This is used to screen for congenital heart disease.

Other Tests

  • Obstetrical: Antepartum surveillance is indicated.

Procedures

  • Specific to obstetrical or neonatal complications (ie, ablation procedure in twin-to-twin transfusion syndrome [TTTS], surgery in conjoined twins)

More on Multiple Births

Overview: Multiple Births
Differential Diagnoses & Workup: Multiple Births
Treatment & Medication: Multiple Births
Follow-up: Multiple Births
Multimedia: Multiple Births
References
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References

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Further Reading

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Keywords

multiple births, multifetal pregnancy, twins, triplets, quadruplets, dizygotic twins, monozygotic twins, dichorionic/diamniotic twins, monochorionic/diamniotic twins, monochorionic/monoamniotic twins, conjoined twins, monozygotic triplets, dizygotic triplets, trizygotic triplets, twin-to-twin transfusion syndrome, TTTS, placenta previa, abruptio placenta, preeclampsia, cord accidents, preterm labor, premature rupture of membranes, hyperemesis gravidarum, placenta previa, polyhydramnios, Cesarean delivery, placental abruption, operative delivery, malpresentation, cord accidents, postpartum endometriosis, low birth weight, prematurity, intrauterine growth retardation, respiratory distress syndrome, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis, patent ductus arteriosus, cerebral palsy

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Contributor Information and Disclosures

Author

Garth E Fletcher, MD, Assistant Professor of Pediatrics and Staff Neonatologist, Joint Division of Newborn Medicine, University of Nebraska Medical Center and Creighton University
Garth E Fletcher, MD is a member of the following medical societies: American Academy of Pediatrics and National Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Terence Zach, MD, Department Vice-Chair, Professor, Department of Pediatrics, Section of Newborn Medicine, Creighton University
Terence Zach, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Nebraska Medical Association
Disclosure: Nothing to disclose.

Arun K Pramanik, MD, MBBS, Professor of Pediatrics, Director of Neonatal Fellowship, Louisiana State University Health Sciences Center
Arun K Pramanik, MD, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

Susannah P Ford, MD, Fellow, Department of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

David N Sheftel, MD, Director, Division of Neonatology, Clinical Associate Professor, Department of Pediatrics, Lutheran General Children's Hospital of Park Ridge, Chicago Medical School
David N Sheftel, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

David A Clark, MD, Chairman, Professor, Department of Pediatrics, Albany Medical College
David A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Pediatric Society, Christian Medical & Dental Society, Medical Society of the State of New York, New York Academy of Sciences, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Carol L Wagner, MD, Professor of Pediatrics, Medical University of South Carolina
Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD, Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine
Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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