Multiple Pregnancy

Introdution

As the name suggests, multiple pregnancy is a pregnancy with two or more fetuses in one womb of mother. There are different names for different numbers of fetuses in the womb as listed below –

Condition         Terminology

2 fetuses          Twins
3 fetuses          Triplets
4 fetuses          Quadruplets
5 fetuses          Quintuplets
6 fetuses          Sextuplets
7 fetuses          Septuplets

While multiples account for only few percentages of all the live births (about 3%), the multiple birth rate is now rising eventually. Acc to National Center for Health Statistics, the twins’ birth rates have risen 59% since 1980 and is currently 30% every 1000 live births only in United States. The birth rate for triplets and other higher order in above list has also risen but they are very rare births.

What causes the multiple pregnancy?

There is no one particular reason that can cause the multiple pregnancy. Various reasons that can divide single fertilization into many are described below –

Heredity: Multiple pregnancy may run in the families. You are likely to have multiple fetuses in your womb if your grandparents or ancestors had them.

High parity: If you had one or more previous pregnancies, especially multiple pregnancy, it increases the chances for you to achieve that again.

Older age: Some researches reveal that women over 30 have more chances of getting multiple conceptions.

Race: American and African women are more susceptible to have twins as compared to other in race. Asian and Native American have fewer chances to get twins. Caucasian women, especially above the age of thirty-five have highest chances to get multiple fetuses.

Apart from all these causes, certain other factors have greatly increased the multiple birth rates in recent years. They include some reproductive technologies such as…

How do multiple pregnancy occur?

Multiple pregnancy generally occur when more than one ovum is fertilized by sperm and implants right in the uterus. This is called as fraternal twinning and it may result in boys, girls or combination of both. Fraternal multiples are simply siblings for what conception has occurred in the same time. However, just as siblings often look alike, fraternal multiples may resemble very same to each other. Fraternal multiples each will be having separate placenta and their own amniotic sacs.

Sometimes, one ovum is fertilized and it divides further into two or more embryos. This is termed as identical twinning and produces all the boys or all the girls. Identical multiples are genetically identical and generally appear so much alike that many times their relatives could not make out the difference. However, these children are different personalities and they are distinct fellows. Identical multiples can have individual placentas and own amniotic sacs, but generally, they share a placenta with separate sacs. In some rarest case, identical twins share single amniotic sac with one placenta in a womb.

Why do multiple pregnancy require special attention?

It is indeed an exciting moment when a woman gets multiple pregnancy. It is the happiest moment for a couple, as they will get one baby in bonus! Equally, multiple pregnancy carry high risk for complications. Here are some of the most common complications those are seen in most of the cases –

Multiple pregnancy induced hypertension

If a woman is carrying multiple fetuses, she is at three times risk to develop high blood pressure during her pregnancy as compare to a woman carrying single fetus. The condition often develops in earlier stages and is more severe than pregnancy with one fetus. Hypertension in multiple pregnancy is also at high risk of placental abruption in which, there is an early detachment of the placenta.

Birth defects

Multiple birth babies carry about twice the risk of congenital (birth) abnormalities such as neural tube defects (spina bifida), heart abnormalities and gastrointestinal anomalies.  

Preterm labor ending into preterm birth

About 50% of twins and nearly all higher-order multiples get delivered before 37th week and are therefore premature ones. The higher the number of fetuses in the womb, the greater the risk for early birth for each one. These premature babies are born before their body systems get fully developed and functioning. These babies are often small and are LBWs (Low Birth Weights) i.e. less than 2.5 kg or 5.5 lb. They may need life supporting systems to help breathing. They might have delayed milestones and in their early lives, they may not able to suck their mother’s milk properly due to poor sucking reflex. This in times, turns to malnourishment of the babies.

Preterm babies are generally shifted to NICU (neonatal intensive care unit) as soon as they are delivered to avoid any complications and to be on safer side. Many premature babies develop neonatal jaundice that is treated carefully with phototherapy and certain medications.

Birth defects

Multiple pregnancy may end up into birth defects of newborns. They are twice the risk of congenital defects such as neural tube defects, gastrointestinal and heart anomalies.

Anemia

Babies delivered by multiple pregnancy are at double risk to have anemia as compared to babies delivered by normal delivery. They then need blood transfusion if the hemoglobin levels are too low.

Miscarriage

In the first trimester of multiple pregnancy, there are chances of miscarriage. It is observed that woman with multiple pregnancy is at more risk with miscarriage. The risk of pregnancy loss increases as the pregnancy progresses.

Twin-to-twin transfusion syndrome

This is the condition in which, the placenta does not supply equal flow of blood to both the fetuses. it occurs in about 15% of twins with a shared placenta.

Cesarean delivery

Multiple pregnancy is often delivered by cesarean sections. This could be due to many reasons. Two fetuses are in one womb so naturally it takes more space and hence, quite difficult to deliver through vagina. Both the fetuses may not have their head down position (which is considered as normal to have normal delivery).

Postpartum hemorrhage

The large placental area and over-distended uterus makes a mother at risk of having bleeding after she delivers the baby. The risk also increases if the mother has delivered many babies in past.

The multifetal pregnancy reduction

In recent years, the technique called multifetal pregnancy reduction has been widely used to decrease the number of multiple fetuses in case of triplets, four or more fetuses in one womb. This is done to save lives of mother and fetuses. MFPR (multifetal pregnancy reduction) involves injecting one or more fetuses with some lethal medication, which will cause death of those targeted fetuses. This will save the life of other fetuses, as they will have fair chances for development. However, the procedure is complicated and needs experts’ hands to perform.