What if triplets

Read on to learn more about multiple births. Believe it or not, there are an increasing number of kids who have a twin. In , there were , twin babies born in the United States. Just for comparison, in there were only 69, The number of triplets born in the United States also has multiplied in recent years, but has leveled off. In , just about 7, triplet babies were born. There are two kinds of twins — fraternal and identical.

The difference comes from the way the egg is fertilized when a woman becomes pregnant. In fraternal twins, two different eggs are fertilized.

With identical twins, one fertilized egg splits into two. If you have friends who are twins and you have trouble telling them apart, they are probably identical. They can even be different sexes. Even though the exact reason for multiple births is not known, doctors and researchers have identified several reasons why they probably happen. Sometimes multiple births run in families. According to research, women who are taller, heavier, and African American are more likely to have twins.

However, the main reason why the number of multiple births is on the rise is because of fertility medicine. Some women who have trouble getting pregnant take medicine to help them conceive. But sometimes multiple births just happen without fertility medicine. This is common among twins and triplets, too.

As the number of fetuses increases, the expected duration of the pregnancy decreases. The average duration is 35 weeks for twins, 33 weeks for triplets, and 30 weeks for quadruplets. Complications increase with each additional fetus in a multiple pregnancy and include many medical issues that will be discussed below.

In addition to these, there is a higher incidence of severe nausea and vomiting, cesarean section, or forceps delivery. If you are pregnant with twins or more, or if you are at risk for a multiple pregnancy, you should be aware of these and other potential problems you might experience. Preterm labor and birth pose the greatest risk to a multiple pregnancy. Cesarean section is often needed for twin pregnancies and is expected for delivery of triplets.

Since preterm labor and birth present such serious risks, the pregnant mother must understand the warning signs of early labor. Sometimes, preterm delivery can be delayed by a few days or more if it is detected early. Each day gained provides valuable fetal growth and development. Once a woman is in advanced labor, delivery cannot be stopped. In rare instances, delivery of a second twin can be delayed. This delay, when possible, allows for continued growth in the protective environment of the uterus.

Currently, there are no effective treatments to prevent preterm birth of multiples. The placenta is attached to the wall of the uterus, and the fetus is attached to the placenta by the umbilical cord. The placenta provides blood, oxygen, and nutrition to the fetus through the umbilical cord.

Placental function is more likely to be abnormal in a multiple pregnancy. If the placenta is unable to provide adequate oxygen or nutrients to the fetus, the fetus cannot grow properly. The placenta ages prematurely and may slow fetal growth, especially late in the third trimester. Another placental problem is twin-twin transfusion, a life-threatening condition in identical twins. This transfusion occurs when blood flows from one fetus to the other through a connection in a shared placenta.

Therapeutic amniocentesis and laser coagulation of blood vessels that link circulation to the twins in the placenta s may reduce complications of twin-twin transfusion. Preeclampsia, also known as toxemia, occurs 2 to 5 times more often in multiple pregnancies. The condition may progress and threaten the health of the mother and baby. When severe, the mother may have seizures, and stroke or other life-threatening complications are possible. Women with multiple pregnancies are more likely to develop gestational diabetes during pregnancy.

Babies of diabetic mothers are more likely to experience respiratory distress and other newborn complications. However, gestational diabetes is common even in singleton pregnancies, and treatment is well established and effective. Preterm delivery places an infant at increased risk for severe complications or early death. Prematurity also may result in visual impairment or blindness. Neonatal intensive care unit admission is required for one-fourth of twin and three-fourths of triplet deliveries.

Despite these numbers, it is important to note that the vast majority of multiple-birth infants do survive. Fetal death occurs in about 1. Furthermore, compared to singleton pregnancies of the same birth weight, there is no significant increase in the incidence of chronic lung disease or brain, eye, or gastrointestinal problems in multiple-birth infants.

Low birth weight of less than 5. The average birth weight is approximately 4 lb. As a result of prematurity, the risk for cerebral palsy is 4 times more likely to occur in twins.

The rates are even greater for triplets and high-order multiple births. Birth weight also corresponds closely to the severity of disability throughout the childhood years. As noted above, the average birth weight even for quadruplets is well above this number. Prevention during infertility treatment is the best approach to avoiding a multiple pregnancy.

In ART cycles, limiting the number of embryos transferred is an effective approach. Consult the ASRM Practice Committee Report titled Guidelines on Number of Embryos Transferred for recommendations regarding the optimal number of embryos to transfer based on patient age, embryo quality, and other criteria. In the United States, physicians and patients jointly decide how many embryos to transfer.

However, in England, no more than two embryos may be transferred in most cases. In Canada, a maximum of three embryos are recommended for transfer.

The ultimate goal of ART is to achieve a high pregnancy rate while transferring a single embryo. While physicians can transfer two embryos and still maintain acceptable pregnancy rates, the transfer of one embryo is associated with good pregnancy rates in certain patient groups, thereby resolving the problem of multiple pregnancies caused by multiple embryo transfer.

Multiple pregnancies are a known complication of ovulation stimulation drugs. Most physicians monitor patients with ultrasound examinations and blood tests. A woman with a large number of ovarian follicles or high hormone levels has an increased risk of a multiple pregnancy, and the cycle may be canceled to avoid the risk. No proven way of reducing multiple pregnancies with superovulation has been identified, although preventing fertilization with development of more than three follicles is helpful in reducing high-order multiples.

When a triplet or high-order multiple pregnancy occurs, multifetal pregnancy reduction may be considered to improve the chance for survival of the fetuses. While multifetal pregnancy reduction carries some risk of a complete miscarriage, it also reduces the chances of extreme premature birth. In order to achieve the best outcome with a multiple pregnancy, the expectant mother must work as part of the health care team.

A nearly total change in lifestyle can be expected, especially after about 20 weeks into the pregnancy. There is an increased need for maternal nutrition in multiple pregnancies.

An expectant mother needs to gain more weight in a multiple pregnancy, especially if she begins the pregnancy underweight. With multiples, weight gain of approximately lb. The pattern of weight gain is important too. Healthy birth weights are most likely achieved when the mother gains nearly one pound per week in the first 20 weeks. The increase in fetal growth with appropriate nutrition and weight gain may greatly improve pregnancy outcome at a minimum of cost.

Many physicians who manage multiple pregnancies believe that a reduction in activities and increased rest prolongs these pregnancies and improves outcomes. However, routine hospitalization for bed rest in multiple pregnancy has not been shown to prevent preterm birth.

Women with high-order multiple pregnancies usually are advised to avoid strenuous activity and employment at some time between 20 and 24 weeks. Bed rest improves uterine blood flow and may be helpful for fetal growth problems. Intercourse generally is discouraged when bed rest is recommended. Since preterm birth and growth disturbances are the major contributors to newborn death and disability in multiples, frequent obstetric visits and close monitoring of the pregnancy are needed.

Prenatal diagnosis using a variety of new techniques can be done near the end of the first trimester to screen for Down syndrome and other genetic abnormalities. Amniocentesis may be performed between 16 and 20 weeks. Amniocentesis may be complicated and difficult to perform in twins and triplets and may not be possible in high-order multiple pregnancies.

However, reasonable data exist for the use of serum screening in the setting of multiple pregnancies and can be a helpful tool to assess risk of these and other conditions. Many physicians perform cervical examinations every week or two beginning early in pregnancy to determine if the cervix is thinning or opening prematurely. If an exam or ultrasound shows that the cervix is thinning or beginning to dilate prematurely, a cerclage, or suture placed in the cervix, may prevent or delay premature dilatation.

However, preventative cerclage has not been shown to prevent preterm birth in twins or triplets. These multiples may be different genders. This form of multiples would be no more genetically identical than normal siblings. Dizygotic multiples occur commonly with infertility treatments. The increase of fraternal multiples is also due to the fact that older women are more likely to have multiples, and many women today are conceiving at a later age.

Other women who have an increased chance of fraternal multiples include those who have a higher body mass index BMI , have recently discontinued hormonal birth control , and those who have had more babies. Higher-order multiples triplets, quadruplets, etc.

For example, triplets can result from one zygote an egg fertilized by one sperm dividing into three. This means that the triplets would be genetically identical. Triplets could also occur if one of two zygotes divide in half. This would mean that two of the triplets would be genetically identical while the third child is considered a fraternal multiple.

Similar scenarios occur in quadruplets and other forms of multiples. How Do Multiple Births Occur?