Multiple Issues

Multiple pregnancies put infants at risk for all kinds of complications. Quite often, a multiple pregnancy results in the necessity for neonatal intensive care services. This is a huge expense for the family as well as a stressful experience for everyone involved. Here are some of the more common fetal complications of multiple pregnancies:

*Low Birth Weight—Any baby whose weight at birth is below 2500 grams is considered to have a low birth weight. Anything below 1500 grams is thought to be very low. The cause of this condition is that the babies have less room for growing inside the uterus. Low birth weight occurs in two thirds of babies born from multiple pregnancies. Low birth weight can result in a variety of significant short and long term health issues.

Congenital Defects

*Birth Defects—Identical or monozygotic twins (from one egg that splits into two) have double the risk of congenital defects of dizygotic twins (from two fertilized eggs).

*Infant Mortality—Infants resulting from multiple pregnancies have a higher risk for infant mortality or the mental and physical issues associated with premature delivery. Babies who don't make it tend to result from pregnancies lasting less than 32 weeks and often have birth weights under 1500 grams. Half of all neonatal deaths connected to premature delivery are due to respiratory distress syndrome (RSD).

*Cerebral Palsy—Multiple pregnancy babies are at increased risk for cerebral palsy as well as other manifestations of long term neurological conditions.

Painful Experience

*Multifetal Pregnancy Reduction (MFPR)—In an effort to reduce the risk of maternal and fetal complications associated with multiple pregnancies, some parents decide to abort some of the fetuses. The decision is hard to make and the experience can be very painful. MFPR is often recommended when there are 4 or more fetuses. There is a 4-5% risk of miscarriage with the procedure, resulting in the loss of the entire pregnancy.

MFPR is an outpatient procedure best performed between 10 and 12 weeks of pregnancy. The doctor uses ultrasound to guide the insertion of a needle into the abdomen, where potassium chloride is injected into one or more fetuses.

The procedure is sometimes done earlier, between 6 and 8 weeks when it is performed in a transvaginal procedure involving embryo aspiration. This type of reduction is less favored because it requires general anesthesia and carries a risk of infection. At this early stage of pregnancy, sometimes a spontaneous fetal reduction can occur, so doctors prefer to wait a bit. Fetal screening cannot be done this early on, so it's impossible to screen the babies for defects.

Avoiding Issues

There has been ample demonstration that educating parents and providing them with trained health care providers can cut down on the complications and mortality rates linked with multiple births. Hospitals that provide high-risk pregnancy care and delivery often have support groups available for parents-to-be of multiples.

Careful monitoring during fertility treatment can reduce the number of multiple pregnancies. In vitro fertilization (IVF) should be performed with an eye toward limiting the number of embryos transferred according to the age of the mother and the quality of the embryos.


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