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Multiple Gestation: Twins, Triplets and Beyond


The incidence of pregnancies resulting in more than one fetus has increased significantly over the past 10 to 15 years. Since the 1980s, there has been a 65 percent increase in the frequency of twins and a more than 500 percent increase in triplets and higher order gestations. This is primarily related to the increase use of ovulation induction agents and assisted reproductive technologies. The presence of a multiple gestation, while exciting, is not normal for human beings and is associated with increased risks to both the mother and the infants with the risk increasing with increasing number of fetuses. These pregnancies are considered high risk and need to be followed more closely to assure the best outcome possible.

While multiple pregnancy accounts for only 3 percent of all live births, they account for 17 percent of all preterm births, 23 percent of all early preterm births (less than 32 weeks), and over a quarter of all low birth weight infants. While preterm delivery is clearly the most common consequence of multiple gestation, there is also significantly increased risk for fetal growth restriction, congenital malformation, cerebral palsy, and other long term handicaps related to preterm birth. Women who are pregnant as a result of either ovulation induction or in-vitro fertilization are at much higher incidence of monochorionic twins, or twins which share a single placenta. This type of twin pregnancy has increased risk above that which has already been described.

Multiple pregnancy also increases the mother’s risk for medical complications including diabetes, hypertension, preeclamsia, venous thrombosis, prolonged hospitalization and increased cesarean section for delivery.
In order to ensure the best outcome possible for the mother and the babies, multiple pregnancies need to be evaluated early and followed more closely than women with normal singleton pregnancies. This enhances the possibility of early detection of maternal or fetal problems and allows for the development of an aggressive management plan.

The staff at the Adventist Maternal Fetal Medicine Center has had considerable experience managing these pregnancies and will work closely with your obstetrician to help achieve a normal outcome.