Medical Complications of Twins, Triplets and Multiples

By Cashmere Lashkari, B.Sc.Reviewed by Afsaneh Khetrapal, BSc

Prenatal care for pregnancy is always more emphasised for multiple births as there is a greater range of possible complications. With that said, with regular check ups and continuous care, it is perfectly possible to deliver healthy twins, triplets and multiples. Active vigilance and an awareness of possible complications that may arise are required so that the pregnant mother can quickly get treatment if symptoms appear.

Gestational diabetes

This is a temporary form of diabetes which can afflict pregnant mothers. Gestational diabetes results due to the body’s inability to produce insulin in the required amount to regulate sugar during pregnancy. Nearly 2 - 9% of women may develop this condition during pregnancy. Symptoms include frequent urination, persistent thirst and increase in sugar in blood and/or urine.

The attending health care professional will usually screen them for gestational diabetes between the 24^th and 28^th week of pregnancy. It is usually managed with a special diet and exercise plan. Close monitoring of the mother and babies is necessary, and insulin therapy may be prescribed in some cases.

Preeclampsia

This is also known as Toxemia or Pregnancy Induced Hypertension (PIH). The condition is likely to occur in 50% of the women who are pregnant with twins or triplets. Symptoms include high blood pressure, water retention, protein in urine, fatigue, headaches, blurred vision, nausea and vomiting, shortness of breath, tendency to bruise easily, and pain in the upper right abdomen.

Screening is usually done for preeclampsia in the 20^th week of pregnancy. Treatment options may include prescribed bed rest, increased frequency of prenatal check ups, reduced salt in food, increased water consumption and extra protein to be added to the diet for the mother-to-be.

Preterm delivery/caesarean section

A normal pregnancy lasts 40 weeks but twins and triplets are often born before the 37^th week of pregnancy. The preterm babies often have not developed enough to survive without support and intensive care is required for them to live. Vaginal delivery is the exception rather than the norm in cases of multiple births. In case of twins, if the lower fetus is in the head first position (with the head facing downwards), the mother may be able to have a normal delivery.

Triplets are almost always delivered by Caesarean section. Twins may require Caesarean section if there is a breach, fetal distress or when the gestational period is less than 32 weeks. Since any number of complications may arise, the delivery should take place with full neonatal support and an entire team of medical professionals.

Umbilical cord entanglement

The umbilical cord is the lifeline for the babies. The fetus is attached to the placenta through the umbilical cord, and they are provided with blood and nutrients necessary for their proper growth and development. However, in monochorionic and monoamniotic twins who share both the same placenta and a single amniotic sac, there is a possibility of umbilical cord entanglement or compression leading to complications.

The umbilical cord cannot function optimally when tangled up or knotted. Hampered delivery of the necessary blood and nutrients leads to a risk of improper development of the fetus. In some cases it may even get entangled around the neck of the baby and cause death. Umbilical cord issues can be diagnosed with an ultrasound.

Intrauterine growth restriction

Intrauterine Growth Restriction (IUGR) basically refers to poor fetal growth. There can be a number of reasons for this condition, including poor nutrition during pregnancy, use of drugs, alcohol or cigarettes, umbilical cord complications, gestational diabetes in the mother, low levels of amniotic fluid available to the fetuses. It is diagnosed by measuring the fetus during an ultrasound to compare it with regular gestational age based development.

In some cases where IUGR is suspected, the health care provider will recommend a Doppler ultrasound. The detection will result in close monitoring of the fetuses. If the gestation period is more than 34 weeks, labor may be induced for an early delivery. The condition increases the risk of a Caesarean section.

Amniotic fluid problems

The Amniotic fluid is the watery content around the fetus in the amniotic sac. Its presence protects and cushions the fetus from physical shock. It is also important for the development of many of the organs. Amniotic fluid is produced by the lungs and kidneys of the fetus. Approximately 7% of pregnancies may have problems related to this fluid.

If there is too much amniotic fluid around the fetus, the condition is known as hydramnios. Symptoms include rapid growth of uterus, discomfort in the abdomen and uterine contractions. When very little amniotic fluid is present around the fetus, the condition is called oligohydramnios. Symptoms may include leaking of amniotic fluid due to rupture of the amniotic sac. It may be detected in ultrasound as well.

References:

1. http://americanpregnancy.org/multiples/complications/
2. http://americanpregnancy.org/pregnancy-complications/gestational-diabetes/
3. http://americanpregnancy.org/pregnancy-complications/preeclampsia/
4. http://americanpregnancy.org/pregnancy-complications/intrauterine-growth-restriction/
5. http://www.cdc.gov/ncbddd/birthdefects/facts.html
6. http://www.chw.org/medical-care/fetal-concerns-center/conditions/infant-complications/birth-defects-in-monochorionic-twin/
7. http://www.chw.org/medical-care/fetal-concerns-center/conditions/pregnancy-complications/amniotic-fluid-problems/
8. https://www.asrm.org/BOOKLET_Multiple_Pregnancy_and_Birth/

Further Reading

• All Pregnancy Content
• Early Signs of Pregnancy
• Is it Safe to Exercise During Pregnancy?
• Pregnancy: 0-8 weeks
• Pregnancy: 9 - 12 weeks