Given the widespread use of IVF, this make a difference, he said. The declines in births of three or more babies at once were highest among white women. Rates were lower for Hispanics and unchanged for blacks, the report found. Evan Myers, professor of obstetrics and gynecology at Duke University Medical Center, said this may reflect lower numbers of black women undergoing costly infertility treatments. Blacks were less likely than whites to have health insurance, at least before the Affordable Care Act, and tend to have lower incomes, he said.
That's an important consideration for those whose insurance doesn't cover infertility treatment, Myers added. 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.
I Accept Show Purposes. Table of Contents View All. Table of Contents. How It Happens. Fraternal Triplets. Fertility and Multiples. What Are Super Twins? Pregnancy Signs of Triplets There are a few pregnancy symptoms that could indicate you might be having triplets.
Causes of Identical and Fraternal Twins. Was this page helpful? Thanks for your feedback! Sign Up. What are your concerns? Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles.
Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Related Articles. Octuplets Overvew and Statistics. Are My Twins Sharing a Placenta? Forgot password? Not a member? Join Now! New to Bounty? Yes No.
Join Now. What are the chances of having triplets? Three buns in the oven? Honestly, what are the odds of conceiving triplets Three or more babies are known as Higher Order Multiples HOMs and can be: Monozygotic — they are formed after one fertilised egg has split into three identical embryos; or Dizygotic — they are formed from separate eggs, that is with a set of identical 2 and a fraternal 1 triplet.
What are the odds of conceiving triplets? AMBA provides the following Australian figures for context: Australian Bureau of Statistics data shows that of the , births in , 4, of these — 1. According to information supplied to AMBA by 34 families of HOMs born in , at least 34 of the 59 were sets of triplets no quadruplets or more were reported.
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