Multiple Pregnancy

What is multiple pregnancy?

Multiple pregnancy is a pregnancy with more than one baby. For example, you might be pregnant with twins, triplets, or more.

Almost 3% of pregnancies are multiple. About a quarter of these multiple pregnancies result from treatments for infertility.

What is the difference between identical and fraternal twins?

Twins in one of every three sets of twins are identical. Because they came from a single fertilized egg that split into two eggs, identical twins have the same genes. They are always the same sex.

Other twins are fraternal. They develop from 2 different eggs and 2 different sperms and do not have identical genes. They may or may not be the same sex.

Your healthcare provider may use ultrasound during the first trimester to try to find out if twins could be identical. He or she will check for 1 or 2 amniotic sacs or placentas. After the babies are born, healthcare providers can use DNA testing to find out if twins are identical.

How can I know if I am pregnant with more than one baby?

Pregnancy with two or more babies can usually be detected by your healthcare provider with ultrasound (a scan of the uterus with sound waves). Your provider may suspect you are pregnant with more than one baby if your uterus seems larger than expected for your stage of pregnancy or if your provider hears more than one heartbeat.

Do I need special treatment if I am pregnant with more than one baby?

The earlier you and your provider know that you are having more than one baby, the better it is for you and the babies. There is a greater chance the babies will be born early and will be smaller than single babies. You and your healthcare provider will discuss what you can do to reduce the risks for your babies. You will talk about your diet and your need for vitamins and iron and enough rest. You will need to limit strenuous activity. You will see your healthcare provider more often.

After 5 to 6 months of the pregnancy you may need more bed rest and less activity. During the last 2 months you may need more prenatal tests, such as nonstress tests, ultrasound scans, and amniocentesis. A nonstress test uses a fetal monitor to check the movements and heartbeats of the babies. Ultrasound checks the movements of the babies and the amount of fluid in the amniotic sac that surrounds the babies. In amniocentesis your healthcare provider uses a needle to remove and examine a sample of fluid from the amniotic sac. Amniocentesis can help your provider check the maturity of the babies' lungs before the babies are born.

You may be admitted to the hospital right away if you have early contractions or other complications. If problems with the pregnancy become severe, the babies may need to be delivered right away.

There is a greater chance that one or more of the babies will need delivery by cesarean section (a surgical procedure also called a c-section). Sometimes your healthcare provider may decide in advance whether the babies may be delivered vaginally or by cesarean section. In some cases the first baby is born vaginally but the next by cesarean section.

What are the risks of being pregnant with more than one baby?

There are more problems with the mother and babies in multiple pregnancies. Examples of possible problems for the babies are:

• preterm delivery (birth of the babies several weeks before their due date)
• slowed growth of the babies
• complications with the umbilical cord, amniotic sac, and placenta
• birth defects
• rash with pimples and pustules (pus in the pimples) on the abdomen and chest
• anemia, which may require a blood transfusion after birth
• one baby may get too much blood, which might cause heart failure
• polyhydramnios (too much fluid in the amniotic sac)
• death of one or more of the babies
• cerebral palsy in one of the babies, especially with triplets

Most identical twins have a greater risk than fraternal twins for complications during pregnancy or birth defects because they share the same placenta. Rarely, they also share the same amniotic sac.

You are also more likely to have problems, such as:

• toxemia (high blood pressure during pregnancy)
• anemia
• blood clot in the lungs (pulmonary embolus)
• a lot of vomiting (called hyperemesis gravidarum)
• problems with the placenta, such as previa or abruption, which might cause you to lose a lot of blood or other problems
• other digestive problems
• gestational diabetes
• kidney infection
• gallbladder problems (called cholestasis)
• liver problems
• postpartum hemorrhage (bleeding more than normal after birth)
• premature labor
• premature rupture of membranes
• blood clotting problems
• postpartum inflammation of the pancreas or diabetes insipidus

Other problems for the mother include:

• more discomfort due to a larger abdomen
• more swelling
• difficulty sleeping

How can I take care of myself?

• Don't miss any appointments with your healthcare provider.
• Follow the diet recommended by your healthcare provider.
• Take any vitamins and minerals recommended by your healthcare provider.
• Don't do any more physical activity than recommended by your healthcare provider.
• Get enough sleep and rest.

When should I call my healthcare provider?

Let your healthcare provider know right away if you have any of the following warning signs of problems:

• headache that doesn't go away
• problems with your vision, such as trouble reading, blurred vision, double vision
• extreme tiredness
• pain in your upper abdomen
• spotting or bleeding or leakage of other fluid from the vagina
• contractions
• continuous vomiting
• burning or pain when you urinate
• severe swelling of your ankles, legs, or fingers

Written by Anthony Angello, MD.
Published by RelayHealth.
© 2009 RelayHealth and/or its affiliates. All Rights Reserved.