Complications Of Multiple Pregnancy

Working at a fertility centre, I am often asked about twin and triplet pregnancy planning. The prospect of having a set of twins or triplets may seem appealing but it is a big task when it comes caring for them. A multiple pregnancy means that a woman has two or more babies in her uterus. The babies could come from the same or different eggs. Multiple pregnancies bear high-risks. There are increased risks to both mother and babies with high chances of miscarriage during the first trimester. Even after that, an expectant mother is faced with many other challenges.

  1. Preterm labor and birth

According to the March of Dimes, about 60% of twins and more than 90% of triplets are born prematurely (before week 37). The average twin pregnancy lasts 35 weeks. Triplet pregnancies average 33 weeks, and quadruplet pregnancies average 29 weeks. Preterm babies may not be completely ready for the external world of the mother’s uterus. Their organs may not have been fully developed and they might not even be able to suck and swallow. They also usually have low birth weight which could lead to many health problems. Breathing on their own could be an issue and they are unable to fight against infections and control their body temperature. Almost all low-birth weight babies have to be put in the neonatal intensive care unit (NICU) before going home, and there are also the hospitalization risks.

2. Preeclampsia

It is a serious condition characterized by high blood pressure and protein in the urine. It develops in about 10% to 15% of women carrying twins; two to three times the rate of women carrying a single baby. Once preeclampsia starts, it can have life-threatening complications. A severe case could affect the expectant mother and child, causing damage to the mother’s organs, often the kidneys, and placenta.

3. Gestational diabetes

It is more common in women carrying more than one baby. If gestational diabetes is developed, the doctor will monitor the expectant mother closely, paying special attention to her weight and blood glucose level. Most mothers are be able to keep their blood sugar under satisfactory levels through diet control and exercise. However, some women would require insulin injections or oral tablets too. Uncontrolled diabetes during pregnancy could lead to serious consequences for both mother and babies.

4. Placental abruption

It is a condition when the placenta detaches from the uterine wall before delivery, more likely in multiple pregnancies. It can happen any time in the second half of pregnancy and could lead to growth problems in fetuses, preterm delivery or stillbirth. In multiple pregnancies, abruption may occur just after the first baby has been delivered vaginally. Once abruption has occurred, the other baby or babies may have to be delivered by a Cesarean section.

5. Twin-to-twin Transfusion Syndrome

It is a rare but serious complication that occurs in identical twins when they share a placenta and the blood flows from one baby to the other. According to the March of Dimes, 10% to 15% of identical twins develop the syndrome. Treatment for the syndrome is a laser surgery to seal off the connection between the babies' blood vessels.

Other than physical complications to mother and babies, multiple pregnancies could also burden a family financially, psychologically and socially if not planned properly. Please talk to your doctor if you have concerns about multiple pregnancy complications if you’re put on controlled ovarian hyper stimulation when you are doing an assisted reproductive technology procedure. After all, prevention is better than cure. However, if you have conceived multiple pregnancy naturally, feel free to discuss with your doctor on methods of reducing the complication risks.


Written by:

Ms Tan Mei Yuen has completed her diploma in nursing from SEGi university. Ms Tan then further pursued her bachelor of nursing science with honours in Open University Malaysia and majoring in Paediatric nursing, renal nursing and intensive care nursing. 7 out of 500 graduates have passed their nursing degree with distinction in nursing school, she is 1 of the 7.

She became a registered nurse in Tropicana Medical Centre(TMC) since year 2011. Since 2011, she was posted in Tropicana Medical Centre, Fertility Centre. Ms Tan obtained her Reproductive Endocrinology and Infertility(REI) nursing certification with flying colours from American Society of Reproductive Medicine(ASRM) on year 2014. Ms Tan is currently a Senior Registered Nurse in charged in TMC fertility centre.

She is actively involved in many quality initiatives for the centre and organising varies fertility public forum to create fertility awareness for Malaysia society. Her biggest wish is to create awareness to young married couple to trying conceive as early as possible because she believe any delay in trying to conceive will decrease their chances in conceiving later, with more expensive price.

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