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    As women get older, it becomes more common for them to have twins or triplets (or even more!). In part, this is because the ovaries of older women sometimes release more than one egg per cycle. Older women are also more likely to become pregnant with the help of assisted reproductive technology, which increases the chances of twins or triplets.

    Although a multiple pregnancy can be an amazing gift, there is a higher risk to both the mother and the babies in these special situations, and all multiple gestations are carefully monitored.
    Testing for abnormalities

    Multiple gestation complicates testing for genetic abnormalities early in pregnancy. First or second trimester serum screening for Down syndrome is considerably less accurate in twins, and cannot be used at all in triplet pregnancies. Many women decide either to forgo testing or go directly to conclusive testing by chorionic villus sampling or amniocentesis. Testing for abnormalities is further complicated if an abnormality is found in only one twin. Choices must then be made about continuing the pregnancy or attempting to reduce the pregnancy to a single baby.
    Risks to the mother

    With multiple pregnancies, there is a greater risk of preeclampsia (two to three limes higher than with a single pregnancy), a slightly increased risk of gestational diabetes, and a 50 percent higher rate of cesarean delivery. With triplets, the risk of gestational diabetes soars, and almost all women deliver by cesarean.

    Later in pregnancy, multiple gestation results in more maternal discomfort and weight gain ¡ª typically 35-451b (16kg-20.5kg).
    Risks to the babies

    Multiple gestation creates several risks for the babies, the main one being preterm labor. Half of twin pregnancies will have delivered by 1 month before their original due date, although the risk of very early preterm delivery (before 28 weeks) is low ¨C approximately 4-5 percent. Triplet pregnancies are at a much greater risk of preterm labor ¡ª almost all triplet pregnancies will deliver before 57 weeks and 12 percent will deliver before 28 weeks.

    As well as the risk of preterm delivery, twins and triplets are more likely than single babies to be growth restricted in the uterus. There is also a small chance that one may die around the time of birth. Although this risk is relatively to w (less than 3 percent), most doctors will monitor the babies frequently during the third trimester by regular ultrasound scans to check growth, and nonstress testing to check the babies’ well-being. Most doctors also recommend delivery of twin pregnancies by 38-39 weeks.

    The risk of cesarean delivery increases with twins for several reasons, first, there is an increased chance that the first twin will be in a breech position (feel or bottom first). In these cases, cesarean delivery is recommended. Second, there is an increased risk of placental problems and to w birth weight in one or both of the twins, decreasing the chances that they will be able to tolerate labor.

    However, if your first twin is in a head-down position, and the twins are about the same size, you should be able to try to have a vaginal delivery. Even if your second twin is in a feel first position, a breech delivery can usually be accomplished quickly and safely because the way has already been paved by the first twin. Most hospitals have monitors that can track each twin’s heart rate separately throughout labor
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