Complications of Multiple Pregnancy
Why is multiple pregnancy a concern?
Being pregnant with more than one baby is exciting and is often
a happy event for many couples. However, multiple pregnancy has
increased risks for complications. The most common complications
include the following:
- preterm labor and birth
About half of twins and nearly all higher-order multiples are
premature (born before 37 weeks). The higher the number of fetuses
in the pregnancy, the greater the risk for early birth. Premature
babies are born before their bodies and organ systems have completely
matured. These babies are often small, with low birthweights
(less than 2,500 grams or 5.5 pounds), and they may need help
breathing, eating, fighting infection, and staying warm. Very
premature babies, those born before 28 weeks, are especially
vulnerable. Many of their organs may not be ready for life outside
the mother's uterus and may be too immature to function well.
Many multiple birth babies will need care in a neonatal intensive
care unit (NICU).
- pregnancy-induced hypertension
Women with multiple fetuses are more than three times as likely
to develop high blood pressure of pregnancy. This condition
often develops earlier and is more severe than pregnancy with
one baby. It can also increase the chance of placental abruption
(early detachment of the placenta).
- anemia
Anemia is more than twice as common in multiple pregnancies
as in a single birth.
- birth defects
Multiple birth babies have about twice the risk of congenital
(present at birth) abnormalities including neural tube defects
(such as spina bifida), gastrointestinal, and heart abnormalities.
- miscarriage
A phenomenon called the vanishing twin syndrome in which more
than one fetus is diagnosed, but vanishes (or is miscarried),
usually in the first trimester, is more likely in multiple pregnancies.
This may or may not be accompanied by bleeding. The risk of
pregnancy loss is increased in later trimesters as well.
- twin-to-twin transfusion syndrome
Twin-to-twin syndrome is a condition of the placenta that develops
only with identical twins that share a placenta. Blood vessels
connect within the placenta and divert blood from one fetus
to the other. It occurs in about 15 percent of twins with a
shared placenta.
In TTTS, blood is shunted from one fetus to the other through
blood vessel connections in a shared placenta. Over time, the
recipient fetus receives too much blood, which can overload
the cardiovascular system and cause too much amniotic fluid
to develop. The smaller donor fetus does not get enough blood
and has low amounts of amniotic fluid.
- abnormal amounts of amniotic fluid
Amniotic fluid abnormalities are more common in multiple pregnancies,
especially for twins that share a placenta.
- cesarean delivery
Abnormal fetal positions increase the chances of cesarean birth.
- postpartum hemorrhage
The large placental area and over-distended uterus place a mother
at risk for bleeding after delivery in many multiple pregnancies.
What is multifetal pregnancy reduction?
In recent years, a procedure called multifetal pregnancy reduction
has been used for very high numbers of fetuses, especially four
or more. This procedure involves injecting one or more fetuses
with a lethal medication, causing fetal death. The objective of
multifetal reduction is that by reducing the number of fetuses
in the pregnancy, the remaining fetuses may have a better chance
for health and survival. Consult your physician for additional
information.
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