Special Considerations For Twins, Triplets and Multiples

It is no surprise that multiple births are increasing.  Ordinarily, the rate of “twinning” (having twins) is one out of every 80 pregnancies, and triplets is one out of every 7,000 pregnancies.  With in vitro fertilization and ovulation-enhancing drugs, the rate of multiple births can increase five to 40 percent, depending on the specific technique or drug used.  These are considered high-risk pregnancies, so doctors must be prepared for known complications.

Multiple Births:  Terminology

    • Identical twins:  one fertilized egg divides into two, creating identical (monozygotic) twins
    • Fraternal twins: two separate eggs are separately fertilized, creating non-identical (dizygotic) twins
    • In vitro fertilization:  process of fertilizing eggs outside of the womb, and implanting them after fertilization
    • Monochorionic:  one placenta for multiple babies
    • Diamnionic:  two amniotic sacs (one for each baby)

Complications of Multiple Gestation

Obstetricians, their staff and nurses are responsible for all of their patients, including the mother and all unborn babies.  Multiple pregnancies are more likely to involve the following complications, which the health care team must be prepared for:

    • Preterm labor (on average, twins are delivered between 36 and 37 weeks, and triplets are delivered between 33 and 34 weeks)
    • Cervical incompetence
    • Twin-to-Twin Transfusion Syndrome: Twins that have separate amniotic sacs and a shared placenta are at risk of developing twin-to-twin transfusion syndrome (TTTS), where blood moves from one twin to the other.  Treatment may require repeated amniocentesis during pregnancy (reducing the amount of amniotic fluid to reduce preterm contractions), and possibly laser surgery to stop the flow of blood.
    • Cerebral palsy  or developmental delays:  Doctors must closely monitor the condition of all babies before delivery to ensure that they each have adequate oxygen.  Failure to do so, or failure to order a timely cesarean section, can cause cerebral palsy or developmental delay injuries.

One of the most pressing issues with multiple births is the method of delivery.  For twins, obstetricians must identify how each baby is presenting, whether vertex (head down) breech (butt down) or transverse (sideways).  If all babies are vertex, they should undergo a trial of labor with cesarean reserved as necessary.  When the first baby is breech and the second is vertex, a trial of labor is also appropriate.  However, if the first baby is breech, or both babies are breech, cesarean section is usually necessary.  Triplets are typically all delivered by cesarean section.

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If your child has cerebral palsy, developmental delays or other injuries as a result of a doctor or other health care provider acting negligently in a multiple birth situation, contact our medical malpractice lawyers at (855) 712-7818 or online for a free consultation.

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