Your Pregnancy After 35 : More Than One Baby (part 2) - Increased Risks Associated with a Multiple Pregnancy

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- Foods That Cause Miscarriage
- Signs Proving You Have Boy Pregnancy

3. Special Issues for Identical Twins

With monozygotic (identical) twins, division of the fertilized egg occurs between the first few days and about day 8. If division of the egg occurs after 8 days, the result can be twins that are connected, called conjoined twins. (Conjoined twins used to be called Siamese twins.) These babies may share important internal organs, such as the heart, lungs or liver. Fortunately this is a rare occurrence.

Identical twins may face some risks. There is a 15% chance they will develop a serious problem called twin-to-twin transfusion syndrome. There is one placenta, and the babies’ blood vessels share the placenta. The problem arises when one baby gets too much blood flow and the other too little.

With monozygotic twins, there is a chance several different types of diseases may occur in both twins during their lifetimes. This is less likely to happen with dizygotic twins.

Due to health concerns, it may be important later in life for your children to know whether they were monozygotic or dizygotic. Before delivery, tell your doctor you would like to have the placenta(s) examined (with a pathology exam) so you will know whether your babies were monozygotic or dizygotic. It may be valuable information in the future. Even if there are two placentas, research shows it doesn’t mean twins are dizygotic; nearly 35% of all monozygotic twins have two placentas.

If you have already given birth to a set of fraternal twins, your chance of having another set of twins quadruples! Other reasons for multiple fetuses include some women having more children, being very tall or obese, recently discontinuing oral contraception or taking large doses of folic acid. Studies have shown the twin birth rate for women who took folic acid can be as high as double the rate of women who did not take large doses of folic acid.

Having more children (or pregnancies) can also result in more than one baby. This is true in all populations and may be related to the mother’s age and female hormone changes.

4. Discovering a Multiple Pregnancy

Diagnosis of twins was more difficult before ultrasound was available. However, most multiple pregnancies are discovered well before delivery. Today, it’s uncommon to discover twin pregnancies just by hearing two heartbeats. Many people believe when only one heartbeat is heard, there could be no possibility of twins. This may not be the case. Two rapid heartbeats may have a similar or almost identical rate. That could make it difficult to determine that there are two babies.

Measuring and examining your abdomen during pregnancy is important. A healthcare provider usually finds out a woman is carrying more than one baby because she has a larger-than-expected uterus. Usually a twin pregnancy is noted during the second trimester because you are too big and growth seems too fast for a single pregnancy. Other signs include more severe nausea and/or vomiting, and hearing more than one fetal heartbeat.

Ultrasound examination is the best way to diagnose a multiple pregnancy.

5. Increased Risks Associated with a Multiple Pregnancy

If a woman is pregnant with more than one baby, her risk of problems during pregnancy increases. You can minimize your risks, and possibly avoid them, with good prenatal care and careful attention to your health. Possible pregnancy problems include the following:

increased risk of miscarriage

fetal death

fetal malformations

low birthweight or growth restriction


problems with the placenta, including placental abruption and placenta previa

maternal anemia

maternal bleeding or hemorrhage

problems with the umbilical cords, including entwinement or tangling of the babies’ umbilical cords

hydramnios or polyhydramnios

labor complicated by abnormal fetal presentation, such as breech or transverse presentation

premature labor

difficult delivery and Cesarean delivery

Birth defects are more common with identical twins than fraternal twins. The incidence of minor malformations in a multiple pregnancy is twice as high as it is in a singleton pregnancy, and major malformations are also more common.

One of the biggest problems with multiple pregnancies is premature delivery. As the number of fetuses increases, the length of gestation and the birth-weight of each baby decreases, although this is not true in every case.

The average length of pregnancy for twins is about 37 weeks. For triplets it is about 35 weeks. For every week the babies remain in the uterus, their birth-weights increase along with the maturity of organs and systems.

It’s important to continue your pregnancy as long as possible, which may best be accomplished by bed rest. You may not be able to carry on with regular activities during your entire pregnancy. If your healthcare provider recommends bed rest, follow his or her advice.

Weight gain is important with a multiple pregnancy. You will probably be advised to gain more than the normal 25 to 35 pounds, depending on the number of fetuses you are carrying. With twins, if you were normal weight before pregnancy, you may be advised to gain 40 to 54 pounds (18 to 24.5 kg). For overweight women, a weight gain between 31 and 50 pounds (14 to 22.7 kg) may be recommended. A weight gain between 25 and 42 (11.3 to 19 kg)pounds may be recommended for obese women. If you’re expecting triplets, your weight gain will probably be between 50 and 60 pounds (22.7 to 27.2 kg) if you are normal weight before pregnancy.

Pay strict attention to your eating plan; eat wisely and nutritiously for all of you. Extra rest is essential. Most pregnant women need at least 2 hours of extra rest each day.

When you’re pregnant with more than one baby, you will probably be monitored more closely. You may have more frequent checkups and more tests.

Beginning around 20 weeks of pregnancy, you will probably visit your healthcare provider every other week until week 30. Then you may be seen once a week until delivery. You may have ultrasound more frequently to monitor babies’ growth. Your blood pressure is watched closely because of preeclampsia, which is twice as common in multiple pregnancies.

Follow your doctor’s instructions closely. Every day and every week you’re able to keep the babies inside you are days or weeks you won’t have to visit them in an intensive-care nursery while they grow, develop and finish maturing.

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