Multiple pregnancy isn’t a piece of cake
Nov 23, 2004
Whereas being pregnant with more than one baby is exciting and is often a happy event for couples, it comes with risks.
By Herbert Mugarura
Whereas being pregnant with more than one baby is exciting and is often a happy event for couples, it comes with risks.
Multiple pregnancy usually occurs when more than one egg is fertilised and is implanted in the uterus. This is called fraternal (dizygotic) twinning and can produce boys, girls, or a combination of both. Fraternal multiples (twins, triplets, etc) are siblings conceived at the same time. Just as siblings often look alike, fraternal multiples may look similar.
Sometimes, one egg is fertilised and then divides into two or more embryos. This is called identical twinning. They are all boys or all girls. Identical multiples are genetically identical, and usually look so much alike that even parents have a hard time telling who is who.
In multiple pregnancies, both the mother and her children face certain life-threatening risks.
l Premature birth
About half of twins and nearly all higher-order multiples (triplets, etc) are born premature. More foetuses increase the risk of premature birth. Premature babies are born before their bodies and organ systems have completely formed. These babies are often small, with low birth weights (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).
l High blood pressure
Women with multiple foetuses are more than three times likely to develop high blood pressure during pregnancy. This condition often develops earlier and is more severe than in pregnancy with one baby. It can also increase the chance of placental abruption (early detachment of the placenta).
l Anaemia
It is more than twice as common in multiple pregnancies as in a single birth.
l 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.
l Miscarriage
A phenomenon called the vanishing twin syndrome in which more than one foetus 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.
l Twin-to-twin transfusion syndrome
It is also known as stuck twin syndrome. It 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 foetus to the other. It occurs in about 15 percent of twins with a shared placenta.
l Abnormal amounts of amniotic fluid
This is more common in multiple pregnancies, especially for twins that share a placenta.
l Caesarean delivery
Abnormal foetal positions increase the chances of caesarean birth.
l Bleeding
The large placental area and over-distended uterus place a mother at risk of bleeding after delivery in many multiple pregnancies.
Because of the risks of multiple pregnancies, in recent years a procedure called multifoetal pregnancy reduction has been used for women with many foetuses, especially four or more. This procedure involves injecting one or more foetuses with a lethal medication early in pregnancy. The objective of multifoetal reduction is that by reducing the number of foetuses in the pregnancy, the remaining foetuses may have a better chance for health and survival.
The writer is a
medical doctor
Whereas being pregnant with more than one baby is exciting and is often a happy event for couples, it comes with risks.
Multiple pregnancy usually occurs when more than one egg is fertilised and is implanted in the uterus. This is called fraternal (dizygotic) twinning and can produce boys, girls, or a combination of both. Fraternal multiples (twins, triplets, etc) are siblings conceived at the same time. Just as siblings often look alike, fraternal multiples may look similar.
Sometimes, one egg is fertilised and then divides into two or more embryos. This is called identical twinning. They are all boys or all girls. Identical multiples are genetically identical, and usually look so much alike that even parents have a hard time telling who is who.
In multiple pregnancies, both the mother and her children face certain life-threatening risks.
l Premature birth
About half of twins and nearly all higher-order multiples (triplets, etc) are born premature. More foetuses increase the risk of premature birth. Premature babies are born before their bodies and organ systems have completely formed. These babies are often small, with low birth weights (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).
l High blood pressure
Women with multiple foetuses are more than three times likely to develop high blood pressure during pregnancy. This condition often develops earlier and is more severe than in pregnancy with one baby. It can also increase the chance of placental abruption (early detachment of the placenta).
l Anaemia
It is more than twice as common in multiple pregnancies as in a single birth.
l 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.
l Miscarriage
A phenomenon called the vanishing twin syndrome in which more than one foetus 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.
l Twin-to-twin transfusion syndrome
It is also known as stuck twin syndrome. It 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 foetus to the other. It occurs in about 15 percent of twins with a shared placenta.
l Abnormal amounts of amniotic fluid
This is more common in multiple pregnancies, especially for twins that share a placenta.
l Caesarean delivery
Abnormal foetal positions increase the chances of caesarean birth.
l Bleeding
The large placental area and over-distended uterus place a mother at risk of bleeding after delivery in many multiple pregnancies.
Because of the risks of multiple pregnancies, in recent years a procedure called multifoetal pregnancy reduction has been used for women with many foetuses, especially four or more. This procedure involves injecting one or more foetuses with a lethal medication early in pregnancy. The objective of multifoetal reduction is that by reducing the number of foetuses in the pregnancy, the remaining foetuses may have a better chance for health and survival.
The writer is a
medical doctor