Complications in multiple pregnancy

Of all types of multiple births, twins usually face the fewest medical problems and complications. Each additional child a woman carries during her pregnancy increases the likelihood of pregnancy complications.

What are the most common complications associated with multiple pregnancy?

Premature birth/delivery

Prematurity/delivery is defined as delivery before 37 completed weeks of gestation. The duration of pregnancy usually decreases with each additional child. On average, most singleton pregnancies last 39 weeks, twins 36 weeks, triplets 32 weeks, quadruplets 30 weeks, and quintuplets 29 weeks.

Nearly 60% of twins are born premature, and 90% of triplets are premature.

Higher order pregnancies are almost always premature. In many cases, preterm labor is the result of premature rupture of the membranes. Premature preterm rupture of membranes is considered to be rupture of membranes before the onset of labor in a patient with a gestational age of less than 37 weeks.

Low birth weight

Low birth weight is almost always associated with preterm birth. Low birth weight is less than 2500 grams. Babies born before 32 weeks and weighing less than 1500 grams have an increased risk of complications during childbirth.

They are at increased risk of long-term problems such as mental retardation, cerebral palsy, vision loss and hearing loss.

Intrauterine growth restriction

Up to a certain point, a multiple pregnancy develops at about the same rate as a single pregnancy. The rate of growth in twin pregnancy begins to slow down between 30 and 32 weeks.

Triplets start to slow down between 27 and 28 weeks, and quadruplets start to slow down between 25 and 26 weeks.

Growth restriction appears to be due to the fact that the placenta can no longer support growth and babies compete for nutrients. Your doctor will monitor your children's growth with ultrasounds and measurements of your abdomen.

Preeclampsia

Preeclampsia, pregnancy-induced hypertension, toxemia, and high blood pressure are synonymous. Preeclampsia is more than twice as likely in twin pregnancies as in singleton pregnancies. Half of triple pregnancies develop preeclampsia.

Frequent prenatal care increases the chances of detecting and treating preeclampsia. Proper prenatal care also reduces the risk of developing the serious problem of preeclampsia in babies and the mother.

Gestational diabetes

The increased risk of gestational diabetes in multiple pregnancies appears to be the result of increased insulin resistance in both placentas, an increase in placental size, and elevated placental hormone levels.

The risk of gestational diabetes in multiple pregnancies remains the subject of research at the present time. In one study, an increased risk of gestational diabetes seemed clear, but participating physicians recommended further testing.

Placental abruption

Placental abruption is three times more common in multiple pregnancies. This may be due to the fact that there is an increased risk of developing preeclampsia. It most often occurs in the third trimester, but the risk increases dramatically after the vaginal birth of the first child.

Death or loss of fetus

Intrauterine fetal death is extremely rare. Your health care provider will determine whether it is best to expose the other baby(s) to the deceased fetus or continue the delivery.

If the pregnancy is dichorionic (two chorions are present), surgery may not be necessary. (The chorion is the membrane that forms the fetal part of the placenta. Fraternal twins always have two chorions, while identical twins can have one or two chorions.)

If the pregnancy has one chorion, the maturity of the fetus will be assessed to see if immediate delivery is recommended. In this situation, one would have to weigh the risks between having a premature baby and the risks of remaining in the womb.

Cesarean

If you are pregnant with twins, this does not necessarily mean that you are going to give birth by caesarean section. The typical recommendation for delivering triplets and higher-order twins is a caesarean section, but twins are often delivered naturally.

The vaginal birth of twins depends on the presentation of the babies.

Twins can give birth naturally if: