Recent scientific research carried out suggests that fertility stimulating drugs could be one of the reasons that have contributed to the increasing number of multiple pregnancies.

Doctor Nyakio Olivier, a gynaecologist working at Butare university teaching hospital says that use of fertility-stimulating drugs such as clomid, and metformin and assisted reproductive techniques such as in-vitro fertilization are some of the factors that have contributed to the increasing number of multiple pregnancies today. Hereditary factors are also major causes of multiple pregnancies.

In-vitro fertilisation involves removal of eggs from the mother, fertilized in a laboratory dish and then transferred to the uterus. The probability of having twins or triplets has been common with the use of this technique.

Medical doctors have now developed measures to monitor fertility treatments carefully so that women will have fewer but healthier babies. This ensures limitation of the number of embryos transferred during the in-vitro fertilisation.

Dr Nyakio explains that physicians monitor women taking certain fertility drugs with ultrasound. If ultrasound shows that a large number of eggs could be released during that treatment cycle, he will stop the treatment instantly.

Although previous generations were often surprised by the delivery of twins or other multiples, today most parents learn the news fairly early. An ultrasound examination can detect most multiples by the beginning of the second trimester.

However, sometimes a twin pregnancy that is identified very early can later be found to have only one foetus. There are other factors that can alert a physician that a woman may be expecting twins or more.

These include abnormal results on a blood test done around 16 weeks of pregnancy to screen for certain birth defects, more than one heartbeat heard by a provider using a hand held ultrasound device (Doppler), rapid weight gain during the first trimester, and larger uterus than expected, morning sickness that involves nausea and vomiting.

Women who are expecting more than one baby are at increased risk of a number of pregnancy complications. This is because the more babies a women carry at once, the greater her risk.

Some of the common complications are premature birth, low birth weight, twin to twin transfusion syndrome and pre-eclampsia.

Twin-twin transfusion syndrome occurs when a connection between the two babies’ blood vessels in the placenta results in one baby getting too much blood flow and the other too little.

Until recently, severe cases often resulted in the loss of both babies. Recent studies, though, suggest that the use of amniocentesis to drain off excess fluid can save up to 64 percent of affected babies.

Nyakio further explains that removing the excess fluid appears to improve blood flow in the placenta and reduces the risk of preterm labour.

With Pre-eclampsia, women expecting twins are more than twice as likely as women with a single pregnancy to develop this complication, characterized by high blood pressure and protein in the urine.

Severe cases can be dangerous for mother and baby. In some cases, the baby must be delivered early to prevent serious complications.

Today women carrying multiples are at increased risk of the pregnancy related form of diabetes caused by high blood sugar.

This condition can cause the baby to grow especially large, increasing the risk of injuries during vaginal delivery. Babies born to women with gestational diabetes may also have breathing and other problems during the new birth period.

According to Nyakio, women who are expecting multiples generally need to visit their health care providers more frequently than women expecting one baby to help prevent, detect and treat the complications that develop more often in a multiple pregnancy.

A woman expecting multiples has high chances of a caesarean delivery in twin pregnancy than in single births.
However, a pregnant woman has a good chance of having a normal vaginal delivery if both babies are in a head-down position and there are no other complications.

When a woman is carrying three or more babies, a caesarean delivery is usually recommended because it is safer for the babies. It’s the fertility stimulating drugs that always induce multiple pregnancies to occur.

The writer is a general medical practitioner

E-mail: josephmunich06@yahoo.co.uk