Multiple pregnancy: pregnant with twins or triplets

A twin or even triplet pregnancy is usually a big surprise for the parents. Suddenly the planning has to be completely different. But how does a multiple pregnancy occur in the first place – and can twins be born normally??

  • Emergence
  • Course
  • Complications
  • Birth

Pregnant woman with two hearts on her belly: twins as a form of multiple pregnancy

Multiple pregnancy: often not a coincidence

A multiple pregnancy exists when more than one embryo is growing in the woman’s body. By far the most common type are twins, i.e. two children of the same parents, created during one pregnancy.


In 2016, 14 women gave birth.635 women in Germany have multiple pregnancies. Of these, 14.371 sets of twins, followed by 258 births of triplets. Only six women gave birth to more than three babies at the same time. In 785.000 births in total, twins in particular are not as rare as one might think. 1

Pregnancy with twins and even triplets occurs more often in women who have Hormone preparations, for example, to increase fertility, have taken. Also in the context of a artificial insemination multiple pregnancies occur more frequently because, for example, several fertilized eggs are implanted during in vitro fertilization. If more than one embryo develops from this, multiples are created.

In women who experience a multiple pregnancy naturally, there is often a familial predisposition. It is estimated that a woman is twice as likely to have twins if her sister has already given birth to twins. However, this only applies to fraternal twins. In addition, the likelihood of a multiple pregnancy increases with the age of the woman.

Pregnant with twins: What does identical and fraternal mean??

Identical twins are a freak of nature. In the process, one of the woman’s eggs is fertilized in her body. However, in the first few days after fertilization, this egg divides in such a way that two embryos are created. The babies have exactly the same DNA, accordingly the same sex, and later look confusingly alike.

At fraternal twins two eggs are fertilized in the fallopian tube. The resemblance of these children is not stronger later than in other siblings. A boy and a girl can also be born.

Course of a multiple pregnancy

A pregnancy with twins or triplets is automatically classified as a high-risk pregnancy. That is why there are more frequent checkups than in regular pregnancies.

Nonetheless, pregnancy occurs at Many multiple pregnancies have no complications at all. But how exactly does a multiple pregnancy proceed and what must be paid attention to??

A multiple pregnancy puts a greater strain on the mother

A multiple pregnancy is generally more stressful for the pregnant woman. The body has to carry more weight, which is a challenge for joints, muscles and connective tissue. Mothers of twins and triplets complain more often about typical pregnancy symptoms. These include:

  • Edema (water retention)
  • Indigestion

It is often recommended to take nutritional supplements, including iron, iodine and calcium.

Above all In the last trimester, women must be careful not to try too hard, as this favors the onset of labor. To make sure twins or triplets are doing well toward the end of the pregnancy, doctors perform a pregnancy test starting at 28 weeks. In the first week of pregnancy, the mother carries out a weekly CTG check (measurement of the strength of contractions and the heartbeat of the children). In a multiple pregnancy, premature birth is not uncommon.

Possible complications of a multiple pregnancy

For the course of the multiple pregnancy it is first of all important, at which point the egg splits openIf this happens quite early, so-called dichorial twins are formed. Each embryo then has its own amniotic cavity, placenta and egg skin. This is medically advantageous because both babies can be ideally cared for in this way.

If splitting occurs later in an identical twin pregnancy, both embryos may have to share a placenta (monochorial twins). In addition, it happens that the twins are in only one amniotic cavity (monoamniote monochorial twins). In these cases, there may be complications in caring for the babies as the pregnancy progresses, as the umbilical cords may become tangled and cut off.

Placental insufficiency more likely in twin pregnancies

Nutrient supply to the baby is also at risk if the mother suffers from placental insufficiency (lack of function of the placenta). Since the placenta is more heavily utilized when there are several babies, a deficiency supply is more likely in this case. This restricted function of the placenta can cause severe developmental disorders in the unborn child. Placental insufficiency can be recognized primarily by:

  • Bleeding and cramps in the mother
  • Slowing of the heartbeat in the baby
  • severe lack of oxygen supply to the child

If placental insufficiency is detected, the expectant mother must take care of herself. The treatment includes the administration of medication and careful medical observation. These drugs are intended to counteract the threat of developmental disorders in the unborn child.

Thrombosis risk increased in multiple pregnancies

When a vessel is completely blocked or narrowed by small clots of clotted blood, it is called a thrombosis. Due to the altered hormonal balance, blood clotting no longer functions properly in some pregnant women, resulting in the formation of clots that can lead to phlebitis in the leg veins. This is expressed primarily by painful, swollen legs. In most cases, however, these symptoms are only the result of water retention in the legs. In rare cases, the blood clot may travel through the bloodstream to the lungs, leading to pulmonary embolism (blockage of pulmonary arteries).

In addition to Overweight and higher age during pregnancy Multiple pregnancy also a risk factor for the development of thrombosis. Because women pregnant with twins or triplets are generally under more stress, they need to rest more often, which may prevent them from getting enough exercise. Since lack of exercise poses a high risk of thrombosis, in this case it is advisable to, thrombosis stockings (available at the pharmacy) to be used, to reduce the risk of a blood clot and thus the threat of thrombosis.

In identical twins, feto-fetal transfusion syndrome is possible

this complication occurs only in identical twins who share a placenta. In this case, sometimes vascular connections are formed between the two umbilical cords. If such a vascular connection exists, feto-fetal transfusion syndrome may develop in rare cases. In this procedure, blood is pumped from one twin (the so-called donor twin) to the other (the recipient twin) with each heartbeat. As a result, a child has too little blood, so it cannot develop normally (also because there is not enough amniotic fluid). The other child receives so much blood that its heart is overtaxed by it. In addition, in the recipient twin, the amount of amniotic fluid increases so drastically that the mother’s abdominal girth increases greatly, causing severe pain.

To In the treatment of feto-fetal transfusion syndrome, the vascular connections are searched for with the help of a fetoscope and then cut with a laser. One speaks then of a fetal laser coagulation. The chance that the multiples will survive is 60 percent if treated early, and the chance that one child will survive is 80 percent. 2

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