Higher than expected blood pregnancy test levels (HCG) early in pregnancy can suggest a multiple gestation, but the only way to confidently diagnose multiple gestations is with an ultrasound exam. Transvaginal sonography, as early as 6 weeks gestation, is used to diagnose multiple gestations. Sometimes, as a pregnancy progresses, fetuses may be missed in higher order multiples. Some quadruplet or quintuplet remain undiagnosed and are first found at the time of delivery because latter ultrasound exams create optical illusions making imaging more difficult.

Answer courtesy of Victor Klein, MD Perinatologist, Great Neck OB/GYN.

Symptoms of multiple pregnancy may include:

• uterus is larger than expected for the dates in pregnancy
• increased morning sickness
• increased appetite
• excessive weight gain, especially in early pregnancy
• fetal movements felt in different parts of abdomen at same time

Tests used to diagnose a multiple pregnancy include:

• HCG blood tests
• Alpha-fetoprotein test
• Ultrasound

Resources for expectant parents of multiples are available on the Expecting Multiples MOST by the Stages web page.

Peace Health's Multiple Pregnancy: Twins or More

MOST also offers our Expecting Multiples booklet covering a variety of topics related to pregnancy and delivery of higher-order multiples.

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Copyright MOST 2005      Updated 5/16/08