What You Need to Know About Multiple Pregnancies

Multiple Pregnancy: Pregnancies with Twins or More Babies Pregnancy is an exciting time for expectant mothers. However, sometimes this excitement can intensify when more than one baby develops in the mother's womb. This condition is known as multiple pregnancy. The most common type is twin pregnancies, but triplet, quadruplet, and higher-order multiple pregnancies are also possible. The incidence of multiple pregnancies has increased with assisted reproductive techniques (such as in vitro fertilization). How Does Multiple Pregnancy Occur?

Multiple pregnancies fall into two main types: Identical twins (monozygotic twins): They form when a single fertilized egg splits into two early in development. The babies are genetically identical; their gender and physical characteristics are generally similar. Popularly known as "identical twins". Fraternal twins (dizygotic twins): It occurs when two separate eggs are fertilized by two separate sperm within the same month. The babies are genetically different; their genders may also be different. In pregnancies involving triplets or more, both single-egg and multiple-egg fertilization combinations may be observed.

Risks and Challenges Possible risks for the mother: Premature birth: Most multiple pregnancies result in birth before 37 weeks. Gestational hypertension and preeclampsia Gestational diabetes Anemia (anemia) Birth complications: The frequency of cesarean section increases. Possible risks for babies: Low birth weight Respiratory and nutritional problems due to premature birth Specific complications in identical twins, such as twin-to-twin transfusion syndrome (TTTS) How Is the Diagnosis Made? Ultrasonography (USG): Multiple pregnancy can be detected by USG in the early period. Beta-hCG hormone level: In multiple pregnancies, the pregnancy hormone may be higher than normal. Excessive nausea or an unusually large uterus size in the expectant mother may also be indicative.

USG is of critical importance for determining the placenta and membrane structure in babies; because this information directly affects pregnancy monitoring. Monitoring and Birth Process In multiple pregnancies, check-ups are performed more frequently. Additional nutritional support and vitamin/mineral supplementation are recommended (iron, folic acid, calcium, protein). The baby's growth is monitored regularly, and the placenta and amniotic fluid are also checked regularly. The mode of delivery is determined based on the babies' position, gestational age, and health condition. In twin pregnancies, if one of the babies is not in the vertex position, cesarean section is usually preferred. Psychological and Physical Support Multiple pregnancies can place greater physical and emotional strain on the expectant mother: Increased weight gain, sleep problems, back pain Difficulties with postpartum care Therefore, it is important to receive support from close family members and, if necessary, psychological support. References:

• American College of Obstetricians and Gynecologists (ACOG). Multiple Gestation: Twin, Triplet, and Higher-Order Multifetal Practice

• Blickstein I, Keith LG. Multiple Pregnancy: Epidemiology, Gestation & Perinatal Outcome. 3rd ed. Taylor & Francis; 2015.

• Cunningham FG, Leveno KJ, Bloom SL, et al. Williams Obstetrics. 25th ed. McGraw-Hill; 2018.

• Hack KE, et al. Twin pregnancies: short-term and long-term outcomes. Semin Fetal Neonatal Med. 2008;13:265–274.

• Luke B, et al. Maternal and perinatal outcomes in multiple gestations. Obstet Gynecol. 2007;109:1041–1048.