Multiple Pregnancy

Being pregnant with more than one baby twins, triplets, quadruplets or more comes under multiple pregnancy. A multiple pregnancy can be a little different from a single pregnancy. Heres more information about multiple pregnancies.

Last Updated: 22 October 2020

Multiple Pregnancy
Multiple Pregnancy

How does a multiple pregnancy occur?

A multiple pregnancy can occur in the following ways?

·         When your ovaries release two or more eggs during ovulation and each of the eggs is fertilized by a sperm, it results in a multiple pregnancy. Such a twin pregnancy which is formed from two eggs develops to fraternal twins.

·         When the single egg your ovary released is fertilized by a sperm and later got divided into two, it forms two embryos that would develop into identical twins.

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What causes a multiple pregnancy?

A multiple pregnancy can occur because of one or more of the following reasons:

·         A family history of twins or triplets pregnancy

·         The use of a fertility drug to induce ovulation

·         Conception by in vitro fertilization (IVF)

·         The mother is more than 35 years old at the time of conception.

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How are multiple pregnancies identified?

If you are pregnant with twins, triplets or quadruplets, you may not experience specific symptoms. For some, there can be higher levels of morning sickness, breast tenderness or weight gain. Multiple pregnancy can be confirmed only by an ultrasound scan during which the presence of two or more embryos and two or more distinct heartbeats can be identified.

What are the risks and complications of multiple pregnancies?

A healthy multiple pregnancy is not rare, though it is common for some of the higher order pregnancies (three or more) to be associated with risks and complications including:

Premature birth

A normal single pregnancy proceeds to full term, that is, 40 weeks. However, with multiple pregnancies, pregnancy usually does not last until 40 weeks. More the number of multiples, higher are the chances for preterm labor and birth. The average gestational age for multiple births is:

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·         Twins: 37 weeks

·         Triplets: 34 weeks

·         Quadruplets: 32 weeks

Risks of miscarriage

A multiple pregnancy carries a risk for miscarriage before 20 weeks of pregnancy. While twin and triplet pregnancies which survive till 20 weeks of pregnancy are more likely out of miscarriage risks, they carry a very small percent of stillbirth risk anytime before or during birth.

Low birth weight

Babies of multiple births most commonly have low birth weight. To reduce the survival risks of low birth weight babies, they will be put under intensive neonatal medical care until their organs are matured enough to survive independently in the outside world.

Gestational diabetes

The risk for gestational diabetes increases with the increase in the number of babies. If you are diagnosed with gestational diabetes, you will be closely monitored throughout your pregnancy for your sugar levels and need to be on a strict diet and exercise regime and medication in some cases if necessary.


Preeclampsia is a high blood pressure disorder during pregnancy which can pose serious complications for the mother and baby. Carrying twins, triplets or more babies increases the chances of preeclampsia risk during pregnancy.

Do babies of a multiple pregnancy share the same placenta and amniotic sac inside the womb?


In single pregnancy, the fetus is connected to the placenta for the supply of nutrients and waste elimination. The fetus is also protected by the amniotic sac which consists of two membranes – an inner membrane (amnion) and an outer membrane (chorion).


The accommodation of babies of a twin pregnancy can be of three different forms as follows (applies to triplet pregnancies too):

·         Dichorionic-diamniotic Twins: Each of the babies have their own placenta and their own inner and outer membranes.

·         Monochorionic-diamniotic Twins: Each of the babies share the same placenta and the same outer membrane but has separate inner membranes.

·         Monochorionic-monoamniotic Twins: They share the same placenta, inner and outer membranes.

How are babies of multiple pregnancies delivered?

Though a caesarean delivery is not mandatory for birthing multiple babies, it is highly recommended as the safest option. The risks of natural delivery of multiple births are:

·         If two or more babies share a placenta during pregnancy, there is a high risk for the baby yet-to-be delivered during a vaginal birth.

·         With multiple births, the chances of all the babies to be aligned in the head down and birthing position until all are delivered may not always be possible.

·         There is an increased risk for umbilical cord entanglement with multiple pregnancy in a normal delivery.

What additional care should be taken for multiple pregnancies, labor and birth?

·         It is important to take keen care of the nutritional requirements your twins, triplets or quadruplets will need during pregnancy. You will need to take additional amounts of calories than a pregnant mother carrying a single baby. Speak with your doctor about the right amount of calorie intake so that you are neither under supplying required nutrition to your babies and yourself nor accumulating excess calories in your body.

·         Carrying multiples is associated with risks. Being alert and aware of the possible complications and regular monitoring with your doctor should be given high priority during pregnancy.

·         As premature labor is common with multiple pregnancies, you must be prepared for labor anytime after 30 weeks, though by rare chances, one may go into labor earlier than 30 weeks. Report to your doctor immediately if you spot any signs of labor such as water breaking, labor contractions or mucus plug release.

·         Soon after birth, your babies may need additional survival support in a neonatal intensive care unit in the hospital. Discuss with your team in the hospital beforehand about what to expect during the first few days after delivery.



Multiple Pregnancy. The American College of Obstetricians and Gynecologists.

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