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Complications of the Fetus and Newborn with Multiple Gestation
• Preterm birth occurs in over 50% of twin pregnancies, 90% of triplet pregnancies, and virtually all
quadruplet pregnancies.
• Compared to singleton pregnancies, a twin is seven times more likely and a triplet is over 20 times more
likely to die in the first month of life.
• Prematurity is associated with an increased risk of respiratory distress syndrome (RDS), intra-cranial
hemorrhage, cerebral palsy, blindness, low birth weight, and neonatal morbidity and mortality. RDS
accounts for 50% of all neonatal deaths associated with premature birth.
• Intrauterine growth restriction, intrauterine death of one or more fetuses, miscarriage, and congenital
anomalies are all more common.
• Lifelong disability is over 25% for babies weighing less than 1,000 grams (2 lbs., 3 oz.).
Maternal Complications Associated with Multiple Gestation
• Preeclampsia, also called pregnancy-induced hypertension, occurs three to five times more frequently.
Severe preeclampsia may be life threatening.
• Premature labor requiring prolonged bed rest or hospitalization is common.
• Placental abnormalities associated with maternal hemorrhage are more likely to occur.
• Gestational diabetes, anemia, and polyhydramnios (excess amniotic fluid) occur more frequently.
• Cesarean section is often needed for twin pregnancies and almost always required for triplets.
Other Considerations
• Multiple gestation is associated with more nausea and vomiting, anemia, fatigue, weight gain, heartburn, lack
of sleep, financial difficulties, depression, and marital discord.

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