ABSTRACT
Routine antepartum care for high-order multiple (HOM) pregnancy ideally should begin in the preconception period. Appropriate monitoring and follow-up of these patients by their fertility specialists should result in early diagnosis of pregnancy as well as high-order multiple pregnancy before the first visit to the obstetrician. In addition, numerous medical and lifestyle issues can and should be addressed at this time, including medical conditions that may affect pregnancy such as diabetes mellitus, hypertension and hypo-or hyperthyroidism. Maternal obesity can also be addressed with a weight-reduction program of diet combined with exercise, which will allow the woman to become pregnant in the best possible condition to respond to the challenges of a potential HOM gestation. Anemia, hemoglobinopathy, rubella immunity and hepatitis B status can be assessed and appropriately managed if need be, and unique genetic risks can be assessed and evaluated, such as carrier states for sickle cell disease, Tay-Sachs disease, Canavan’s disease or cystic fibrosis.
