Multiple Pregnancy – Risks and Complications

Twin pregnancy risks

Healthy twins and multiples are born every day. But it’s also important to be aware of the risks and complications that usually occur in a multiple pregnancy.

The rate of having twins or multiples has particularly increased in recent times, due to fertility techniques such as ovulation stimulation, artificial insemination and IVF. The risk of complications with twins and multiples are also plenty – which is why, some fertility clinics counsel patients undergoing fertility treatment about their chances of having twins or multiples.

Some Common Risks And Complications In Multiple Pregnancies

Preterm Labor

The average length of a pregnancy is 39 weeks for a single pregnancy, 35 weeks for twins and 33 for triplets. Preterm labour – where contractions begin to open the cervix before week 37 – occurs over 50% in twin pregnancy and in 90% of triplets. Sometimes preterm labor can be stopped with fluids, rest or medication.

Preterm Birth

If preterm labor can’t be stopped, your babies may be born too early – the most common problem for multiples. When this in anticipated, you may be given injections of a steroid medication to speed your babies’ lung development. Even then, the smallest preemies may fight to survive. Complications may include low birth weight, breathing and digestive difficulties, underdeveloped organs, learning disabilities and developmental problems.

High Blood Pressure

Mothers of multiples are more likely to develop high blood pressure during pregnancy. By reducing blood flow to the uterus, this condition – known as preeclampsia – may deprive the babies of oxygen and nutrients. It is characterized by a sudden rise in blood pressure, excessive weight gain, swelling, severe headache, visual disturbances, and excessive protein in the urine (proteinuria). Severe preeclampsia can be life threatening.

Twin-Twin Transfusion

With identical twins, it’s possible for a blood vessel in the placenta to connect the babies’ circulatory systems – causing one baby to receive too much blood and the other too little. Often, babies in this situation are delivered as soon as the benefits of early birth outweigh the potential problems of prematurity.

Vanishing Twin

A phenomenon called the vanishing twin syndrome in which more than one fetus is diagnosed, but vanishes (or is miscarried) usually in the first trimester is more likely in multiple pregnancies. This may or may not be accompanied by bleeding. If this is early in the pregnancy then it is possible that the mother’s body will simply absorb any remaining tissue. If it happens late in the pregnancy then very close observation and follow-up is required. The risk of pregnancy loss is increased in later trimesters as well.


Stillbirth rates and neonatal death rates are relatively higher in twin and multiples. For example, for a single birth the incidence of stillbirth is less than 1%, for twins 4.7% and for triplets 8.3%.

Birth Defects

Twins and multiples have about twice the risk of congenital (present at birth) abnormalities including neural tube defects (such as spina bifida), gastrointestinal, and heart abnormalities.

Caesarean Birth

About 50 per cent of women carrying twins deliver their babies by
C-section – especially if the babies aren’t in a head-down position.
C-sections are considered safer for triplets and higher order multiples.

Bleeding After Delivery

The risk of excessive bleeding after delivery increases with a larger placenta or multiple placentas. Your doctor will be prepared to help with medications or other interventions if needed.

Caring For Multiples

Healthy multiples have the same needs as other newborns. You, however, may need more rest and support than you imagined. Take time to enjoy your babies – and ask friends, loved ones and others for help.

While many complications of twin pregnancies have little to do with your behaviour or lifestyle, getting an early confirmation that you are indeed carrying twins will give your Doctor plenty of time to anticipate and treat any complications that may crop up.

Tips & Tricks