Multiple birth

Our approach

If you found out you are having twins, or possibly even more babies, you are certainly not alone. The incidence of multiple births has increased rapidly over the years through the popularity of treatments such as in-vitro fertilization (IVF) and women waiting to conceive at a later age in life.

Throughout your pregnancy, you will need extra monitoring from our maternal fetal medicine specialists who are skilled in providing comprehensive care for multiple gestations. This high-risk, fellowship-trained team works closely with obstetricians to ensure that each woman receives personalized care to provide the healthiest outcome for moms and their babies.

While the use of fertility methods has gained momentum, Northwell Health fertility specialists have improved IVF techniques to such a degree that they are better able to control the number of embryos implanted, and reduce the chances of multiples greater than twins or triplets.

Overview

Multiple birth is defined as twins or higher order of multiples, including triplets, quadruplets, quintuplets, sextuplets, septuplets, etc.

When more than one fertilized egg implants into the uterus, multiple births occur. When the fertilized egg splits into two or more embryos, identical twinning occurs, which is associated with unique pregnancy complications. When each egg has its own embryo, fraternal twinning takes place. 

Risk factors

The number of placentas (chorionicity) is one of the chief factors that determine your risk for pregnancy complications. If the twins each have his or her own placenta (dichorionic, diamniotic twins), they are considered the lowest-risk type of multiples, usually delivering only two to three weeks before your due date. A vaginal delivery is possible based on the babies’ positions.

Multiple birth is linked with elevated risk for almost every pregnancy complication. There is a greater chance of gestational diabetes, hypertensive disease, preterm delivery, C-sections (and higher risk C-sections) as well as fetal growth restriction. However, with our team's proactive approach to care, you’ll be in good hands throughout your pregnancy.

There are several other factors associated with having a multiple pregnancy. Factors that occur naturally include:

  • Heredity — Family history of multiple pregnancy increases your chances of having twins.
  • Age — Women over the age of 30 have an increased chance of multiple birth. If you plan on postponing having children until later in life, there is a chance you could have twins as a result.
  • History — If you’ve had children, and especially if you’ve had a multiple pregnancy in the past, your chances of having multiples is increased.
  • Race — African-American women have an elevated chance of having twins. Asian and Native Americans have the lowest chance.

Reproductive technologies have increased the multiple birth rate immensely. These technologies include:

  • Ovulation induction — Medications like clomiphene citrate and follicle stimulating hormone (FSH) assist in stimulating egg production. If multiple eggs are fertilized, it can result in multiple babies.
  • Assisted reproductive technologies — IVF and other methods can help couples conceive. Sometimes, these technologies use ovulation-stimulating medications to produce numerous eggs, which are then fertilized and returned to the uterus to mature.

Symptoms

Every woman experiences the symptoms of multiple births differently. Some common symptoms include:

  • Uterus is larger than anticipated for particular point in pregnancy
  • Increased morning sickness
  • Increase in appetite
  • Weight gain early on in pregnancy
  • Fetal movement felt in several parts of abdomen at the same time
  • Earlier onset of contractions or uterine cramping

Diagnosis and testing

Our experts diagnose the type of multiple birth early in pregnancy so you can have the outstanding prenatal care you deserve. In addition to a comprehensive medical history and physical examination, our team will make a diagnosis through the use of:

  • Pregnancy blood testing — Levels of human chorionic gonadotrophin (hCG) could be elevated with multiple pregnancy.
  • Ultrasound — Ultrasound technology is a diagnostic imaging technique that creates images of blood vessels, tissues and organs. Ultrasounds are used to assess internal organs and to gauge blood flow through various vessels. With a multiple birth, it is critical to determine the chorionicity using transvaginal ultrasound in the first trimester.

Treatments

The following treatment options are used for women with multiple births:

  • Labor and delivery services — Northwell Health offers labor and delivery facilities with top-notch quality and a compassionate team. Our staff members are dedicated to providing you with a family-oriented approach to childbirth. Our team is supported by a wide array of adult and neonatal specialists, capable of providing expert care for any complication before, during or after your delivery.
  • Fetal monitoring — Noninvasive tests that monitor the health and well-being of the babies, including biophysical profile, nonstress tests and Doppler studies.
  • Neonatal Intensive Care Unit — Newborns who need intensive medical attention, such as those that deliver early are typically admitted into a special area of the hospital called the neonatal intensive care unit (NICU).

Maternal Fetal Medicine

When your pregnancy requires special care...

Our fellowship-trained physicians provide specialized care for women with high-risk pregnancies and work collaboratively with genetics counselors, nurses, neonatologists and pediatrics subspecialists to provide the best possible outcomes for each baby.