View Full Version : dr question - over 35

08-06-2009, 06:57 PM
I am over 35 and pregnany with twins. All is going well and babies are healthy. Is it customary to see both a perinatologist and your OBGYN weeks 20 - delivery?

08-07-2009, 08:03 AM
I did. Twin pregnancies are considered high risk, especially for women 35+. I'm glad I saw a perinatologist, even though my pregnancy didn't go as smoothly as I had hoped (check my signature.)

08-07-2009, 10:54 AM
I probably would, given your age and the fact that you're having twins. I didn't, but I was 30 when I had mine, and I had no complications, carried to 38 weeks.. My OB was very experienced with twins and the practice had a couple of perinatologists that he could refer me to if needed, but I never had a need. I was seen by my OB/had sonos more frequently since he did consider twins high-risk but in the end I never needed a peri.

If you love your OB, and he is closely associated with peris in the practice, then you could consider staying with him/her but making sure that they treat you as high-risk/take into account your age/would refer you to a peri in a heartbeat should a need arise.

08-07-2009, 11:13 AM
Do you have to see both every single appointment? I saw a peri at 20 weeks, but since everything was OK, except for my fibroid, that was it. I did have problems with the fibroid later, but my OB handled it. I was 38 then with a singleton.

My suggestion will be to at least see the perinatalogist once, and then you can discuss the need to see both the peri and OB for the rest of the pregnancy depending on the findings.

Best wishes

08-07-2009, 12:02 PM
I was 35 during my twin pregnancy and did not see a peri, just my regular OB. I was considered high-risk because of my age and the fact that it was a twin pregnancy. My OB is experienced with high risk and twin pregnancies. Pregnancy went smoothly and I had no issues or complications. Babies arrived a bit early at 35.5 weeks, but came home from the hospital with me, no NICU.

In my case, my OB said that even though I was high risk, it was also lessened by the fact that I had 2 prior singleton pregnancies with no issues, so he had some history to base things on.

I did have ultrasounds every 2-3 weeks in the 3rd trimester, but that is pretty much standard practice here for a twin pregnancy so they can track fetal growth.

Could you stick with regular OB and just get a peri referral if any issues arise?

Good luck!

08-08-2009, 06:26 PM
I was a month short of 36yo when I delivered. I did not see a perinatologist however, I have a fantastic OBGYN who delivered my first 2 babies/pregnancies and I know he is very well informed. Also, I did a lot of reading about twin pregnancies and I was in some ways, better focused on the end goal. I guess what I"m trying to say is, the goal of a singleton pregnancy is a little different than a mulitples pregnancy. With a singleton you are simply trying to have a healthy preganncy and not gain too much weight. With a multiples pregnancy you are trying to prevent preterm labor and keep the babies growing safely in your womb for as long as possible. 2 different goals, thus 2 different strategies. I think from being well-informed, I was better able to keep us both working toward that goal (asking the right questions, etc.), if that makes sense. I delivered at 37 weeks with very healthy babies. Frankly, I had 2 other little children I was taking care of so I really didn't want to have to make more doctors' appointments than necessary.

However, if this had been my first pregnancy, I might have been more able to see the OBGYN as well as the perinatologist.

If I were you, I'd simply stay well informed and keep the number to a well respected peri available incase something should come up. Hopefully, you trust your doctor enough to know that if they have the slightest concern, they'll refer you. Multiples pregnancies are not a time to have a "Wait and see" attitude, iykwim.


08-08-2009, 10:03 PM
My ultrasounds and NSTs were done at a maternal-fetal medicine office. But otherwise, my OBs (and midwives) handled all of my care. I am 36yo and had no complications during the pregnancy; the girls were born at 37w5d.

I don't know if it mattered that I had already carried two pregnancies uneventfully to term (38w and 39w, respectively), as I understand that that is a strong indicator of how a subsequent twin pregnancy will go.

08-09-2009, 12:55 AM
I turned 35 while pregnant with my twins and my experience was almost identical to Lori's. I was even supposed to have my boys at 37 weeks 5 days via a scheduled c-section, but they decided to come a day early.

I had all of my ultrasounds done at maternal-fetal medicine where they were reviewed by a perinatologist before I left. I met with one of the doctors briefly after my NST and again after my 20 week anatomy scan just to see if I had any questions. I had complications with my first pregnancy, but I'd had a uneventful second pregnancy. With the twins, I had a few minor issues, but none of them were life threatening and I was completely comfortable with letting my OB manage my care. I trust him more than I would have trusted a new doctor.

08-09-2009, 11:58 PM
I have identical twins who were mono/di -- they shared a placenta.

Due to the higher risk of this particular configuration (not the highest risk for twins, but higher than if they did not share a placenta), I saw the perinatologist every 3 weeks from about 20 weeks onward -- with a full set of measurements each time. I also saw the OB on a more frequent-than-singleton schedule. So, some weeks I would see both, other times the appointments would be in different weeks altogether.

I was over 35, but I was seeing a midwife until the twin (and mono/di twin) diagnosis. After that ultrasound (~11-13wks), I got bumped to the OBs in the office and a maternal-fetal specialist (the perinatologist). So it was the twin diagnosis that increased the risk, much more so than the age.

08-11-2009, 12:25 AM
I am 36 years old and 36 weeks pregnant with mono-di twins. I saw a peri once - around 20 weeks - when my OB suspected mo-mo twins - the peri found a membrane and I have not been back since. I have felt very comfortable with my OB's care and feel confident that I would be referred to the peri again if necessary. I have had ultrasounds every visit according to the following schedule - 8, 12, 15, 18, 20, 22, 24, 26, 28, 30, 32, 33, 34, 35, 36 weeks - and will continue weekly until my scheduled c on 9/1. Aside from nuchal at 12 weeks and anatomical at 20 weeks (plus the peri visit, which was also anatomical), my ultrasounds have been for growth, cervical measurements and checking for calcification of the placenta.

08-11-2009, 11:26 PM
I am like Momof3 labs and dowlinal, I was 37 (just had a b-day though, yikes!) and saw the maternal-fetal specialists for all ultrasounds at 10, 13, 18, 21, 25, 29, 33 weeks. That is the way our hospital is set up though. The twins were born naturally at 34 weeks 3 days. They were big too! I also have two other singleton kids and one of their pregnancies was completely normal, the other not. My OB saw me for all the visits and ran just about everything he needed to when necessary. Besides my long labor (over 30 hours) everything went relatively smoothly. Age was never a factor either as I must have asked if special tests needed to be done since I was of 'mature age". My doctor thinks most of that view point is hokey. He says old age is over 40 for multiples and a lot of how you are treated is based on your previous pregnancies and what kind of shape you are in. He saw me every week from week 20 on as that is nature. Due to some other complications I fell into the high risk category and was treated as such which to me means they watch you more and for that I am very thankful. Some moms I know from our area who had twins did not see their MF specialists until they were over 30 weeks as that is their practice. I think it depends a lot on your doctor and what he/she is comfortable with and that their hospital policy is to.

In any case, good luck, here's to happy healthy babies and mom!!! After birth the real fun begins!!!!