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Risks and complications of IVF treatment

The maternal and fetal risks of multiple pregnancy

Whereas twins are frequently viewed by couples as a favorable outcome, triplets and higher order multiple pregnancies are associated with significant risks both mother and child. The risk of these complications arising must be balanced against the number of embryos transferred and the corresponding increase in success rate.

Maternal risks associated with multiple pregnancy

  • Miscarriage
  • Hemorrhage
  • Pregnancy induced high blood pressure
  • Pre-eclampsia occurs three to five times more frequently
  • Diabetes
  • Anemia
  • Polyhydramnios (excessive amounts of amniotic fluid that surrounds the fetus)
  • Caesarean section is often needed in twin pregnancy, and almost always required for triplets or more
  • Prolonged hospitalization resulting in higher cost of medical care

Fetal complications associated with multiple pregnancy

  • Preterm delivery. The average length of a pregnancy is 39 weeks for a single pregnancy, 35 weeks for twins and 33 for triplets. Preterm delivery occurs over 50% in twin pregnancy and in 90% of triplets.
  • Multiple pregnancy has a four-fold increase in the rate of preterm delivery and low birth weight compared to single pregnancy. The proportion of twins and triplets delivering before 30 weeks pregnancy is around 7% and 15% respectively. These babies are more likely to suffer serious, lifelong, health problems, such as cerebral palsy and disability. The risk per pregnancy producing a child with cerebral palsy is 8 times greater in twin pregnancies and 47 times greater in triplet pregnancies than in singleton pregnancies.
  • Low birth weights. This is more frequent in multiple pregnancy. The lifelong disability is over 25% for babies weighing less than 1 Kg.
  • Stillbirth rates and neonatal death rates. For example, for a single birth the incidence is less than 1%, for twins 4.7% and for triplets 8.3%.
  • Birth defects are twice as common as in single birth.
Week of pregnancy 23 24 25 26 27 28
Moderate to severe handicap 65% 50% 40% 20% 15% less than 10%
Survival rate 15% 45% 60% 75% 80% 90%

An enquiry into quality of care and its effect on the survival of babies born at 27-28 weeks. CESDI Project 27/28, 2003

EPICure study, New England Journal of Medicine, 2005

Other problems

Multiple pregnancy is associated with more sickness, fatigue, heartburn, lack of sleep and financial difficulties etc.

Monozygotic (Identical) and Dizygotic (Non-identical) twins

Twins born as a result of two embryos implanted are usually non-identical. However, in about 4% of cases they can be identical as one embryo may fail to implant, while the second divides into two. The perinatal mortality risk among monozygotic twins has been reported to be two to three times higher than the risk among dizygotic twins. The rate of monozygotic twins increases with the use of ovulation induction, assisted hatching and ICSI.

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Last updated: Sat, 15 Oct 2005 - 0:22:57
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