Multiple Births Treatment & Management

Updated: Dec 20, 2019
  • Author: Garth E Fletcher, MD; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Medical Care

Obstetric medical care is specific to the type of multifetal pregnancy. The highest risk is in monochorionic/monoamniotic pregnancies. An inherent risk of other conditions (ie, preterm labor, intrauterine growth retardation [IUGR], hypertensive diseases) is also found in multiple-fetus pregnancies.

In a systematic review and meta-analysis of 32 studies, Cheong-See et al investigated the risks of stillbirth and neonatal complications by gestational age in uncomplicated monochorionic and dichorionic twin pregnancies. They found that neonatal morbidity rates showed a consistent reduction with increasing gestational age in both monochorionic and dichorionic pregnancies. Based upon their findings, the investigators recommend that to minimize perinatal deaths, delivery should be considered at 37 weeks' gestation in uncomplicated dichorionic twin pregnancies and at 36 weeks in monochorionic pregnancies. [14]

In a retrospective, multicenter US cohort, Lappen et al compared the outcome of attempted vaginal delivery versus planned cesarean delivery of triplets. Eighty sets of triplets met inclusion criteria; 24 sets (30%) had an attempted vaginal delivery, with a success rate of 16.7%. Compared with planned cesarean delivery, attempted vaginal delivery was associated with a higher risk of maternal transfusion (20.8% vs 3.6%, P = 0.01) and neonatal mechanical ventilation (26.4% vs 7.7%; adjusted incidence rate ratio, 1.12; 95% confidence interval, 1.01-1.24). [22]

Neonatal medical care is dictated by general and specific morbidities. Many neonates require only routine newborn care; others require neonatal intensive care secondary to prematurity, low birth weight, and their associated complications. Refer to specific Medscape Drugs & Diseases neonatology articles for more information.

Medication requirements vary depending on specific comorbidities. Refer to the relevant Medscape Drugs & Diseases topics for specific complications.



A woman with a multiple-gestation pregnancy may benefit from a consultation with a perinatologist.

A neonatologist may be involved during prenatal counseling and in the postnatal care of multiple-birth infants, particularly if the births are premature or congenital anomalies are present.

Special concerns

The impact of neonates from multifetal pregnancies on the family has been studied. Increased incidence of maternal depression, poor parent satisfaction with parenting, child abuse, and sibling behavior problems have all been associated with multifetal pregnancies. [23]