Dr Sarthak Sidapara

Twins or Triplets Pregnancy

What is Multiple Pregnancy?

If more than one egg fertilizes and grows in the uterus, it can result in multiple pregnancies. In numerous pregnancies, similar-looking boys, girls or both boys and girls are born, known as fraternal twinning. The babies have different amniotic sac and placenta.
However, in the case of identical twins, the egg fertilizes and breaks into two to produce either a male or female child. These identical twins have a different amniotic sac but may not share a single placenta. In some cases, they share a single amniotic sac. These children may look similar but have different personalities and are different from each other.

Management of multiple Pregnancies

You can control and manage complications relating to multiple pregnancies if the following points are taken care of:

  • Healthy food – For carrying two or more babies, you must provide them with proper nutrients. The mother will have to consume more than usual nutrients to provide them with the required iron, protein, and other nutrients. Weight gain is also essential in multiple pregnancies for standard delivery.
  • Visit the doctor more often – The doctor recommends taking more prenatal visits to control any complication before it’s late. Frequent visit also ensures avoiding complications that may affect in future.
  • Rest adequately – Listen to your body; if you require more rest, give yourself a proper nap. Multiple pregnancies need more bed rest than usual.
  • Tocolytic medications – If there is preterm labor, then tocolytic medications can reduce the contraction. You can either inject these medications or take it orally.
  • Cervical Cerclage – In this case, the woman’s cervix is weak and cannot close during pregnancy. So cerclage is performed to stitch the cervix opening.
  • Maternal testing – It is essential to go through maternal testing to check the baby’s health. It also helps to monitor complications, if any.

How are multiple pregnancies delivered?

The delivery of multiple babies can depend on the following:

  • Gestation period
  • Fetal positions
  • Your health and your baby’s health.

There will be no problem in delivery if both the fetus has their head down; in this case, standard vaginal delivery is possible. But if both are upside down and facing oppositely, then deliver the first through the vagina. The second one either has to be moved in the vertex position or delivered through the buttocks. In this opposite direction case, complications may increase, leading to performing an emergency cesarean or C-section. Most multiple deliveries is through C-section. C-section is advisable in complications like fetal distress, specific health problems in the mother, and the fetus’s abnormal position.

Early signs of multiple pregnancies

Each woman indicates different signs. However, most commons are:

  • Extreme morning sickness
  • The uterus is more extensive than usual for the particular month of pregnancy
  • Greater appetite
  • Excessive weight gain
  • Movement of the fetus felt in different positions of the belly at the same time.

Symptoms of twins during pregnancy

There may be some symptoms that can indicate that you are carrying a twin:

  • The amount of hCG produced in the body is higher than usual as they are enormous for two fetuses.
  • You can hear the baby’s heartbeat from eight to ten weeks from a device called fetal Doppler. When you hear from the device, two heartbeats are hearable.
  • There is an abnormal increase in weight. Usually, upto twelve weeks of pregnancy, there is an increase in weight of 1-4 pounds in the women. But if you experience more, it’s a sign of multiple pregnancies.

Causes of multiple pregnancies

There can be a lot of factors that can cause multiple pregnancies. Some are as follows:

  • Women’s age – Women who have crossed the age of thirty have a higher chance of multiple pregnancies. As they had delayed the process, there is a possibility to conceive twin.
  • Heredity – If there is a genetic history of conceiving a twin, the chance of multiple pregnancies increases.
  • More births – If you have been pregnant more than once, there is a higher chance of multiple pregnancies.
  • Race – If you are African or American, you have a greater chance of multiple pregnancies. At the same time, Native American and Asian women have the lowest possibility to bear twins.

Complications of multiple pregnancies

Multiple complications can occur in delivering a twin or higher standard of pregnancy:

  • Gestational Hypertension – Women having multiple fetuses have a higher chance of suffering from high blood pressure. High blood pressure can affect the baby’s placenta, and it has a threat to get detached from the appropriate place.
  • Anemia – It is widespread in multiple gestations, which can increase complications during birth.
  • Miscarriage – In multiple pregnancies vanishing twin syndrome is very common. In this syndrome, one of the fetuses gets vanished or miscarried. There may or may not be any bleeding. Miscarriage usually takes place in the first trimester.

Risk of multiple pregnancies

Twin pregnancy is risky for both the mother and the baby. There are many threats to the mother while carrying a twin or a triplet. These threats include hypertension, preeclampsia, gestational diabetes, premature labor, hyperemesis gravidarum, C-section, and many others. While some risks are just slight complications, some can cause real danger like fetal death. These can be life-threatening to both mother and the baby.

The risk that is involved with the baby is the threat of getting vanished. In other words, one of the babies has the chance of getting miscarried. Twins also can carry intrauterine growth discordance in which one twin cannot grow correctly like the other. Twin birth can result in underweight infants or the babies getting jaundice.

Types of multiple pregnancies

1. Twin pregnancy

When one single embryo divides into two, it forms identical twins. This type of pregnancy carries a lower risk than identical twins. Each embryo carries the same genetics, thus has the same DNA. The same DNA means the twins will have the same characteristics but different personalities. They have the same placenta and amniotic sacs, but sometimes they have separate placenta and amniotic sacs.

There is another type of twin who is conceived by different eggs. They may or may not be of the same gender. They share a uterus but have a different placenta and amniotic sacs. This type of twins is called fraternal twins.

2. Triplet pregnancy

Triplets can be a fusion of both fraternal and identical twins. Formation of triplets takes place from three separate fertilized eggs, or they can be identical, like formed from a single fertilized egg that breaks into three, or a fusion of both the condition.

Diagnosis of multiple pregnancies

You may perform the following diagnosis in the case of multiple pregnancies to avoid any complications at the time of delivery:

  • HCG Testing – The doctor can test your blood to check the possibility of human chorionic gonadotrophin (hCG).
  • Ultrasound – There must be a proper inspection of the body’s inside to read its blood flow. This checking involves recording the sound waves for creating an image of tissues, blood vessels, and internal organs.
  • Alpha-Fetoprotein – In this test, measurement of the amount of protein secreted by the fetal liver. The mother should maintain the amount of protein release to avoid complications.

Prevention of multiple pregnancies

An excellent option to avoid multiple pregnancies is to prevent some infertility conditions. If you do not implant multiple embryos in the uterus walls for taking precautions, you can avoid numerous births.

A woman suffering from enlarged ovarian follicles or a high level of hormones has a risk of multiple pregnancies. So take steps to prevent fertilization of an egg with more than three follicles can help reduce the chance of high-order pregnancies.

You can perform Multifetal pregnancy reduction in case of triplets or high-order pregnancy for a healthy delivery. But the treatment comes with a risk of complete miscarriage. It can also reduce the chance of premature birth.