Multiple Loss

What complications occur more frequently in a multiple gestation?
Twins generally face the fewest medical complications and are usually born healthy. The more babies a woman carries at once, the greater her risk of complications.

Close to 60 percent of twins, over 90 percent of triplets and virtually all quadruplets and higher multiples are born preterm. The length of gestation decreases with each additional baby. On average, most singleton pregnancies last 39 weeks; for twins, 36 weeks; for triplets, 32 weeks; for quadruplets, 30 weeks; and for quintuplets, 29 weeks.

Most preterm multiples weigh less than 5 1/2 pounds (2,500 grams), which is considered low birthweight. Low-birthweight babies, especially those born before 32 weeks of gestation and/or weighing less than 31/3 pounds (1,500 grams), are at increased risk of health complications in the newborn period as well as lasting disabilities, such as mental retardation, cerebral palsy and vision and hearing loss. While advances in caring for very small infants has brightened the outlook for these tiny babies, chances remain slim that all infants in a set of sextuplets or more will survive and thrive.

Before birth, identical twins face an additional risk . One-third of all twin pairs are identical—they begin as one fertilized egg that subsequently divides in half. The remaining two-thirds of twins are fraternal, resulting from two different eggs fertilized by two different sperm. Fraternal twins are no more similar genetically than are any other siblings. They may not be the same sex; they may not even look alike. Higher order multiples can result from three (or more) eggs being fertilized, one egg splitting twice (or more) or a combination of both.

Identical twin fetuses have a 15 percent chance of developing a serious complication called twin-to-twin transfusion syndrome . This condition, which occurs when there is a connection between the two babies' blood vessels in their shared placenta, can result in one baby getting too much blood flow and the other too little. Until recently, severe cases often resulted in the loss of both babies. Recent studies, though, suggest that the use of amniocentesis to drain off excess fluid can save about 60 percent of affected babies. Removing the excess fluid appears to improve blood flow in the placenta and reduces the risk of preterm labor. Recent studies also suggest that using laser surgery to seal off the connection between the blood vessels may save a similar number of babies. An advantage of laser surgery is that only one treatment is needed, while amniocentesis generally must be repeated more than once.

Women who are pregnant with multiples also face an increased risk of pregnancy-related forms of high blood pressure (preeclampsia) and diabetes. More than half of triplet pregnancies are complicated by preeclampsia. With proper treatment, these disorders usually do not pose a major risk to mother or baby.

Vanishing Twin Syndrome

Twin To Twin Syndrome

 

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