Complications in Twin and Multiple Birth Pregnancies

Pregnancy is a time filled with wonderful experiences and lots of great surprises. But you may also find that you are a little nervous throughout your pregnancy, particularly when it comes to those pregnancy complications. Though most women experience complication-free pregnancies, there is always a risk that you could develop some type of health concern throughout these nine months. In particular, women who are expecting twins or multiples are at increased risk of experiencing pregnancy complications. So, if you are expecting twins or multiples, be sure to become familiar with the signs and symptoms of these complications.

Miscarriage
Miscarriage is a concern for all pregnant women, particularly in the first trimester. Miscarriage occurs when a pregnancy is lost before the 20th week of pregnancy. It is actually a fairly common occurrence, taking place in almost 20% of all pregnancies. Unfortunately, the risk of miscarriage is even higher in twin and multiple pregnancies, due to an increased chance of one baby having a chromosomal abnormality. Miscarriage is usually accompanied by various symptoms, including abdominal cramping and bleeding.

Miscarriage in multiple pregnancies often takes place in the form of "Vanishing Twin Syndrome." This is a condition in which two fetuses are detected, but only one develops throughout the pregnancy. For unknown reasons, this miscarried twin is reabsorbed into the mother’s body, but causes no outward symptoms of miscarriage.

Preterm Labor
Preterm labor is probably the most common complication found in twin and multiple pregnancies. In fact, approximately 70% of twins, and close to 100% of higher order multiples are born prematurely. Preterm labor occurs when contractions or dilation of the cervix begin before the 38th week of pregnancy. It occurs fairly frequently in single pregnancies and is often the result of infection, abnormal placenta, or maternal illness (such as gestational diabetes). In multiple pregnancies, however, preterm labor is often the result of overcrowding inside the uterus. The more babies you are expecting, the more likely it is that you will experience a preterm labor.

Preterm labor doesn’t usually occur that early in multiple pregnancies. Most twins or triplets are born after the 28th week of pregnancy. However, if your multiples are born before the 28th week, they may be at risk for serious complications, including birth defects or breathing difficulties. Be sure to keep an eye out for the signs of preterm labor, including early, sustained contractions, vaginal bleeding, or severe abdominal cramping.

Intrauterine Growth Retardation (IUGR)
Intrauterine growth retardation can occur in any pregnancy, although it is much more common in women who are expecting twins or multiples, with as much as 50% of all multiples experiencing some degree of IUGR. IUGR occurs when one (or more than one) baby experiences difficulties with growth and development while in utero. Specifically, IUGR is diagnosed when a baby is less than 10% of her expected weight for her fetal age.

IUGR can be caused by a number of factors, including infection and poor placental blood circulation. However, in multiple pregnancies, it is most commonly caused by overcrowding in the uterus. IUGR can be quite serious because it can lead to preterm labor.

Twin-to-Twin Transfusion Syndrome (TTTS)
Twin-to-Twin Transfusion Syndrome is a serious complication associated with twin pregnancies. Affecting identical twins that share a placenta, TTTS causes one twin to take over the other’s blood supply in utero. This prevents one baby from receiving enough nutrients and oxygen, while the other receives too many nutrients. As a result, one twin becomes very large while the other remains small and undernourished.

TTTS only occurs in about 1 in every 1,000 pregnancies, yet it can be quite damaging when it does occur. It can result in poor fetal development, heart failure, brain damage, or even fetal death if left untreated. To ensure that you receive necessary treatment for TTTS, be on the lookout for symptoms including rapid maternal weight gain, premature contractions, and abdominal pain or tightness.

Preeclampsia
Preeclampsia is a relatively common complication in all types of pregnancies. It usually occurs in the second trimester and is characterized by high blood pressure levels and large amounts of protein in the urine. Women who are pregnant with twins or multiples are at an increased risk of suffering from preeclampsia. In fact, between 10% and 20% of all women experiencing multiple pregnancies will develop some form of preeclampsia.

When kept under control, preeclampsia does not pose any risk to you or your babies. However, if left untreated, preeclampsia can lead to severe complications including preterm labor and HELLP syndrome. Symptoms to watch out for include high blood pressure, swelling of the face and hands, as well as fever or headaches.

Conjoined Twins
Conjoined twins are a very rare complication of multiple pregnancies, occurring in fewer than 1 in 400,000 births. Conjoined twins form when your fertilized egg does not split completely into two separate balls of cells. Instead, the two halves of the egg remain attached at some point and the cells of each baby become mixed up. This causes the two babies to grow into one another. There are many different types of conjoined twins, classified according to where on the body they are attached.

Unfortunately, the majority of conjoined twins are stillborn or die within 24 hours of birth. This is because many conjoined twins share vital organs with one another. Conjoined twins that do survive are typically separated at birth, but this can be a very risky and complicated surgery.

Preventing Complications in Twin and Multiple Pregnancies
The vast majority of multiple pregnancies are free of complications. However, it is still important to be aware of the possible health risks that can take place. Though it is impossible to prevent all pregnancy complications, there are some steps that you can take to ensure that you and your babies remain healthy and happy during these nine months.

• Attend all of your prenatal appointments.
• Get confirmation of your multiple pregnancy as soon as possible.
• Maintain a healthy pregnancy diet.
• Stay well hydrated.
• Be aware of the signs and symptoms associated with major pregnancy complications.

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