Overview

Multiple pregnancy, as the name suggests, is when a woman is pregnant with two or more foetuses. Generally, multiple pregnancies are not very common (only 3 out of 100 births). Multiple pregnancies usually happen when more than one egg is fertilised. Another case of multiple pregnancies may occur when only one egg gets fertilised initially and later splits into two or more embryos. In such cases, the doctor may not be able to detect a twin pregnancy until the 5 weeks’ ultrasound, at it may not get detected just after a few weeks of conception.

Types of Multiple Pregnancies

There are different types of multiple pregnancies categorised based on the number of foetuses a woman is carrying. If there are two foetuses, it is called a twin pregnancy. Similarly, if the number of foetuses is three, it is called a triplet pregnancy; four foetuses are known as quadruplets, and so on. The umbrella term for more than three babies at one time is high-order multiples. However, the most common type of multiple pregnancy is twin pregnancy. Here’s more on the different types of twin pregnancy:

Monochorionic Twin Pregnancy: In this type of pregnancy, both foetuses share one placenta. It is not necessary for these twins to always be identical.

Monochorionic-Monoamniotic Twin Pregnancy: In this type of pregnancy, both foetuses share the same placenta and amniotic sac. Monochorionic-monoamniotic twins are always identical.

Monochorionic-Diamniotic Twin Pregnancy: In this type of pregnancy, both foetuses share a single placenta but not an amniotic sac. These twins are also identical.

Dichorionic-Diamniotic Twin Pregnancy: In this type of twin pregnancy, each foetus has its own placenta and amniotic sac. Although all fraternal (non-identical) twins are dichorionic twins, sometimes identical twins can also be dichorionic diamniotic.

Symptoms

One can only get confirmation about multiple pregnancies with an ultrasound exam. The reason behind this is that usually there is no difference between single and twin pregnancy symptoms, other than a more rapid weight gain. This is one of the early signs of twin pregnancy shown in the first 2 weeks. In some cases, a female can experience more intense symptoms, indicating that it is a twin pregnancy or that she is pregnant with triplets, quadruplets, etc.

Some of the early twin or multiple pregnancy symptoms include:

• Severe morning sickness
• Breast tenderness
• Frequent urination
• Increased appetite

Apart from an ultrasound, getting a blood test done is also one way to determine if there is more than one foetus being carried. In such cases, the female will have high hCG levels and high amounts of the protein alpha-fetoprotein in her bloodstream.

Causes

There are a few factors that can add to the chance of multiple pregnancies, such as:

Heredity: If any of the parents has a family history of multiple pregnancies, it increases one’s chances of having twins, triplets, quadruplets, etc.

Age: Usually, when a female conceives after the age of 30 years, her chances of multiple conceptions increase automatically.

High Parity: In females, parity can be defined as the number of previous pregnancies with gestation periods of more than 20 weeks. The ones with high parity also have a greater chance of getting pregnant with multiples. 

Other than these natural factors, there are a few more things that can cause multiple pregnancies. These are:

Ovulation Stimulating Medicines: Due to certain medical conditions such as infertility or other issues with reproductive health, some women have to take ovulation-stimulating medicines. These medicines often lead to the production of more than one egg. In such a scenario, if fertilisation happens, it may result in multiple pregnancies.

Assisted Reproductive Technologies: For females dealing with infertility, there are several methods, such as in-vitro fertilisation (IVF), that can help them get pregnant. Usually, these methods use ovulation-stimulating medicines to produce multiple eggs, which can be fertilised in the lab and moved back to the uterus to grow. In such cases, the chances of multiple conceptions are also higher.

How to Manage Multiple Pregnancies

Carrying more than one foetus doesn't necessarily mean that the pregnancy will be problematic. However, women with multiple pregnancies do have a higher chance of developing complications. So, it is important to visit the doctor for check-ups on a regular basis. Management of multiple pregnancies can vary from one woman to another, depending on things like:

• Overall health and medical history
• The number of foetuses
• One’s tolerance for specific medications or procedures
• Method of conception

However, there are a few common things that one needs to take care of regardless of the number of foetuses. These are:

Good Nutrition: Every woman needs enough nutrition during her pregnancy, but it gets even more important to consume more calories if she is carrying two or more foetuses. One should take a healthy diet that is rich in protein and provides all other essential nutrients, such as calcium and iron.

Timely Prenatal Check-Ups: It is important to make regular visits to the doctor. With frequent visits, the doctor may find any complications at an early stage, if there are any. This way, any health issues (related to the unborn baby or mother) can be taken care of on time.

Enough Rest: Although pregnancy is not a condition that requires complete bed rest, it becomes necessary in some cases. Usually, the belly size in twin or multiple pregnancy increases rapidly, week by week, a woman may start feeling more discomfort. This is why getting enough rest is advised.

Regular Testing: During pregnancy, it is important to get ultrasounds and other types of tests done as advised. This is required to monitor the health of twins or multiples in the womb week by week. This helps rule out any twin or multiple pregnancy complications.

When to See a Gynaecologist/Obstetrician 

Generally, the best time to visit a gynaecologist/obstetrician is right after taking an at-home pregnancy test. If multiple pregnancies are detected during one of the prenatal visits, regular check-ups become all the more important. To avoid any kind of complications that are associated with multiple pregnancies, it is recommended to visit the doctor for follow-ups without a miss.