Multiple births -problems and management

Usually a woman conceives and delivers one baby at a time. But occasionally more than one baby can develop in the womb simultaneously leading to multiple births.

Twins are more common than triplets or quadruplets. It is very rare to see more than 3 babies at a time.

Twins occur once is approximately eighty deliveries. Twinning can occur is two ways. Two ova can be fertilized by two sperms. These are called di-zygotic twins.

This commonly occurs after treatment for infertility with a drug that induces ovulation (clomiphine). Rarely two ova can be fertilized by sperms from different people.

Mono-zygotic twins (identical twins) occur when the ovum after being fertilized by a sperm completely divides into two resulting in the formation of two babies.

Conjoined twins occur when the division is incomplete. It is possible to detect multiple pregnancies as early as five weeks by ultrasound.

Problems associated with multiple births: Pregnancy is usually not carried to term in case of multiple births-higher the number of fetuses, greater the risk of premature delivery.

The increased pressure inside the uterus results in early onset of labor pains. There can be problems in delivering the babies due to interlocking and cesarean may be required.

Sometimes one baby does not develop properly due to inadequate blood supply. Blood can sometimes run from one fetus to the other resulting in twin to twin transfusion. In such a case one baby will be found to be severely anemic at birth requiring blood transfusion.

The other suffers from a condition called polycythemia, in which the blood will be very thick and can clot inside blood vessels blocking them, depriving cells of oxygen.

This is a very serious and potentially fatal condition. Such babies require an exchange transfusion in which part of the baby’s blood is replaced with either plasma (blood without cells) or normal saline, as an emergency.

Deformities are more common due to lack of space in uterus. The mother in disturbed frequently, does not get adequate rest and suffers from fatigue and anxiety. She needs someone to help her.

She may not get enough breast milk and may have to give artificial milk. This causes additional financial burden. But some mothers do get enough milk for both babies. It is even possible to breast feed both the twins simultaneously.

Conjoined twins: The two babies may be fused at different areas-heads, abdominal walls or backs. Such babies pose additional problems.

Separation is not always easy and depends on several factors-like the parts which have fused, type of blood supply and whether each one can have fully functional organs. Sometimes the difficult decision of sacrificing one baby has to be taken.

If the two babies are of different intelligence levels they may suffer from discrimination which leads to sibling jealousy. If one in handicapped the problems multiply. Congenital abnormalities are slightly more common in multiple births than in singletons.

Twin pregnancy is associated with higher incidence of pre-eclampsia- a condition is which the pregnant woman suffers from increased blood pressure which can lead to convulsions if not treated promptly.

Polyhydramnias (excess fluid in the sac covering the fetus) and prolapsed umbilical cord -a condition in which the umbilical cord comes out first are also more common. The latter condition is very serious because the umbilical cord can be compressed resulting in decreased blood flow to the baby.

Page last reviewed on 14th November 2009

Return from multiple births to common childhood problems