High-Risk Pregnancy - Multiple Pregnancy

Multiple Pregnancy

What is multiple pregnancy?

Multiple pregnancy is a pregnancy with two or more fetuses. Names for these include the following:

While multiples account for only a small percentage of all births (about 3 percent), the multiple birth rate is rising. According to the National Center for Health Statistics, the twin birth rate has risen 59 percent since 1980, and is currently 30.1 per 1,000 live births. The birth rate for triplets and other higher order multiples has also risen a staggering 423 percent. However, since 1998, the birth rate for triplets and higher has slowed.

What causes multiple pregnancy?

There are many factors related to having a multiple pregnancy. Naturally occurring factors include the following:

Other factors that have greatly increased the multiple birth rate in recent years include reproductive technologies, including the following:

How does multiple pregnancy occur?

Multiple pregnancy usually occurs when more than one egg is fertilized and implants in the uterus. This is called fraternal twinning and can produce boys, girls, or a combination of both. Fraternal multiples are simply siblings conceived at the same time. However, just as siblings often look alike, fraternal multiples may look very similar. Fraternal multiples each have a separate placenta and amniotic sac.

Sometimes, one egg is fertilized and then divides into two or more embryos. This is called identical twinning and produces all boys, or all girls. Identical multiples are genetically identical, and usually look so much alike that even parents have a hard time telling them apart. However, these children have different personalities and are distinct individuals. Identical multiples may have individual placentas and amniotic sacs, but most share a placenta with separate sacs. Rarely, identical twins share one placenta and a single amniotic sac.

Why is multiple pregnancy a concern?

Being pregnant with more than one baby is exciting and is often a happy event for many couples. However, multiple pregnancy has increased risks for complications. The most common complications include the following:

What is multifetal pregnancy reduction?

In recent years, a procedure called multifetal pregnancy reduction has been used for very high numbers of fetuses, especially four or more. This procedure involves injecting one or more fetuses with a lethal medication, causing fetal death. The objective of multifetal reduction is that by reducing the number of fetuses in the pregnancy, the remaining fetuses may have a better chance for health and survival. Consult your physician for additional information.

What are the symptoms of multiple pregnancy?

The following are the most common symptoms of multiple pregnancy. However, each woman may experience symptoms differently. Symptoms of multiple pregnancy may include:

How is multiple pregnancy diagnosed?

Many women suspect they are pregnant with more than one baby, especially if they have been pregnant before. Diagnosis of multiple fetuses may be made early in pregnancy, especially if reproductive technologies have been used. In addition to a complete medical history and physical examination, diagnosis may be made by:

Management of multiple pregnancy:

Specific management for multiple pregnancy will be determined by your physician based on:

Management of multiple pregnancy may include the following:

How are multiple pregnancies delivered?

Delivery of multiples depends on many factors including the fetal positions, gestational age, and health of mother and fetuses. Generally, in twins, if both fetuses are in the vertex (head-down) position and there are no other complications, a vaginal delivery is possible. If the first fetus is vertex, but the second is not, the first fetus may be delivered vaginally, then the second is either turned to the vertex position or delivered breech (buttocks are presented first). These procedures can increase the risk for problems such as prolapsed cord (when the cord slips down through the cervical opening). Emergency cesarean birth of the second fetus may be needed. Usually, if the first fetus is not vertex, both babies are delivered by cesarean. Most triplets and other higher-order multiples are born by cesarean.

Vaginal delivery may take place in an operating room because of the greater risks for complications during birth and the need for cesarean delivery. Cesarean delivery is usually needed for fetuses that are in abnormal positions, for certain medical conditions of the mother, and for fetal distress.

Care of multiple birth babies:

Because many multiples are small and born early, they may be initially cared for in a special care nursery called the neonatal intensive care unit (NICU). Once babies are able to feed, grow, and stay warm, they can usually be discharged. Other babies, that are healthy at birth, may need only a brief check in a special care nursery.

Breastfeeding multiples is certainly possible and many mothers of twins and even triplets are successful in breastfeeding all of their babies. Lactation specialists can help mothers of multiples learn techniques for breastfeeding their babies separately and together, and to increase their milk supply. Mothers whose babies are unable to breastfeed because they are sick or premature can pump their breast milk and store the milk for later feedings.

Families with more than one baby need help from family and friends. The first two months are usually the most difficult as everyone learns to cope with frequent feedings, lack of sleep, and little personal time. Having help for household chores and daily tasks can allow the mother the time she needs to get to know her babies, for feedings, and for rest and recovery from delivery.

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