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1. Therapies

In order to prevent early fetal loss, women with multiple pregnancies may be prescribed certain types medication, including progesterone and Human Chorionic Gonadotropin. Aspirin may be administered to women, who are at risk of hypertension and blood clotting disorders. These are hormonal preparations intended to supplement similar compounds produced in the body. An additional amount of folic acid, calcium and iron may be advised to ensure a healthy pregnancy. It is not uncommon for women pregnant with more than one baby to have preterm labor. Medications that help relax the uterus may be administered in such circumstances. If labor is imminent before the term, corticosteroid drugs will be administered to the pregnant woman as it helps to promote lung maturity in babies. Some women with multiple pregnancies require cervical cerclage. This is a procedure performed to prevent premature cervical dilation and subsequent fetal loss.

2. Increased rest

Based on their health status and the condition of the fetuses, some women may need bed rest-either at home or in the hospital depending upon the pregnancy complications or the number of fetuses. Higher-order multiple pregnancies often require bedrest, which often begins in the middle of the second trimester. However, bed rest has not proven to help prevent preterm birth in such cases.The timing

About 60% of the ‘twin’ pregnancies result in spontaneous birth before 37 weeks and approximately 75% of the ‘triplet’ pregnancies result in spontaneous birth before 35 weeks. Spontaneous preterm birth and elective preterm birth of twins and triplets are associated with an increased risk of admission to a special care baby unit. The continuation of uncomplicated twin pregnancies beyond 38 weeks and triplet pregnancies beyond 36 weeks increases the risk of fetal death.

3. C-Section or normal?

The delivery depends on many factors - including the fetal positions, gestational age, and health status of the mother as well as the fetuses. Generally, in twins, if both fetuses are in the vertex (head-down) position and do not have any other complication, a vaginal delivery is possible. If one of the fetuses is in the vertex position, while the other is not, the first fetus may be delivered vaginally, while the second is either turned to the vertex position or delivered breech (i.e ‘buttocks’ first). These procedures can increase the risk for problems such as prolapsed cord (i.e the cord slips down through the cervical opening). Emergency cesarean birth of the second fetus may be needed. Usually, if the first fetus is not vertex, both babies are delivered by a cesarean section (C-Section). Most triplets and other higher-order multiples are delivered by cesarean sections.

4. Health issues of the mother

a) Hypertension

The mother’s blood pressure may be measured and urine may be tested for proteinuria. This helps to detect hypertensive disorders at each antenatal appointment in twin and triplet pregnancies.
The doctor may prescribe a daily dose of aspirin (about 75 mg), from the 12th week until the birth of the babies, if you have one or more of the following risk factors:
• First pregnancy
• Age > or = 40-years-old
• Pregnancy interval of more than 10 years
• BMI of 35 kg/m2 or more at first visit
Family history of pre-eclampsia.

b) Preterm labor

Preterm labor can lead to premature birth (i.e before 37 weeks of pregnancy).When babies are born prematurely, they are vulnerable for complications like respiratory distress, hypothermis, hypoglycemia and hypocalcemia as well as neonatal jaundice. These babies often require admission to neonatal special care nursery

c) Anemia

Iron is the most essential mineral for the formation of red blood cells. When women carry twins or higher order fetuses, she requires more iron than that of other women. The lack of iron in her body results in anemia. This could increase the possibilities of premature labor. The physician may prescribe an iron supplement in such cases.

d) Excessive vomiting of pregnancy

When a woman suffers from morning sickness, vomiting or nausea, the condition is called Hyperemesis gravidarum. It is more prevalent among women having multiple pregnancies. This is because the level of the hormone called Human Chorionic Gonadotropin is high and is thought to provoke the vomiting sensation

e) Cholestasis of pregnancy

Bile is a fluid that helps your body break down fats and helps the liver get rid of toxins (poisonous substances). The stagnation of bile in the bile duct results in the formation of bile stones. When bile acids accumulate in the body, the woman is likely to experience some itiching.

f) Polyhydramnios

When the fluid (Amniotic fluid) that surrounds the baby in the uterus (womb) exceeds in volume, it results in poly hydramnios. The excess fluid in the uterus may cause breathlessness. Polyhydramnios put the woman at risk of preterm labor due to overstretching of the muscles of the uterus.

When a woman suffers from morning sickness, vomiting or nausea, the condition is called Hyperemesis gravidarum. It is more prevalent among women having multiple pregnancies. This is because the level of the hormone called Human Chorionic Gonadotropin is high and is thought to provoke the vomiting sensation.

e) Cholestasis of pregnancy

Bile is a fluid that helps your body break down fats and helps the liver get rid of toxins (poisonous substances). The stagnation of bile in the bile duct results in the formation of bile stones. When bile acids accumulate in the body, the woman is likely to experience some itching.

5. Polyhyramnios

When the fluid (Amniotic fluid) that surrounds the baby in the uterus (womb) exceeds in volume, it results in poly hydramnios. The excess fluid in the uterus may cause breathlessness. Polyhydramnios put the woman at risk of preterm labor due to overstretching of the muscles of the uterus.

  1. Postpartum depression Some women experience this type of depression after the birth of her baby. Postpartum Depression (PPD) is a strong feeling of sadness. These feelings can make it difficult for the woman to take care of her baby
  2. Postpartum hemorrhage This refers to heavy bleeding after child-birth. It’s a serious but rare condition; usually occurs due as the uterus fails to contract. This is followed by trauma or operative delivery and certain blood coagulation disorders.

While most cases of multiple pregnancies result in healthy babies, there is always a risk involved in such situations. Hence it is mandatory to seek supervision during the course of the pregnancy.

Summary
Twin, triplets or more: Understanding multiple pregnancies – Part 2
Article Name
Twin, triplets or more: Understanding multiple pregnancies – Part 2
Description
Our in-house expert tells us more about the various aspects of multiple pregnancies
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Peepom.com

This article has been written by Dr. Namitha Subrahmanyam. She has been working as a nurse for over 13 years and holds an M.Sc in OBG Nursing. Recently, Namitha Subrahmanyam has been awarded a PhD. She is also working as an Associate Professor at the Department of Obstetrical and Gynaecological Nursing of the MOSC College of Nursing, Kochi, Kerala, India.