Multiple pregnancy is a type of pregnancy in which more than one fetus develops in the woman’s body. Over recent decades, the incidence of multiple pregnancy has increased significantly and ranges from 3 to 40 cases per 1,000 births, depending on the region, predominant population characteristics, the prevalence of assisted reproductive technologies (ART), and regulations regarding the number of embryos transferred during ART cycles.
In multiple pregnancy, perinatal risks are significantly higher than in singleton pregnancy. For this reason, multiple pregnancy and childbirth are classified as high-risk or complicated pregnancies.
Main complications of multiple pregnancy
Maternal complications
The most common maternal complications include disorders that may arise at different stages of gestation.
- In the first trimester, conditions such as pregnancy-related vomiting (early toxicosis) and threatened miscarriage may occur, caused by hormonal and immunological changes.
- In the second trimester, the risk of pregnancy-related anemia, gestational diabetes mellitus (GDM), preeclampsia (PE), urinary tract infections, and polyhydramnios increases, requiring timely diagnosis and close follow-up.
Fetal complications
- Pathological pregnancy course is often accompanied by complications affecting fetal development and condition:
- Congenital malformations — resulting from genetic factors, infections, toxins, or maternal endocrine disorders.
- Fetal growth restriction (FGR) — a consequence of chronic placental insufficiency leading to fetal weight and size below gestational age norms.
- Vanishing twin phenomenon — a clinical situation in which one fetus in a multiple pregnancy ceases development at an early stage, most commonly in the first trimester and detected by ultrasound.
- Discordant fetal growth and persistent critical blood flow in the umbilical artery of one fetus (selective intrauterine growth restriction, sIUGR) is a complication defined by a difference in estimated fetal weight of more than 20% between the fetuses.
Main pathologies of multiple pregnancy
- Preterm birth. Multiple pregnancy significantly increases the risk of preterm delivery, which may lead to fetal organ immaturity, especially of the lungs, which requires specialized neonatal care.
- Twin-to-twin transfusion syndrome (TTTS). Occurs in monochorionic twins when blood flow is unevenly distributed through a shared placenta, leading to anemia in one fetus and cardiac overload or failure in the other. This is one of the most severe complications of multiple pregnancy.
- Growth restriction of one fetus. In multiple pregnancies, particularly monochorionic ones, unequal distribution of resources may result in slower development of one fetus.
- Preeclampsia. Women with multiple pregnancy are at increased risk of developing preeclampsia, characterized by hypertension, urine proteine, and edema, posing a threat to both mother and fetuses.
- Preterm rupture of amniotic fluid sac. The risk is higher in multiple pregnancy and may require urgent medical intervention.
- Twin reversed arterial perfusion (TRAP) sequence. A rare complication in which one fetus lacks a functional cardiovascular system and receives blood from the healthy fetus, creating a serious risk for the donor twin.
Diagnosis of multiple pregnancy complications
Management of multiple pregnancy in Belarus includes regular examinations aimed at early detection of complications. The main diagnostic methods include:
- Ultrasound examination. Performed more frequently than in singleton pregnancy to monitor fetal condition and growth, assess placental status, detect TTTS, and identify growth restriction.
- Doppler ultrasound. Assessment of blood flow in the umbilical vessels, uterine arteries, and fetal vessels, particularly important for diagnosing TTTS and evaluating shared circulation.
- Cardiotocography (CTG). Used in later stages of pregnancy to monitor fetal heart rate and detect signs of hypoxia.
- Blood and urine tests. Performed to monitor maternal condition, including blood pressure, hemoglobin levels, and renal function.
Treatment of multiple pregnancy complications in Belarus
Depending on the identified pathology, treatment may include conservative management or surgical intervention. The main treatment approaches include:
Prevention and treatment of preterm birth
Measures to reduce the risk of preterm delivery include:
- Progesterone therapy to support pregnancy and reduce the risk of preterm cervical dilation.
- Bed rest and reduction of physical activity to lower the risk of preterm labor.
- Hospitalization for close monitoring in cases of threatened preterm birth.
- Tocolytic therapy to temporarily suppress uterine contractions and allow further fetal maturation or preparation for delivery.
Treatment of twin-to-twin transfusion syndrome
- Laser coagulation of placental vessels. In selected cases, fetoscopic laser surgery is performed to ablate abnormal vascular connections and restore balanced blood flow.
- Amnioreduction. In cases of excessive amniotic fluid accumulation, removal of excess fluid may be performed.
Treatment of fetal growth restriction
If one or both fetuses demonstrate growth restriction, measures are aimed at improving placental blood flow and fetal nutrition:
- Medications to improve uteroplacental circulation.
- Regular ultrasound monitoring to assess fetal growth and promptly identify deterioration.
Management of preeclampsia
- Regular blood pressure monitoring.
- Antihypertensive and supportive therapy to prevent progression to severe forms.
- Hospitalization and, if necessary, early delivery in cases of severe preeclampsia posing a threat to maternal or fetal life.
Delivery planning in multiple pregnancy
In Belarus, delivery management in multiple pregnancy requires an individualized approach. Depending on maternal and fetal condition, the optimal mode of delivery is selected:
- Cesarean section. Often the preferred method in multiple pregnancy, especially in the presence of complications or non-vertex presentations.
- Vaginal delivery. Possible when both fetuses are in cephalic presentation and no obstetric complications are present.
Management of multiple pregnancy complications in Belarus is based on regular monitoring of maternal and fetal condition, early detection of risks, and the use of modern treatment strategies. With strong state support and a high level of medical technology, multiple pregnancies can be successfully carried to term with minimal risk to the health of the mother and children.
