Multiple Births Workup

Updated: Dec 20, 2019
  • Author: Garth E Fletcher, MD; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Laboratory Studies

The evaluation of a multifetal pregnancy involves routine prenatal and postnatal care, as well as specific assessment directed by the type of multiple pregnancy and neonatal complications. Guidelines for the evaluation of multifetal pregnancies have been established by American College of Obstetricians and Gynecologists, including the following laboratory studies [2] :

  • Obstetrical: Routine prenatal laboratory studies are indicated.

  • Neonatal: A CBC count is obtained to evaluate for anemia and polycythemia.

  • Neonatal arterial blood gas and cord blood gas: These are measured to evaluate for respiratory distress, hypoxia, acidosis, and perinatal depression.

  • Metabolic panel: Fluid status and electrolyte levels should be evaluated and metabolic status should be determined, including through screening for hypoglycemia and hypocalcemia.

  • Bilirubin level: This is obtained to screen for increased risk of hyperbilirubinemia associated with prematurity and polycythemia.


Imaging Studies

Several imaging studies are useful in the workup of multifetal pregnancy, including the following:

  • 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 considerations: Antepartum surveillance is indicated.

Procedures are specific to the obstetrical or neonatal complications (ie, ablation procedure in twin-to-twin transfusion syndrome [TTTS], surgery in conjoined twins).