High-risk pregnancies require specialized expert care: Multiple pregnancy

August 31, 2020
Multiple pregnancy, with a woman carrying two or more children in her womb, is often viewed as blessing for the mother. Yet, the blessing comes with a higher risk of complications. For instance, more than 60 percent of twins and nearly all higher-order multiples are premature.
For a mother pregnant with multiple children it is of utmost importance to start monitoring the pregnancy early on, to safeguard both her and the babies’ health.

How does multiple pregnancy occur?

Multiple babies may be conceived naturally or through assisted reproductive technology (ART) which is used to treat infertility. More than one egg released during the menstrual cycle may result in fraternal twins - or triplets or more. When a single fertilized egg splits, it results in identical twins - or more.
Identical twins are less common than fraternal twins. Very rare are identical triplets or even quadruplets. Triplets would result when the original fertilized egg splits and then one of the resultant cells splits again. For identical quadruplets, an even more rare further split would occur.

Who is more likely to have a multiple pregnancy?

Any women can become a multiple mother with a single pregnancy. Yet the condition is more prevalent among women older than 35. They are more likely to release two or more eggs during a single menstrual cycle. Besides maternal age, undergoing ART increases the likelihood of multiple pregnancy, as does a family history of multiple pregnancy or the previous birth of twins or triplets.

What are some of the symptoms of multiple pregnancy?

Expectant women who carry more than one child in their womb may have more severe morning sickness and breast tenderness than women who are pregnant with a single fetus. They also may gain weight more quickly, which can be daunting for the mother, yet it's vitally important for the health of the babies and for mom as well.
Increased weight gain is a natural occurrence for women who are pregnant with two or more babies. Women should eat as they feel hungry and not regulate the diet too stringent. Each fetus needs an extra 300 calories a day. Pregnancy with twins requires an extra 600 calories a day.

Is multiple pregnancy riskier than being pregnant with one child?

Being pregnant with multiples requires more frequent prenatal care visits since the risk of complications is higher. Diagnose by ultrasound is the safe practice for monitoring the growth of the fetuses from the earliest stage on.
Multiples, for example, are more likely to have fetal growth problems with low weight. One fetus can be much smaller than the other. So-called discordant growth is common with multiples, yet does not always signal a problem. Frequent ultrasound exams are advised to track the growth of the fetuses.

Preeclampsia and gestational diabetes in multiple pregnancy

Preeclampsia is a blood pressure disorder that usually starts in the second half of pregnancy or even after childbirth. The condition occurs more often in multiple than singleton pregnancies. Preeclampsia also tends to occur earlier and more severely in multiple pregnancies.
Preeclampsia is a high-risk pregnancy that can damage many of the mother's organs, such as the kidneys, liver, brain and also eyes. When the disorder occurs during pregnancy, the babies may need to be delivered right away, even if they are not fully grown.
Gestational diabetes is another high-risk condition for women pregnant with single and multiple fetuses. Gestational diabetes can not only increase the risk of preeclampsia. Newborns may also have breathing problems or low blood sugar levels.

Preterm birth

The most common complication for multiples is preterm birth. A normal pregnancy lasts for about 40 weeks. More twins are born preterm – before 37 weeks of pregnancy – rather than full term.
Multiple pregnancy is more liable to maternal hypertension, fetal distress, fetal growth restriction and placental abruption, in many cases leading to the need for early termination of the pregnancy.
Babies born prematurely have an increased risk of both short- and long-term health problems, including issues with breathing, eating and staying warm. Later in childhood or even in adulthood, learning and behavioral disabilities may appear. Children born with problems related to being preterm may need lifelong medical care.
Preterm multiples also face a greater risk for serious complications that could lead to cerebral palsy. Preterm birth also leads to a higher incidence of congenital anomaly, preeclampsia and gestational diabetes.

Preterm babies are safe at Bumrungrad NICU

An early birth of your twins or triplets is nothing to be worried about. Neonatal Intensive Care Unit (NICU) at Bumrungrad Hospital provides specialized care for premature babies who are born before 37 weeks of pregnancy and usually have a low birth weight.
The babies might be weak and still need help eating or breathing on their own, which are the milestones required for NICU discharge. On average, babies born at 32 weeks will stay in NICU for about a month.
Bumrungrad Hospital is working with the most advanced technology. A team of specially trained medical experts and nurses is on hand to provide babies in need with intensive care to the highest standards of care and safety 24 hours a day.

Is vaginal birth advised for multiples?

Delivery of multiples by vaginal birth is more the exception. Whether doctors recommend vaginal delivery or cesarean section depends on the number of babies and their position as well as the weight and health of each baby.
Further factors to be taken into consideration by medical specialists are the mother’s health, how long labor is going and how experienced the ob-gyn specialist team in the delivery room is.
Potential delivery complications can be detected at the initial stage of the multiple pregnancy. An ultrasound exam finds out whether the twins share the placenta. Babies in a shared placenta have a higher risk of complications than those with separate placentas.
Fetuses sharing a placenta are more likely to suffer from unbalanced blood flow between the two. One twin donates blood to the other. The donor twin has too little blood, the recipient twin has too much blood. The earlier this twin–twin transfusion syndrome (TTTS) occurs, the more serious are the outcomes for one or both babies.
The most common problem however with babies sharing a placenta is an umbilical cord complication. Women with this type of pregnancy are monitored more frequently and are likely to have a cesarean birth.
Cesarean sections in general are more common for multiples. While Bumrungrad interdisciplinary specialist teams encourage mothers to have vaginal delivery, each case is evaluated individually to ensure the well-being of both mother and babies.

Should a mother carrying multiple babies stay active during pregnancy?

Movements and the ability to exercise might be more restricted when a woman carries more than one baby in her womb. Staying active is important for health, yet due to the greater demands on the body, low-impact exercise should be pursued, such as swimming, prenatal yoga or walking. It is generally recommended that you aim for 30 minutes of exercise a day. If problems arise during your multiple pregnancy, it may be recommended that you avoid exercise.
Since multiple pregnancy also means enormous stress for the immune system, having multiples might in some rare cases increase the risk of postpartum depression. As an affected mother you are advised to contact your obstetrician–gynecologist (ob-gyn) if you have intense feelings of sadness, anxiety or despair preventing you from being able to do your daily tasks. Bumrungrad interdisciplinary specialist teams would consult with psychologists for help with post-partum depression.

At Bumrungrad, multiple pregnancy is in good hands

The health and well-being of mother and children are the utmost priority at Bumrungrad Hospital. Multiple pregnancy will require more frequent prenatal care visits with your ob-gyn or other health care professionals, such as maternal fetal medicine specialist (MFM). If a problem is suspected, additional special tests are performed, such as a nonstress test, a biophysical profile and more frequent ultrasound exams.
Bumrungrad Hospital has the specialists and facilities to assist and monitor multiple pregnancy from start to giving birth and perinatal. Multidisciplinary experts take care of the mother and babies closely and individually, to ensure a safe and stable multiple pregnancy which is considered to be one of the riskier special cases of pregnancy.
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