Antepartum management of the multiple gestation: the case for specialized care.

Multiple gestations are increasingly more common and represent one of the highest risk conditions faced in pregnancy. The population-attributable fetal and newborn risks of twin and triplet gestations are compelling. This article is dedicated to a discussion of the antepartum management of multiple gestations and a conclusion that specialized care can improve both perinatal morbidity and mortality in these pregnancies. Prenatal care for multiple gestations should be provided by an experienced and dedicated staff that can anticipate and manage the various and complex problems presented by the multifetal gestation. Specialized care for multiple gestations should include components such as consistent evaluation of maternal symptoms and cervical status by a single care-provider, intensive preterm birth prevention education, individualized modification of maternal activity, increased attention to nutrition, ultrasonography, tracking of clinic nonattenders, and a supportive clinical environment. This sort of specialization and individualization of antepartum care for multiple gestations provides the best opportunity to maximize intrauterine fetal 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 to reduce adverse perinatal outcome.