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Risks and complications of IVF treatment
Why are multiple pregnancies a problem?
If all twins, triplets, and quads were born as healthy as singletons there would not be any concerns. Unfortunately, multiple pregnancies have much higher risks than singletons for the fetuses and also for the mother. 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. 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 of producing a child with cerebral palsy is 8 times greater in twin pregnancies and 47 times greater in triplet pregnancies than in singleton pregnancies.
- Multiple pregnancies have a four-fold increase in the rate of low birth weight compared to single pregnancy. The risk of lifelong disability is over 25% for babies weighing less than 1 Kg.
- Stillbirth rates and neonatal death rates are higher for multiple pregnancies compared to singletons. 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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