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OBSTETRICIANS' HIGH RISK PREGNANCY PRACTICE GETS PLENTY OF TWINS AND TRIPLETS

triple option

Anthony "Tony" Gregg, MD has been seeing triple-as in triplets. Lots of them. Gregg, an associate professor of obstetrics/gynecology for the School of Medicine, is director of maternal/fetal medicine and medical director of the Division of Genetics. He and his new partner, Paul Browne, MD, an associate professor in obstetrics/gynecology, receive high-risk obstetric referrals across the mid-state of South Carolina that includes a 16-county area surrounding the Midlands.

Many private-practice obstetricians refer their patients to Gregg and Browne when multiple-birth pregnancies or other high-risk factors are involved. That's how the two became the primary physicians for five mothers who were all pregnant with triplets at the same time earlier this year.

"I'd never had the opportunity to care for so many patients with twins and triplets at one time until I came to the University of South Carolina School of Medicine," said Gregg, who has been providing obstetrical care of mothers with high-risk pregnancies for the past five years at the School of Medicine's University Specialty Clinics and at Palmetto Health Richland Hospital. "There are different views on how to manage twin and triplet pregnancies-we take an extremely vigilant approach."

For Gregg and nurse manager Heidi Mason, that means providing an initial counseling session to mothers who are often overwhelmed but ecstatic at the prospect of a multiple birth.

"What most mothers don't understand at first is that carrying triplets means they are at high risk for being hospitalized for some time during the pregnancy, that they likely will have low birth weight babies, and that there is a higher risk for their newborns to have cerebral palsy or to experience neonatal death," Gregg said. "Sharing that information is a reality check that gets them prepared for the road ahead."

The statistics are sobering: Triplets have a 17-times greater risk of suffering from cerebral palsy than singletons. They also are 20-times more likely to die in the first year; have an average birth weight of less than four pounds each; and an average-length stay of 30 days in a neonatal intensive care unit. The pregnancies can tax families emotionally and financially.

But Gregg's intensive approach to high-risk pregnancy management-he provides his cell phone number to mothers (and fathers) and encourages them to call with any concern-pays dividends. Nearly all of his patients carrying twins and triplets approach their gestational targets-35-36 weeks for triplets; 36-37 for twins-and avoid long and expensive hospitalizations for themselves and their newborns.

"The rocky road for a triplet pregnancy starts at 18-20 weeks. That's when the uterine volume and fetal size begin to conflict", he said. "Dr. Browne and I start seeing these patients almost weekly after 18 weeks of pregnancy to monitor the condition of the cervix, which can thin much faster with a multiple pregnancy and to review patient symptoms and address psycho-social stresses.

"This approach results in many more office visits than with a singleton pregnancy, but the extra attention can prevent weeks of expensive care in the neonatal intensive care unit. We're also vigilant about making sure our patients get adequate nutrition, rest and supplementation with vitamins, iron and folic acid during the pregnancy."

Along with expectant mothers carrying multiples, Gregg and Browne also see patients who are diabetics, have high blood pressure or some other underlying health condition that threatens to complicate the pregnancy. Managing their care often translates into 14-hour days.

"I'm excited to come to work every day and I go home with a sense of fulfillment," Gregg said. "The patient population I am privileged to care for makes my job exciting and patients are usually extremely appreciative."

Wendy is one of the five mothers of triplets who were under Gregg's care at the same time. She gave birth to three healthy girls in June.

"Dr. Gregg is very conservative; he never wants you to become complacent about doing all the right things while you're pregnant," she said. "You make it to 24 weeks, and he immediately starts encouraging you not to let your guards down-to shoot for 28 weeks, then 32 weeks. It was always like, 'You're doing good, Wendy, but…' And it worked-I made it!"

Wendy's husband, Nate, called Gregg several times during the pregnancy, and Linda, whose triplets were born in October, has called after hours, too. "He said it's OK to call any time. That's good peace of mind," she said.

Article reproduced with permission from South Carolina Medicine -Winter 2009

Ask the Expert Archives

View previous issues by clicking on the title:

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