Merck Manual

Please confirm that you are a health care professional

honeypot link

Multifetal Pregnancy

By

Julie S. Moldenhauer

, MD, Children's Hospital of Philadelphia

Last full review/revision Jul 2021| Content last modified Jul 2021
Click here for Patient Education

Multifetal pregnancy is presence of > 1 fetus in the uterus.

Multifetal (multiple) pregnancy occurs in up to 1 of 30 deliveries.

Risk factors for multiple pregnancy include

Complications

Multifetal pregnancy increases the risk of

  • Twins: 35 to 36 weeks

  • Triplets: 32 weeks

  • Quadruplets: 30 weeks

Fetal presentation may be abnormal. The uterus may contract after delivery of the first child, shearing away the placenta and increasing risk for the remaining fetuses. Sometimes uterine distention impairs postpartum uterine contraction, leading to atony and maternal hemorrhage Postpartum Hemorrhage Postpartum hemorrhage is blood loss of > 1000 mL or blood loss accompanied by symptoms or signs of hypovolemia within 24 hours of birth. Diagnosis is clinical. Treatment depends on etiology... read more .

Some complications develop only in multifetal pregnancies. An example is twin-twin transfusion syndrome (when twins share the same placenta; this syndrome results in vascular communication between the two, which can lead to unequal sharing of blood).

Diagnosis

  • Prenatal ultrasonography

Multifetal pregnancy is suspected if the uterus is large for dates; it is evident on prenatal ultrasonography.

Treatment

  • Cesarean delivery when indicated

Cesarean delivery Cesarean Delivery Cesarean delivery is surgical delivery by incision into the uterus. Up to 30% of deliveries in the US are cesarean. The rate of cesarean delivery fluctuates. It has recently increased, partly... read more is done when indicated. Cesarean delivery is recommended for twins unless the presenting twin is in vertex presentation. Higher-order multiples are typically delivered by cesarean regardless of presentation.

Key Points

  • In multifetal pregnancies, the overdistended uterus tends to stimulate preterm labor, resulting in preterm delivery.

  • Check for other possible complications, such as preeclampsia and gestational diabetes, and prepare for preterm delivery, cesarean delivery, and postpartum hemorrhage.

  • If the uterus is large for gestational age, do ultrasonography.

  • For most multifetal pregnancies, deliver by cesarean unless the presenting twin is in vertex presentation.

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Professionals also read
Test your knowledge
Management of Normal Delivery
Options for pain management during normal delivery include regional, local, and general anesthesia. Of these types of anesthesia, which of the following is a safe and simple method for uncomplicated spontaneous vaginal deliveries in women who wish to bear down and push?
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
TOP