The placenta ages prematurely and may slow fetal growth, especially late in the third trimester. Another placental problem is twin-twin transfusion, a life-threatening condition in identical twins. This transfusion occurs when blood flows from one fetus to the other through a connection in a shared placenta. Therapeutic amniocentesis and laser coagulation of blood vessels that link circulation to the twins in the placenta s may reduce complications of twin-twin transfusion.
Preeclampsia, also known as toxemia, occurs 2 to 5 times more often in multiple pregnancies. The condition may progress and threaten the health of the mother and baby. When severe, the mother may have seizures, and stroke or other life-threatening complications are possible. Women with multiple pregnancies are more likely to develop gestational diabetes during pregnancy.
Babies of diabetic mothers are more likely to experience respiratory distress and other newborn complications. However, gestational diabetes is common even in singleton pregnancies, and treatment is well established and effective. Preterm delivery places an infant at increased risk for severe complications or early death. Prematurity also may result in visual impairment or blindness. Neonatal intensive care unit admission is required for one-fourth of twin and three-fourths of triplet deliveries.
Despite these numbers, it is important to note that the vast majority of multiple-birth infants do survive. Fetal death occurs in about 1. Furthermore, compared to singleton pregnancies of the same birth weight, there is no significant increase in the incidence of chronic lung disease or brain, eye, or gastrointestinal problems in multiple-birth infants. Low birth weight of less than 5. The average birth weight is approximately 4 lb. As a result of prematurity, the risk for cerebral palsy is 4 times more likely to occur in twins.
The rates are even greater for triplets and high-order multiple births. Birth weight also corresponds closely to the severity of disability throughout the childhood years. As noted above, the average birth weight even for quadruplets is well above this number. Prevention during infertility treatment is the best approach to avoiding a multiple pregnancy. In ART cycles, limiting the number of embryos transferred is an effective approach. Consult the ASRM Practice Committee Report titled Guidelines on Number of Embryos Transferred for recommendations regarding the optimal number of embryos to transfer based on patient age, embryo quality, and other criteria.
In the United States, physicians and patients jointly decide how many embryos to transfer. However, in England, no more than two embryos may be transferred in most cases. In Canada, a maximum of three embryos are recommended for transfer.
The ultimate goal of ART is to achieve a high pregnancy rate while transferring a single embryo. While physicians can transfer two embryos and still maintain acceptable pregnancy rates, the transfer of one embryo is associated with good pregnancy rates in certain patient groups, thereby resolving the problem of multiple pregnancies caused by multiple embryo transfer.
Multiple pregnancies are a known complication of ovulation stimulation drugs. Most physicians monitor patients with ultrasound examinations and blood tests. A woman with a large number of ovarian follicles or high hormone levels has an increased risk of a multiple pregnancy, and the cycle may be canceled to avoid the risk. No proven way of reducing multiple pregnancies with superovulation has been identified, although preventing fertilization with development of more than three follicles is helpful in reducing high-order multiples.
When a triplet or high-order multiple pregnancy occurs, multifetal pregnancy reduction may be considered to improve the chance for survival of the fetuses. While multifetal pregnancy reduction carries some risk of a complete miscarriage, it also reduces the chances of extreme premature birth.
In order to achieve the best outcome with a multiple pregnancy, the expectant mother must work as part of the health care team. A nearly total change in lifestyle can be expected, especially after about 20 weeks into the pregnancy. There is an increased need for maternal nutrition in multiple pregnancies. An expectant mother needs to gain more weight in a multiple pregnancy, especially if she begins the pregnancy underweight.
With multiples, weight gain of approximately lb. The pattern of weight gain is important too. Healthy birth weights are most likely achieved when the mother gains nearly one pound per week in the first 20 weeks.
The increase in fetal growth with appropriate nutrition and weight gain may greatly improve pregnancy outcome at a minimum of cost.
Many physicians who manage multiple pregnancies believe that a reduction in activities and increased rest prolongs these pregnancies and improves outcomes. However, routine hospitalization for bed rest in multiple pregnancy has not been shown to prevent preterm birth. Women with high-order multiple pregnancies usually are advised to avoid strenuous activity and employment at some time between 20 and 24 weeks. Bed rest improves uterine blood flow and may be helpful for fetal growth problems.
Intercourse generally is discouraged when bed rest is recommended. Since preterm birth and growth disturbances are the major contributors to newborn death and disability in multiples, frequent obstetric visits and close monitoring of the pregnancy are needed.
Prenatal diagnosis using a variety of new techniques can be done near the end of the first trimester to screen for Down syndrome and other genetic abnormalities. Amniocentesis may be performed between 16 and 20 weeks. Amniocentesis may be complicated and difficult to perform in twins and triplets and may not be possible in high-order multiple pregnancies.
However, reasonable data exist for the use of serum screening in the setting of multiple pregnancies and can be a helpful tool to assess risk of these and other conditions. Many physicians perform cervical examinations every week or two beginning early in pregnancy to determine if the cervix is thinning or opening prematurely. If an exam or ultrasound shows that the cervix is thinning or beginning to dilate prematurely, a cerclage, or suture placed in the cervix, may prevent or delay premature dilatation.
Fraternal twins come from two eggs that are fertilized by two separate sperm and are no more alike than other siblings born to the same parents.
They may or may not be the same sex. This type of twins is much more common. These babies can be identical, fraternal, or a combination of both. Eating properly, getting enough rest, and regular prenatal care are ways for any expectant mother to stay healthy. It's important to find health care professionals who have experience with multiple births, and to see your health care provider as he or she recommends.
This is so that the doctor can be on the lookout for problems and treat them as needed. Ask your doctor to recommend a facility that specializes in multiple births. You should be part of a pre-term birth prevention program at your hospital and have immediate access to a specialized NICU should you go into early labor or if one of your babies is born with a health problem.
If you're pregnant with multiples, you should follow general pregnancy nutrition guidelines, including increasing your calcium and folic acid intake. Another dietary requirement that must be increased if you're expecting more than one baby is protein. Getting enough protein can help your babies grow properly. During pregnancy, an increased supply of iron is needed to make enough healthy red blood cells.
Low numbers of red blood cells are common in multiple pregnancies. Your doctor will probably prescribe an iron supplement, as your requirement for this mineral usually can't be met by diet alone. Iron is absorbed more easily when combined with foods that have high amounts of vitamin C, like orange juice. The doctor will also tell you what vitamins to take to get the nutrients your growing babies need.
There is also an increased chance of pregnancy complications, such as high blood pressure preeclampsia and diabetes.
The bubs are also at higher risk of being smaller than expected and premature and may need to go to neonatal intensive care for a period after birth.
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