Multiple pregnancy: Monitoring, delivery, and newborn care

A multiple pregnancy occurs when a woman is pregnant with two or more fetuses at a time. While twins are the most common, triplets and higher-order multiples are also possible.

We spoke to a highly esteemed consultant obstetrician and specialist in fetal and maternal medicine, about multiple pregnancies, addressing the joys, questions, and considerations for both mother and babies.

What increases the likelihood of a multiple pregnancy?

Several factors can increase the likelihood of a multiple pregnancy:

Genetics: A woman with a family history of multiple pregnancies has a higher chance of carrying multiples herself, especially if there is a family history of non-identical twins.

Age: Women over the age of 30, particularly those aged between 35 and 40, are more likely to conceive twins or higher-order multiples. This is due to hormonal changes that can lead to the release of more than one egg during ovulation.

Fertility treatments: Fertility treatments, such as in vitro fertilisation (IVF), increase the chances of a multiple pregnancy. These interventions often involve the stimulation of the ovaries to release multiple eggs or the implantation of more than one embryo.

Finally, if a woman has previously had a multiple pregnancy, the chances of having another increase with later pregnancies.

Are multiple pregnancies high-risk?

Yes, multiple pregnancies are generally considered high-risk due to the increased chances of complications for both the mother and the babies:

Preterm birth and low birth weight: The likelihood of preterm labour is higher in multiple pregnancies, often before week 37. Babies born prematurely are often born with a low birth weight, which can lead to an increased risk of health problems.

Twin-to-twin transfusion syndrome (TTTS): TTTS can occur in identical twins sharing a placenta if there is an unequal distribution of blood between the twins. This condition requires close monitoring and, in some cases, medical intervention.

Gestational diabetes and pre-eclampsia: Women carrying multiple pregnancies are at a greater risk of developing gestational diabetes and pre-eclampsia (high blood pressure during pregnancy). Both conditions require close monitoring and management.

Placental issues: Multiple pregnancies can increase the risk of placental complications, such as placental abruption (where the placenta detaches from the uterus) or placenta previa (where the placenta covers the cervix), which can cause complications during delivery.

How is a multiple pregnancy monitored?

Women with multiple pregnancies require more frequent ultrasounds and prenatal visits to ensure that both the mother and the babies are doing well. The primary method of monitoring multiple pregnancies is through ultrasound scans.

In the early stages, ultrasounds determine the type of twins (identical or non-identical) and whether they share a placenta or amniotic sac.

As the pregnancy progresses, mothers carrying twins with separate placentas typically have ultrasounds every 4 weeks. For mothers carrying twins with a single placenta, ultrasounds are performed every 2 weeks from around 16 weeks to monitor for conditions like TTTS. Pregnancies involving triplets or higher-order multiples require even more frequent assessments.

Additional tests are performed to monitor fetal development, including Doppler ultrasounds, amniotic fluid assessments, urine analyses, and growth scans. Regular monitoring of blood pressure, as well as blood tests, are also crucial for assessing the mother's health and detecting pre-eclampsia or anaemia.

What are my options for delivery?

The delivery of a multiple pregnancy depends on several factors, including the health of the mother and the babies’ gestational age, health, and position in the uterus.

In twin pregnancies, a vaginal birth may be possible if the first baby is in a head-down position. However, even with a vaginal delivery plan, an emergency caesarean may be necessary if the second baby is in a breech or transverse position, or if other complications arise during labour.

For triplets or higher-order multiples, a planned caesarean is usually recommended to minimise risks to both the mother and the babies. Twins are typically delivered around 36 to 37 weeks, while triplets are usually delivered between 32 and 34 weeks. Higher-order multiples are delivered earlier than this.

Will my babies require special care after birth?

Babies born from multiple pregnancies often require extra care after birth, especially if they are born prematurely or have a low birth weight. Premature babies may need to stay in a neonatal intensive care unit (NICU) for assistance with breathing, feeding, and monitoring of their vital signs. Babies with low birth weight will require additional support to ensure proper nutrition and a stable body temperature.

Ultimately, the need for special care will depend on the individual circumstances of the pregnancy. Many babies will go on to thrive and grow up without long-term complications.