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Multiple Pregnancies

(Twins; Triplets; Quadruplets; or More)

Definition

A multiple pregnancy is when a woman is pregnant with two or more fetuses. Twins are the most common type of multiple pregnancy. So-called “higher-order” pregnancies (when a woman is carrying triplets, quadruplets, quintuplets, or more) are less common.
The risk for certain complications during and after pregnancy is higher in multiple pregnancies. To lessen these risks your doctor will see you more often than a woman carrying one baby.
Twins in Utero
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Causes

Multiple pregnancies occur when a single fertilized egg divides and develops into two or more fetuses (identical twins) or when more than one egg is fertilized by a different sperm (fraternal twins). Triplets, quadruplets, and quintuplets can be identical, fraternal, or a combination of both.

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition. The following factors increase your chance of having a multiple pregnancy. If you have any of these risk factors, tell your doctor:
  • Use of fertility treatments
  • A previous multiple pregnancy
  • A family history of multiple births
  • More than one previous pregnancy
  • African-American race
  • Older age

Symptoms

If you experience any of these symptoms do not assume it is due to a multiple pregnancy. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.
Symptoms include the following:
  • More rapid weight gain than expected in the first trimester
  • Larger than expected uterus
  • Severe morning sickness
  • More fetal movement than with a singleton pregnancy

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Your doctor may refer you to a healthcare professional who has experience with multiple pregnancies.
Most multiple pregnancies are discovered during an ultrasound examination. An ultrasound examination is a test that uses sound waves to see how the fetus is developing. An ultrasound can detect more than 95% of multiples by the second trimester of pregnancy.
Other tests that may detect a multiple pregnancy include:
  • An abnormal result on certain blood tests done near the 16th week of pregnancy
  • Hearing more than one heart beat during a routine examination

Treatment

Multiple pregnancies have a greater risk for certain complications. If you experience any of these conditions, your doctor will discuss the best treatment plan for you.

Preterm Labor

Most multiple births are preterm (before the end of 37 weeks of pregnancy). Babies born preterm have a higher risk for many health problems. To delay preterm birth, your doctor may suggest bed rest at home or in a hospital or prescribe certain drugs. If labor threatens to occur before 34 weeks of pregnancy you may be given steroid medication to help your babies’ lungs mature.

Gestational Diabetes

Gestational diabetes is a disorder in which the body becomes less sensitive to insulin resulting in high blood sugar levels. Gestational diabetes treatment aims to return blood sugar levels to normal through diet, exercise, blood sugar level testing, and sometimes insulin shots.

Preeclampsia

Preeclampsia is a condition occurring during pregnancy when a woman has high blood pressure and more than normal amounts of protein in her urine. Treatment may include drugs, rest, and early delivery of the baby.

Abnormal Fetal Position (Breech or Transverse)

More than one fetus in the uterus increases the chance that one of them will be unable to turn head down. A breech or transverse presentation increases the chance of needing a cesarean delivery.

Twin Twin Transfusion Syndrome (TTTS)

Twins sometimes share vessels in the placenta. If this sharing is unequal, this syndrome can develop. In TTTS, one twin transfuses (donates blood) to the other. The donor twin becomes anemic and the receiving twin develops problems of having too much blood and fluid in its body.

Postpartum Hemorrhage

More than one fetus in the uterus increases the chance of postpartum hemorrhage . This is heavy blood loss in the mother after delivering the babies.

Prevention

To help reduce your chance of having health problems during a multiple pregnancy, take the following steps:
  • Get early and regular prenatal care so your doctor can closely monitor your pregnancy.
  • Follow general pregnancy nutrition advice, including getting more calcium, folic acid, protein, and iron in your diet.
  • Gain the appropriate amount of weight, especially in the first 20-24 weeks of pregnancy.

RESOURCES

American Congress of Obstetricians and Gynecologists http://www.acog.org/

March of Dimes http://www.marchofdimes.com/

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca/index-eng.php

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org/index%5Fe.asp

References

Having twins. American College of Obstetricians and Gynecologists website. Available at: http://www.medem.com/medlb/article%5Fdetaillb.cfm?article%5FID=ZZZ9MI9O97C&sub%5Fcat=2005 . Accessed August 2, 2005.

Multiple births. National Center for Health Statistics website. Available at: http://www.cdc.gov/nchs/fastats/multiple.htm . Accessed August 2, 2005.

Multiple Gestations: complicated Twins, Triplets and High-Order Multifetal Pregnancies. The American congress of Obstetricians and Gynecologists, Practice Bulletin No. 56 . October 2004 (Reaffirmed 2009).

Multiples: twins, triplets, and beyond. March of Dimes Birth Defects Foundation website. Available at: http://www.marchofdimes.com/professionals/681%5F4545.asp . Accessed August 2, 2005.

Preparing for multiple births. KidsHealth–Nemours Foundation website. Available at: http://kidshealth.org/parent/pregnancy%5Fnewborn/pregnancy/multiple%5Fbirths.html . Accessed August 2, 2005.

Revision Information

  • Reviewer: Andrea Chisholm
  • Review Date: 11/2012 -
  • Update Date: 11/26/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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