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Multiple Pregnancy: What to Expect

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If you're currently pregnant with twins or a higher order multiple pregnancy (HOM, which means triplets or more), you probably have lots of questions and concerns about what is happening now, and what you can expect during the rest of your pregnancy. This article will answer some of those concerns.

Before the mid 1970s, multiple pregnancy often went undetected, and multiples were often a surprise at the time of birth. Now, however, thanks to obstetric ultrasound, multiples can be seen very early in a pregnancy, sometimes as early as 6 weeks. As with those of singletons, the heartbeats of multiples can be detected somewhere around 10 weeks of pregnancy with a special machine called a Doppler. Although it can be difficult sometimes to distinguish one baby's heartbeat from the other, your health care provider will count the actual number of beats per minute for each multiple, and the number will probably be slightly different for each baby.

  Multiple Pregnancy: What's Different

  Multiple Pregnancy With Identical Twins vs. Fraternal Twins

  Multiple Pregnancy and Prematurity

Multiple Pregnancy: What's Different

When a multiple pregnancy is diagnosed, you automatically become a high risk patient. You may feel fine, but having twins or a HOM comes with special risks and possible complications that you need to be know about. Depending on where you live, and the availability of specialist providers, you will probably be referred to a doctor with advanced training in high risk pregnancy called a Maternal Fetal Medicine specialist. That's a good thing. These MFM doctors only take care of women with high risk pregnancies. With a multiple pregnancy, you will probably have more prenatal visits than do women with singleton pregnancies, and more blood tests and ultrasounds.

Multiple Pregnancy With Identical Twins vs. Fraternal Twins

Some of these prenatal visits are to determine how well the babies are growing, and just what type of twins (or HOM) you are carrying. Identical twins, the least common type of twinning, occur when one egg splits into two embryos; thus the resulting babies are "identical." In this type of twinning, sometimes both babies are in the same amniotic sac, which can increase their risk for such problems as becoming tangled in the umbilical cords. Another complication is twin-to-twin transfusion, in which one twin gets most of the nutrition, and the other gets too little. This is one of the reasons health care providers always want to measure each fetus's size during a multiple pregnancy.

Fraternal twins, on the other hand, are really two separate pregnancies that happen at the same time. Two (or more) eggs are fertilized simultaneously and several embryos result. In HOM, there may be both identical and fraternal twins or triplets in one pregnancy. The chief risk of fraternal twinning is premature birth.

Multiple Pregnancy and Prematurity

Premature birth is actually the most important risk of any multiple pregnancy. Pregnancy is supposed to last 40 weeks, and being born at 40 weeks gives a baby sufficient time to grow and become strong enough to live outside your uterus. When twins or HOM occur, each baby tends to be smaller (there's only so much room in a uterus!), and you become much more likely to go into labor and give birth before 40 weeks. Being born a week before 40 weeks (called "term") isn't such a bad thing, but being born before 36 weeks can mean that the baby will have problems breathing and sucking, and there is a higher risk of bleeding into the brain, cerebral palsy, intestinal problems, and other, longer-term consequences such as learning difficulties. In addition, the financial and emotional burdens of having one or more preterm babies are enormous. Premature babies are much more likely to die during the first 30 days of life, and during the first year of life.

All in all, prematurity is something we want to avoid, that's for sure. While the rate of preterm birth in the U.S. is 12.8 percent overall, the rate among twins is 58.2 percent, in triplets is 92.4 percent, and 96.8 percent in quadruplets. The World Health Organization estimates that about 9.8 percent of babies born worldwide are preterm babies, with a large concentration of those in Africa and Asia.

During your multiple pregnancy, be sure that you follow your provider's advice about caring for yourself and go to all your prenatal visits. Because you're at higher risk of complications, it's really important to treat yourself to extra rest every day during this special pregnancy!


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