Although multiples account for only a small percentage of all live births, they are responsible for a disproportionate share of all newborn morbidity and mortality in the United States. Multiples give rise to 13% of all preterm births (<37 weeks); 15% of all preterm births <32 weeks; 21% of all low birth weight (<2500 grams); and 25% of all very low birth weight (<1500 grams) deliveries. As consequence of these high rates of both prematurity and low birth weight, twins are at an approximately fivefold greater risk of dying before their first birthday compared to singletons, while triplets are at almost a 14-fold greater risk. Multiple births account for 16% of all newborn deaths in the United States. 
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Multiple pregnancies have rapidly become one of the most common high-risk conditions encountered in obstetrics. Since 1980, the number of twins delivered in the United States has risen by more than 60% and now represents approximately one out of every 35 deliveries. Triplets and higher order births, which formerly were statistical improbabilities, have increased 470% over the same time period and now occur with a frequency approaching one in every 1000 live births. Two major factors contribute most to this increasing frequency of multiple births. The first is the emergence of assisted reproductive technologies, such as ovulation induction and in vitro fertilization, while the second is the societal trend toward delayed childbirth since twinning is more frequent in women over the age of 30.
Among survivors, multiples experience an increased risk of both mental and physical long-term handicaps. Twin pregnancies result in a child with cerebral palsy 12 times more often than do singleton births, while one out of five triplet and half of all quadruplet pregnancies result in at least one child with a major long-term disability. Not unexpectedly, multiples are also associated with significantly higher health care costs. Prolonged neonatal intensive care unit admissions are required by one-fourth of twins, three-fourths of triplets, and virtually all quadruplets. Women pregnant with multiples are at a six times higher risk of being hospitalized with antepartum complications, most frequently preterm labor, preterm PROM, and preeclampsia. About the Prenatal Wellness Multiple Pregnancy Program:
In order to minimize these risks and make each twin and triplet gestation a safe and rewarding experience, Prenatal Wellness initiated a multidisciplinary specialty clinic for multiples in 1989. Over the ensuing years, we have learned that there is no one approach, single intervention, or magic bullet that makes every multiple gestation successful. Instead, we have learned that successful prenatal care of multiple gestations requires careful surveillance, attention to detail, the application of multiple interventions, and experience in dealing with the varied complications that can occur in these pregnancies. Primary patient care in the Prenatal Wellness Multiple Pregnancy Program is provided by a certified nurse midwife, obstetrical residents, and maternal-fetal medicine specialists with special interest in multiple gestations. A multidisciplinary staff allows the Multiple Pregnancy Program to provide comprehensive and compassionate care. Ultrasound evaluation is performed by Registered Diagnostic Medical Sonographers while nutritional status is monitored by a nutritional consultant. A board certified specialist in maternal-fetal medicine provides obstetrical consultation and oversees all Multiple Pregnancy Program activities. Since its inception, more than 600 twin gestations have been cared for and delivered through our program. In addition, more than 60 triplet gestations, two sets of quadruplets, and one set of quintuplets have also been delivered. A review of these pregnancies reveals significant improvement in outcomes including higher mean birth weight, fewer very low birth weight deliveries, fewer neonatal intensive care unit admissions, and a significantly lower perinatal mortality rate. Why would a patient want to choose the Prenatal Wellness Multiple Pregnancy Program for their care?
There are several aspects of the prenatal care of women with multiples that are critical to the success of their pregnancies. Each of these components are emphasized and expertly performed by the staff of the Prenatal Wellness Multiple Pregnancy Program. Optimal prenatal care for multiples is achieved when all these components can be offered in a single comprehensive program. 1. Ultrasonographic surveillance:
Early ultrasonographic evaluation is necessary to determine placentation and to exclude congenital anomalies. Monochorionic (single placenta twins) pregnancies are at higher risk for complications, such as growth retardation, congenital anomaly, and fetal death. Monoamniotic twins (twins that share the same sac) represent a pregnancy at extreme risk for fetal death due to cord entanglement. Congenital malformations are also known to occur approximately twice as often in multiples. The Prenatal Wellness Center offers the highest quality ultrasound capabilities in the region in addition to almost 15 years of experience in high-risk pregnancy surveillance. The Prenatal Wellness Center is certified by the American Institute of Ultrasound in Medicine for advanced obstetrical ultrasound. The Prenatal Wellness Center has a proven track record of accurately identifying both chorionicity and amnionicity as well as reliably identifying congenital malformations.
2. Nutritional counseling:
One of the most important but least appreciated interventions that can improve outcome for multiples is maternal nutrition. Our emphasis on adequate nutrition and appropriate BMI-specific weight gain for gestational age has contributed to improved fetal growth, prolongation of pregnancy, and lower rates of complications, such as growth retardation, preeclampsia, and premature rupture of the membranes. To achieve these goals, frequent nutritional education is needed with an emphasis on both early and mid pregnancy weight gain. The nutritional demands of a multiple pregnancy greatly exceed that of a singleton and optimal outcomes cannot be achieved unless this fact is appreciated and maternal nutrition proportionately enhanced.
3. Prevention of prematurity:
Premature delivery is the leading cause of illness and death in multiple births. The average gestational age at delivery is inversely related to the number of fetuses. All patients are instructed in the signs and symptoms of premature labor and are empowered to request evaluation as needed for possible early labor. Patients also undergo frequent cervical assessment using both ultrasound and digital examinations in order to identify women who might be at risk for impending premature birth. Some of the interventions used to reduce the risk of premature birth include cerclage placement to reinforce or close the cervix that is prematurely dilating, home uterine activity monitoring to identify early preterm labor, and various tocolytic drugs including subcutaneous infusion pump therapy to reduce excessive uterine activity. These cervical assessments also help the physician know how to better recommend the work, activity, and lifestyle modifications that are commonly employed in multiple pregnancies.
4. Evaluation of fetal growth:
Next to premature delivery, abnormalities of fetal growth represent the second largest contributor to illness and death in multiples. Ultrasound plays a vital role as the only technique that allows assessment of each fetus individually. Ultrasound examinations are typically done on a monthly basis in multiples. Identification of a multiple gestation with growth restriction involving one or more fetuses can lead to antenatal surveillance or delivery in an effort to decrease the likelihood of fetal or newborn loss. Ultrasound is also the only modality that can be used to identify other complications such as twin-to-twin transfusion syndrome or abnormalities of the amniotic fluid volume. The Prenatal Wellness Center offers outstanding ultrasound technology as well as the experience to interpret the patterns of fetal growth that are identified.
5. Fetal surveillance:
A variety of fetal surveillance techniques are available through the Prenatal Wellness Center including fetal heart rate monitoring, ultrasound evaluation of fetal activity, Doppler monitoring of umbilical blood flow, and fetal kick counting. These surveillance techniques are usually initiated in the third trimester and their interpretation allows the care provider to decide on a weekly or bi-weekly basis as to the safety of continuing the pregnancy.
6. Timing of delivery:
Appropriate timing of delivery in twin and triplet gestations is critical to optimizing outcome. This decision involves simultaneous consideration of gestational age, estimated fetal weight, and fetal maturity. Other factors that influence this decision include maternal conditions, such as preeclampsia, the adequacy of fetal growth, and the health of the fetus as determined by fetal surveillance techniques.
Multiple gestations represent one of the most common, high-risk conditions faced in obstetrics. The population attributable fetal and newborn risks are dramatic. Prenatal care for multiples should be provided by an experienced and dedicated staff that can anticipate and manage the varied and complex problems presented by multiples. This sort of specialized prenatal care for multiples provides the best opportunity to maximize intrauterine growth, identify congenital anomalies, prevent extremely preterm or very low birth weight deliveries, and identify fetal or maternal complications that may necessitate more intensive fetal surveillance or even delivery in order to reduce adverse perinatal outcomes. The care provided at the Prenatal Wellness Multiple Pregnancy Program is provided by expert and experienced maternal-fetal medicine specialists trained to provide this special antepartum care needed by women carrying multiple gestations. The director of the Multiple Pregnancy Program is Dr. Roger B. Newman, and its co-director is Mary Myers, RN, CNM. Other maternal-fetal medicine specialists providing care to multiples are Drs. Jill Gossett Mauldin, Donna D. Johnson, and J. Peter VanDorsten. Also involved in providing care to multiples are the obstetrical residents at the Medical University of South Carolina and our maternal-fetal medicine fellows, Drs. Eugene Chang, Scott Sullivan, and Christopher Robinson.
For further questions and information regarding your multiple gestation, please don’t hesitate to call the Prenatal Wellness Multiple Pregnancy Program at 135 Cannon Street and ask to speak to Mary Myers, RN, CNM, or Roger Newman, M.D. or any other member of the Prenatal Wellness Center staff.
Best of luck with your multiple gestation.
It is truly one of the most remarkable accomplishments of your life and the birth of your multiples will be an unforgettable life-changing event.
Location and Hours:
135 Cannon Street
2nd Floor
Charleston, SC 29425
The Multiple Pregnancy Program meets on Thursdays from 8:00 AM to 5:00 PM
P atients can be seen on other days as necessary
 Click here for maps and driving directions
Parking Information:
Parking is provided free of charge to patient's of the Women's Center. Parking is available in the parking lot located directly across the street from Cannon Place. See map below for more information. 
 Click on map to enlarge
Appointment Scheduling:
Telephone (843) 792-1414
Toll Free Number: 1-800-424-MUSC (outside of the Charleston Area)
Representatives are available from 7 a.m. to 7 p.m. Monday through Friday  Online appointment request
Patient Education Interactive Tutorials:
NOTE: In order to view these tutorials, you must have Macromedia Flash installed on your computer.
 More information on the installation and use of the Macromedia Flash Plug-In
Ultrasound- Patient Education Institute Medlineplus
MUSC Online Health Library Resources:
 What is multiple pregnancy?
Other Online Resources:
Twins, Triplets, Multiple Births- Medlineplus
Preparing for Multiple Births- Nemours Foundation
Multiples Born to Older Moms Fare Same as or Better than Those Born to Younger Moms- National Institute of Child Health and Human Development
Multiples: Twins, Triplets and Beyond- March of Dimes
Pregnant with Multiples- Resolve National Infertility Association
More Multiple Births With Better Survival- American College of Obstetrics & Gynecology  Back to Top
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