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A multiple birth is the culmination of one multiple
pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...
, wherein the mother gives birth to two or more babies. A term most applicable to
vertebrate Vertebrates () comprise all animal taxa within the subphylum Vertebrata () ( chordates with backbones), including all mammals, birds, reptiles, amphibians, and fish. Vertebrates represent the overwhelming majority of the phylum Chordata, ...
species, multiple births occur in most kinds of
mammal Mammals () are a group of vertebrate animals constituting the class Mammalia (), characterized by the presence of mammary glands which in females produce milk for feeding (nursing) their young, a neocortex (a region of the brain), fur or ...
s, with varying frequencies. Such births are often named according to the number of offspring, as in ''
twin Twins are two offspring produced by the same pregnancy.MedicineNet > Definition of TwinLast Editorial Review: 19 June 2000 Twins can be either ''monozygotic'' ('identical'), meaning that they develop from one zygote, which splits and forms two em ...
s'' and ''triplets''. In non-humans, the whole group may also be referred to as a ''
litter Litter consists of waste products that have been discarded incorrectly, without consent, at an unsuitable location. Litter can also be used as a verb; to litter means to drop and leave objects, often man-made, such as aluminum cans, paper cups, ...
'', and multiple births may be more common than single births. Multiple births in humans are the exception and can be exceptionally rare in the largest mammals. A multiple pregnancy may be the result of the
fertilization Fertilisation or fertilization (see spelling differences), also known as generative fertilisation, syngamy and impregnation, is the fusion of gametes to give rise to a new individual organism or offspring and initiate its development. Proce ...
of a single egg that then splits to create identical
fetus A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal deve ...
es, or it may be the result of the fertilization of multiple eggs that create fraternal ("non-identical") fetuses, or it may be a combination of these factors. A multiple pregnancy from a single
zygote A zygote (, ) is a eukaryotic cell formed by a fertilization event between two gametes. The zygote's genome is a combination of the DNA in each gamete, and contains all of the genetic information of a new individual organism. In multicellula ...
is called ''
monozygotic Twins are two offspring produced by the same pregnancy.MedicineNet > Definition of TwinLast Editorial Review: 19 June 2000 Twins can be either ''monozygotic'' ('identical'), meaning that they develop from one zygote, which splits and forms two em ...
'', from two zygotes is called ''
dizygotic Twins are two offspring produced by the same pregnancy.MedicineNet > Definition of TwinLast Editorial Review: 19 June 2000 Twins can be either ''monozygotic'' ('identical'), meaning that they develop from one zygote, which splits and forms two em ...
'', or from three or more zygotes is called ''polyzygotic''. Similarly, the
sibling A sibling is a relative that shares at least one parent with the subject. A male sibling is a brother and a female sibling is a sister. A person with no siblings is an only child. While some circumstances can cause siblings to be raised separat ...
s themselves from a multiple birth may be referred to as monozygotic if they are identical or as dizygotic (in cases of twins) or polyzygotic (for three or more siblings) if they are fraternal, i.e., non-identical. Each fertilized
ovum The egg cell, or ovum (plural ova), is the female reproductive cell, or gamete, in most anisogamous organisms (organisms that reproduce sexually with a larger, female gamete and a smaller, male one). The term is used when the female gamete is ...
(
zygote A zygote (, ) is a eukaryotic cell formed by a fertilization event between two gametes. The zygote's genome is a combination of the DNA in each gamete, and contains all of the genetic information of a new individual organism. In multicellula ...
) may produce a single
embryo An embryo is an initial stage of development of a multicellular organism. In organisms that reproduce sexually, embryonic development is the part of the life cycle that begins just after fertilization of the female egg cell by the male spe ...
, or it may split into two or more embryos, each carrying the same genetic material. Fetuses resulting from different zygotes are called ''fraternal'' and share only 50% of their genetic material, as ordinary full siblings from separate births do. Fetuses resulting from the same zygote share 100% of their genetic material and hence are called ''identical''. Identical twins are always the same sex.


Terminology

Terms used for the number of offspring in a multiple birth, where a number higher than three ends with the suffix ''-uplet'': *two offspring –
twins Twins are two offspring produced by the same pregnancy.MedicineNet > Definition of TwinLast Editorial Review: 19 June 2000 Twins can be either ''monozygotic'' ('identical'), meaning that they develop from one zygote, which splits and forms two em ...
*three offspring –
triplets A multiple birth is the culmination of one multiple pregnancy, wherein the mother gives birth to two or more babies. A term most applicable to vertebrate species, multiple births occur in most kinds of mammals, with varying frequencies. Such bir ...
*four offspring –
quadruplets A multiple birth is the culmination of one multiple pregnancy, wherein the mother gives birth to two or more babies. A term most applicable to vertebrate species, multiple births occur in most kinds of mammals, with varying frequencies. Such bir ...
*five offspring –
quintuplets ''Quintuplets'' is an American sitcom that aired 22 episodes on Fox from June 16, 2004 to January 12, 2005. The program starred Andy Richter and Rebecca Creskoff and shared some of their experiences parenting teenage quintuplets. Synopsis The ...
*six offspring –
sextuplets A multiple birth is the culmination of one multiple pregnancy, wherein the mother gives birth to two or more babies. A term most applicable to vertebrate species, multiple births occur in most kinds of mammals, with varying frequencies. Such bir ...
*seven offspring –
septuplets A multiple birth is the culmination of one multiple pregnancy, wherein the mother gives birth to two or more babies. A term most applicable to vertebrate species, multiple births occur in most kinds of mammals, with varying frequencies. Such bir ...
*eight offspring –
octuplets A multiple birth is the culmination of one multiple pregnancy, wherein the mother gives birth to two or more babies. A term most applicable to vertebrate species, multiple births occur in most kinds of mammals, with varying frequencies. Such bir ...
*nine offspring –
nonuplets A multiple birth is the culmination of one multiple pregnancy, wherein the mother gives birth to two or more babies. A term most applicable to vertebrate species, multiple births occur in most kinds of mammals, with varying frequencies. Such bir ...
*ten offspring – decuplets Terms used for multiple births or the genetic relationships of their offspring are based on the
zygosity Zygosity (the noun, zygote, is from the Greek "yoked," from "yoke") () is the degree to which both copies of a chromosome or gene have the same genetic sequence. In other words, it is the degree of similarity of the alleles in an organism. Mo ...
of the pregnancy: * Monozygotic – multiple (typically two) fetuses produced by the splitting of a single
zygote A zygote (, ) is a eukaryotic cell formed by a fertilization event between two gametes. The zygote's genome is a combination of the DNA in each gamete, and contains all of the genetic information of a new individual organism. In multicellula ...
* Polyzygotic – multiple fetuses produced by two or more zygotes: ** Dizygotic – multiple (typically two) fetuses produced by two zygotes ** Trizygotic – three or more fetuses produced by three zygotes ** Sesquizygotic – an egg which is fertilized by 2 sperms, which produce 2 fetuses Multiple pregnancies are also classified by how the fetuses are surrounded by one or more
placenta The placenta is a temporary embryonic and later fetal organ that begins developing from the blastocyst shortly after implantation. It plays critical roles in facilitating nutrient, gas and waste exchange between the physically separate mater ...
s ( chorionicity) and
amniotic sac The amniotic sac, also called the bag of waters or the membranes, is the sac in which the embryo and later fetus develops in amniotes. It is a thin but tough transparent pair of membranes that hold a developing embryo (and later fetus) until shor ...
s ( amnionicity).


Human multiple births

In humans, the average length of pregnancy (two weeks fewer than
gestation Gestation is the period of development during the carrying of an embryo, and later fetus, inside viviparous animals (the embryo develops within the parent). It is typical for mammals, but also occurs for some non-mammals. Mammals during pregna ...
) is 38 weeks with a single fetus. This average decreases for each additional fetus: to thirty-six weeks for twin births, thirty-two weeks for triplets, and thirty weeks for quadruplets. With the decreasing gestation time, the risks from immaturity at birth and subsequent viability increase with the size of the sibling group. Only as of the twentieth century have more than four all survived infancy. Recent history has also seen increasing numbers of multiple births. In the United States, it has been estimated that by 2011, 36% of twin births and 78% of triplet and higher-order births resulted from conception by
assisted reproductive technology Assisted reproductive technology (ART) includes medical procedures used primarily to address infertility. This subject involves procedures such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), cryopreservation of gametes o ...
.


Twins

Twins are by far the most common form of multiple births in humans. The U.S. Centers for Disease Control and Prevention report more than 132,000 sets of twins out of 3.9 million births of all kinds each year, about 3.4%, or 1 in 30. Without fertility treatments, the probability is about 1 in 60; with fertility treatments, it can be as high as 20-25%. Dizygotic (fraternal) twins run in families; however, the man does not influence the chances of the woman having twins, even if there are twins in his family. The hyperovulation gene is the cause for having twins and is only a factor for the mother. Although the man does not influence the woman's chances of having twins, he could influence his children's chances for having twins; if he carries the gene for hyperovulation and has a daughter, she may also have the gene for hyperovulation and then have twins herself. Monozygotic (identical) twins do not run in families. The twinning is random, due to the egg splitting, so all parents have an equal chance of conceiving identical twins.


Triplets

Triplets can be either fraternal, identical, or a combination of both. The most common are strictly fraternal triplets, which come from a polyzygotic pregnancy of three eggs. Less common are triplets from a dizygotic pregnancy, where one zygote divides into two identical fetuses, and the other does not. Least common are identical triplets, three fetuses from one egg. In this case, the original zygote divides into two and then one of those two zygotes divides again but the other does not. Triplets are far less common than twins, according to the U.S. Centers for Disease Control and Prevention, accounting for only about 4300 sets in 3.9 million births, just a little more than 0.1%, or 1 in 1000. According to the American Society of Reproductive Medicine, only about 10% of these are identical triplets: about 1 in ten thousand. Nevertheless, only 4 sets of identical triplets were reported in the U.S. during 2015, about one in a million. According to Victor Khouzami, Chairman of Obstetrics at Greater Baltimore Medical Center, "No one really knows the incidence". Identical triplets or quadruplets are very rare and result when the original fertilized egg splits and then one of the resultant cells splits again (for triplets) or, even more rarely, a further split occurs (for quadruplets). The odds of having identical triplets is unclear. News articles and other non-scientific organizations give odds from one in 60,000 to one in 200 million pregnancies.


Quadruplets

Quadruplets are much rarer than twins or triplets. As of 2007, there were approximately 3,556 sets recorded worldwide. Quadruplet births are becoming increasingly common due to
fertility treatment Assisted reproductive technology (ART) includes medical procedures used primarily to address infertility. This subject involves procedures such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), cryopreservation of gametes ...
s. There are around 70 sets of all-identical quadruplets worldwide. Many sets of quadruplets contain a mixture of identical and fraternal siblings, such as three identical and one fraternal, two identical and two fraternal, or two pairs of identicals. One famous set of identical quadruplets was the
Genain quadruplets The Genain quadruplets (born in 1930) are a set of identical quadruplet sisters. All four developed schizophrenia, suggesting a large genetic component to the cause of the disease. The pseudonym ''Genain'', used to protect the identity of the fa ...
, all of whom developed
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
. Quadruplets are sometimes referred to as "quads" in Britain.


Quintuplets

Quintuplets occur naturally in 1 in 55,000,000 births. The first quintuplets known to survive infancy were the identical female Canadian
Dionne Quintuplets The Dionne quintuplets (; born May 28, 1934) are the first quintuplets known to have survived their infancy. The identical girls were born just outside Callander, Ontario, near the village of Corbeil. All five survived to adulthood. The Dionn ...
, born in 1934. Quintuplets are sometimes referred to as "quins" in the UK and "quints" in North America. A famous set of all-girl quintuplets are the Busby quints from the TV series
OutDaughtered ''OutDaughtered'' is an American reality series on TLC (TV network), TLC starring Adam and Danielle Busby, parents of the only American all-girl Multiple birth, quintuplets on record. The series debuted on May 10, 2016 and premiered its eighth sea ...
.


Sextuplets

Born in
Liverpool Liverpool is a city and metropolitan borough in Merseyside, England. With a population of in 2019, it is the 10th largest English district by population and its metropolitan area is the fifth largest in the United Kingdom, with a popul ...
,
England England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe b ...
, on 18 November 1983, the
Walton sextuplets The Walton sextuplets were born at Liverpool Maternity Hospital in Liverpool, England on 18 November 1983 and were the world's first all-female surviving sextuplets, and the world's fourth known set of surviving sextuplets. The children are Hanna ...
were the world's first all-female surviving sextuplets, and the world's fourth known set of surviving sextuplets. Another well-known set of sextuplets is the
Gosselin sextuplets ''Jon & Kate Plus 8'', later known as ''Kate Plus 8'', is an American reality television series starring Kate Gosselin, Jon Gosselin, and their eight children, which ran from April 4, 2007 to July 24, 2017. History After the success of two on ...
, born on May 10, 2004, in
Hershey, Pennsylvania Hershey is an unincorporated community and census-designated place (CDP) in Derry Township, Dauphin County, Pennsylvania, United States. It is home to The Hershey Company, which was founded by candy magnate Milton S. Hershey. The community is lo ...
. Reality television shows ''Jon & Kate Plus 8'' and later ''
Kate Plus 8 ''Jon & Kate Plus 8'', later known as ''Kate Plus 8'', is an American reality television series starring Kate Gosselin, Jon Gosselin, and their eight children, which ran from April 4, 2007 to July 24, 2017. History After the success of two on ...
'' have chronicled the lives of these sextuplets. Other shows of this nature include ''
Table for 12 ''Table for 12'' is an American reality television series featuring the Hayes family, with two sets of twins and a set of sextuplets, who reside in Morganville, New Jersey Morganville is an unincorporated community and census-designated place ( ...
'' and ''
Sweet Home Sextuplets ''Sweet Home Sextuplets'' is an American reality series on TLC starring Eric and Courtney Waldrop, parents of a 3-3 set of sextuplets in Alabama. The series debuted on September 18, 2018. Synopsis The Waldrop family consists of Eric and Courtney ...
''.


Very high-order multiple births

In 1997, the
McCaughey septuplets The McCaughey septuplets (; born November 19, 1997) are septuplets born to Kenny and Bobbi McCaughey in Des Moines, Iowa. They are the world's first known set of surviving septuplets. Background, conception and birth Kenny McCaughey (b. 1969) an ...
, born in
Des Moines, Iowa Des Moines () is the capital and the most populous city in the U.S. state of Iowa. It is also the county seat of Polk County. A small part of the city extends into Warren County. It was incorporated on September 22, 1851, as Fort Des Moines, ...
, became the first septuplets known to survive infancy. Multiple births of as many as eight babies have been born alive, the first surviving set on record goes to the
Suleman octuplets The Suleman octuplets are six male and two female children conceived via in vitro fertilization (IVF) and subsequently born to Nadya Suleman on January 26, 2009, in Bellflower, California. Residing in Lancaster, California, they are the first kno ...
, born in 2009 in
Bellflower, California Bellflower is a city located in southeast Los Angeles County, California, in the Los Angeles metropolitan area. It was founded in 1906 and municipal corporation, incorporated on September 3, 1957. As of the 2020 census, the city had a total popu ...
. , all of them were alive and turned 10 years old. In May 2021, the Cissé nonuplets were born in
Morocco Morocco (),, ) officially the Kingdom of Morocco, is the westernmost country in the Maghreb region of North Africa. It overlooks the Mediterranean Sea to the north and the Atlantic Ocean to the west, and has land borders with Algeria to ...
to
Halima Cissé Halima Cissé (born 21 March 1996) is the Mali, Malian mother to the world's only known nonuplets that have survived birth. Early life Cissé was born in Timbuktu, Mali. Prior to the birth of her nonuplets, she had one daughter with her husband, ...
, a 25-year-old woman from
Mali Mali (; ), officially the Republic of Mali,, , ff, 𞤈𞤫𞤲𞥆𞤣𞤢𞥄𞤲𞤣𞤭 𞤃𞤢𞥄𞤤𞤭, Renndaandi Maali, italics=no, ar, جمهورية مالي, Jumhūriyyāt Mālī is a landlocked country in West Africa. Mali ...
. , one year since their births, all nine are still living and reportedly in good health. The
list of multiple births This is a list of multiple births, consisting of notable higher order (4+) multiple births and pregnancies. Twins and triplets are sufficiently common to have their own separate articles. With the use of reproductive technology such as fertility ...
covers notable examples.


Causes and frequency

The frequency of ''N'' multiple births from natural pregnancies has been given as approximately 1:89''N''−1 (''
Hellin's law Hellin's law, also called Hellin-Zeleny's law, is an empirical observation in demography that the approximate rate of multiple birth A multiple birth is the culmination of one multiple pregnancy, wherein the mother gives birth to two or more bab ...
'') and as about 1:80''N''−1. This gives: *1:89 (= 1.1%) or 1:80 (= 1.25%) for twins *1:892 (= 1:7921, about 0.013%) or 1:802 (= 1:6400) for triplets *1:893 (= approx. 0.000142%, less than 1:700,000) or 1:803 for quadruplets North American dizygotic twinning occurs about once in 83 conceptions, and triplets about once in 8000 conceptions. US figures for 2010 were: * Twins, 132,562, 3.31% * Triplets, 5,503, 0.14% * Quadruplets, 313, 0.0078% * Quintuplets and more, 37, 0.00092% Human multiple births can occur either naturally (the woman ovulates multiple eggs or the fertilized egg splits into two) or as the result of
infertility Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects). It is the normal state ...
treatments such as
in vitro fertilization In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova (egg or eggs) ...
(several embryos are often transferred to compensate for lower quality) or fertility drugs (which can cause multiple eggs to mature in one ovulatory cycle). For reasons that are not yet known, the older a woman is, the more likely she is to have a multiple birth naturally. It is theorized that this is due to the higher level of
follicle-stimulating hormone Follicle-stimulating hormone (FSH) is a gonadotropin, a glycoprotein polypeptide hormone. FSH is synthesized and secreted by the gonadotropic cells of the anterior pituitary gland and regulates the development, growth, pubertal maturation, an ...
that older women sometimes have as their ovaries respond more slowly to FSH stimulation. The number of multiple births has increased over the last decade. For example, in Canada between 1979 and 1999, the number of multiple birth babies increased 35%. Before the advent of ovulation-stimulating drugs, triplets were quite rare (approximately 1 in 8000 births) and higher-order births much rarer still. Much of the increase can probably be attributed to the impact of fertility treatments, such as
in-vitro fertilization In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova (egg or eggs) ...
. Younger patients who undergo treatment with
fertility medication Fertility medications, also known as fertility drugs, are medications which enhance reproductive fertility. For women, fertility medication is used to stimulate follicle development of the ovary. There are very few fertility medication options a ...
containing artificial FSH, followed by intrauterine
insemination Insemination is the introduction of sperm into a female’s reproductive system for the purpose of impregnating, also called fertilizing, the female for sexual reproduction. The sperm is introduced into the uterus of a mammal or the oviduct of an ...
, are particularly at risk for multiple births of higher order. Certain factors appear to increase the likelihood that a woman will naturally conceive multiples. These include: *mother's age: women over 35 are more likely to have multiples than younger women *mother's use of
fertility drug Fertility medications, also known as fertility drugs, are medications which enhance reproductive fertility. For women, fertility medication is used to stimulate follicle development of the ovary. There are very few fertility medication options av ...
s: approximately 35% of pregnancies arising through the use of fertility treatments such as IVF involve more than one child The increasing use of fertility drugs and consequent increased rate of multiple births has made the phenomenon of multiples more frequent and hence more visible. In 2004 the birth of sextuplets, six children, to Pennsylvania couple Kate and Jon Gosselin helped them to launch their television series, originally ''
Jon & Kate Plus 8 ''Jon & Kate Plus 8'', later known as ''Kate Plus 8'', is an American reality television series starring Kate Gosselin, Jon Gosselin, and their eight children, which ran from April 4, 2007 to July 24, 2017. History After the success of two on ...
'' and (following their divorce) ''
Kate Plus 8 ''Jon & Kate Plus 8'', later known as ''Kate Plus 8'', is an American reality television series starring Kate Gosselin, Jon Gosselin, and their eight children, which ran from April 4, 2007 to July 24, 2017. History After the success of two on ...
'', which became the highest-rated show on the ''
TLC TLC may refer to: Arts and entertainment Television * ''TLC'' (TV series), a 2002 British situational comedy television series that aired on BBC2 * TLC (TV network), formerly the Learning Channel, an American cable TV network ** TLC (Asia), an As ...
'' network.


Risks


Premature birth and low birth weight

Babies born from multiple-birth pregnancies are much more likely to result in
premature birth Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 2 ...
than those from single pregnancies. 51% of twins and 91% of triplets are born preterm, compared to 9.4% in singletons. ''Note: This study was done by looking at the 1991–1995 U.S. Natality Files, which were received from the National Center for Health Statistics'' 14% of twins and 41% of triplets are even born ''very preterm'', compared to 1.7% in singletons. Drugs known as betamimetics can be used to relax the muscles of the uterus and delay birth in singleton pregnancies. There is some evidence that these drugs can also reduce the risk of preterm birth for twin pregnancies, but existing studies are small. More data is required before solid conclusions can be drawn. Likewise, existing studies are too small to determine if a cervical suture is effective for reducing prematurity in cases of multiple birth. As a result of
preterm birth Preterm birth, also known as premature birth, is the Childbirth, birth of a baby at fewer than 37 weeks Gestational age (obstetrics), gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 we ...
, multiples tend to have
lower birth weight Low birth weight (LBW) is defined by the World Health Organization as a birth weight of an infant of or less, regardless of gestational age. Infants born with LBW have added health risks which require close management, often in a neonatal intensi ...
than singletons. Exceptions are possible, however, as with the Kupresak triplets, born in 2008 in
Mississauga Mississauga ( ), historically known as Toronto Township, is a city in the Canadian province of Ontario. It is situated on the shores of Lake Ontario in the Regional Municipality of Peel, adjoining the western border of Toronto. With a popul ...
,
Ontario Ontario ( ; ) is one of the thirteen provinces and territories of Canada.Ontario is located in the geographic eastern half of Canada, but it has historically and politically been considered to be part of Central Canada. Located in Central Ca ...
, Canada. Their combined weight was 17 lbs, 2.7 oz, which set a world record. Two of the triplets were similar in size and, as expected, moderately low birth weight. The two combined weighed 9 lbs, 2.7 oz. The third triplet, however, was much larger and weighed 8 lbs. individually.


Cerebral palsy

Cerebral palsy Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensa ...
is more common among multiple births than single births, being 2.3 per 1,000 survivors in singletons, 13 in twins, and 45 in triplets in
North West England North West England is one of nine official regions of England and consists of the ceremonial counties of England, administrative counties of Cheshire, Cumbria, Greater Manchester, Lancashire and Merseyside. The North West had a population of ...
. This is likely a side effect of premature birth and low birth weight.


Incomplete separation

Multiples may be
monochorionic Monochorionic twins are monozygotic (identical) twins that share the same placenta. If the placenta is shared by more than two twins (see multiple birth), these are monochorionic multiples. Monochorionic twins occur in 0.3% of all pregnancies. ...
, sharing the same
chorion The chorion is the outermost fetal membrane around the embryo in mammals, birds and reptiles (amniotes). It develops from an outer fold on the surface of the yolk sac, which lies outside the zona pellucida (in mammals), known as the vitelline ...
, with resultant risk of
twin-to-twin transfusion syndrome Twin-to-twin transfusion syndrome (TTTS), also known as feto-fetal transfusion syndrome (FFTS), twin oligohydramnios-polyhydramnios sequence (TOPS) and stuck twin syndrome, is a complication of monochorionic multiple pregnancies (the most common ...
. Monochorionic multiples may even be
monoamniotic Monoamniotic twins are identical or semi-identical twins that share the same amniotic sac within their mother's uterus. Monoamniotic twins are always Monochorionic twins, monochorionic and are usually termed Monoamniotic-Monochorionic ("MoMo" or ...
, sharing the same
amniotic sac The amniotic sac, also called the bag of waters or the membranes, is the sac in which the embryo and later fetus develops in amniotes. It is a thin but tough transparent pair of membranes that hold a developing embryo (and later fetus) until shor ...
, resulting in risk of
umbilical cord compression Umbilical cord compression is the obstruction of blood flow through the umbilical cord secondary to pressure from an external object or misalignment of the cord itself. Cord compression happens in about one in 10 deliveries. ...
and
nuchal cord A nuchal cord is when the umbilical cord becomes wrapped around the fetus's neck. Symptoms present in the baby shortly after birth from a prior nuchal cord may include duskiness of face, facial petechia, and subconjunctival bleeding, bleeding in t ...
. In very rare cases, there may be
conjoined twins Conjoined twins – sometimes popularly referred to as Siamese twins – are twins joined ''in utero''. A very rare phenomenon, the occurrence is estimated to range from 1 in 49,000 births to 1 in 189,000 births, with a somewhat higher incidence ...
, possibly impairing function of internal organs.


Mortality rate (stillbirth)

Multiples are also known to have a higher mortality rate. It is more common for multiple births to be stillborn, while for singletons the risk is not as high. A literary review on multiple pregnancies shows a study done on one set each of septuplets and octuplets, two sets of sextuplets, 8 sets of quintuplets, 17 sets of quadruplets, and 228 sets of triplets. By doing this study, Hammond found that the mean gestational age (how many weeks when birthed) at birth was 33.4 weeks for triplets and 31 weeks for quadruplets. This shows that stillbirth happens usually 3–5 weeks before the woman reaches full term and also that for sextuplets or higher it almost always ends in death of the fetuses. Though multiples are at a greater risk of being stillborn, there is inconclusive evidence whether the actual mortality rate is higher in multiples than in singletons.


Prevention in IVF

Today many multiple pregnancies are the result of
in vitro fertilisation In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova (egg or eggs) ...
(IVF). In a 1997 study of 2,173
embryo transfer Embryo transfer refers to a step in the process of assisted reproduction in which embryos are placed into the uterus of a female with the intent to establish a pregnancy. This technique (which is often used in connection with in vitro fertilizati ...
s performed as part of
in vitro fertilisation In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova (egg or eggs) ...
(IVF), 34% were successfully delivered pregnancies. The overall multiple pregnancy rate was 31.3% (24.7% twins, 5.8% triplets, and .08% quadruplets). Because IVFs are producing more multiples, a number of efforts are being made to reduce the risk of multiple births- specifically triplets or more. Medical practitioners are doing this by limiting the number of embryos per embryo transfer to one or two. That way, the risks for the mother and fetuses are decreased. The appropriate number of embryos to be transferred depends on the age of the woman, whether it is the first, second or third full IVF cycle attempt and whether there are top-quality embryos available. According to a guideline from The
National Institute for Health and Care Excellence The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health and Social Care in England that publishes guidelines in four areas: * the use of health technologies withi ...
(NICE) in 2013, the number of embryos transferred in a cycle should be chosen as in following table:Fertility: assessment and treatment for people with fertility problems
. NICE clinical guideline CG156, February 2013.
Also, it is recommended to use single embryo transfer in all situations if a top-quality blastocyst is available.


Management

Bed rest Bed rest, also referred to as the rest-cure, is a medical treatment in which a person lies in bed for most of the time to try to cure an illness. Bed rest refers to voluntarily lying in bed as a treatment and not being confined to bed because of ...
has not been found to change outcomes and therefore is not generally recommended outside of a research study.


Selective reduction (procedure)

Selective reduction Selective reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. The procedure is also called multifetal pregnancy reduction. The procedure is most commonly don ...
is the practice of reducing the number of fetuses in a multiple pregnancy; it is also called "multifetal reduction". The procedure generally takes two days; the first day for testing in order to select which fetuses to remove, and the second day for the procedure itself, in which
potassium chloride Potassium chloride (KCl, or potassium salt) is a metal halide salt composed of potassium and chlorine. It is odorless and has a white or colorless vitreous crystal appearance. The solid dissolves readily in water, and its solutions have a salt ...
is injected into the heart of each selected fetus under the guidance of ultrasound imaging. Risks of the procedure include bleeding requiring transfusion, rupture of the uterus,
retained placenta Retained placenta is a condition in which all or part of the placenta or membranes remain in the uterus during the third stage of labour. Retained placenta can be broadly divided into: * failed separation of the placenta from the uterine lining * p ...
, infection, a miscarriage, and
prelabor rupture of membranes Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labor. Women usually experience a painless gush or a steady leakage of fluid from the vagina. Complicati ...
. Each of these appears to be rare. There are also ethical concerns about this procedure, since it is a form of
abortion Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregn ...
, and also because of concerns over which fetuses are terminated and why. Selective reduction was developed in the mid-1980s, as people in the field of assisted reproductive technology became aware of the risks that multiple pregnancies carried for the mother and for the fetuses.


Care in pregnancy

Women with a multiple pregnancy are usually seen more regularly by midwives or doctors than those with singleton pregnancies because of the higher risks of complications. However, there is currently no evidence to suggest that specialised antenatal services produce better outcomes for mother or babies than ‘normal’ antenatal care.


Nutrition

As preterm birth is such a risk for women with multiple pregnancies, it has been suggested that these women should be encouraged to follow a high-calorie diet to increase the birth weights of the babies. Evidence around this subject is not yet good enough to advise women to do this because the long term effects of the high-calorie diets on the mother are not known.


Cesarean section or vaginal delivery

A study in 2013 involving 106 participating centers in 25 countries came to the conclusion that, in a twin pregnancy of a
gestational age In obstetrics, gestational age is a measure of the age of a pregnancy which is taken from the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method if available. Suc ...
between 32 weeks 0 days and 38 weeks 6 days, and the first twin is in
cephalic presentation A cephalic presentation or head presentation or head-first presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex pr ...
, planned
Cesarean section Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mo ...
does not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal
disability Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be Cognitive disability, cognitive, Developmental disability, dev ...
, as compared with planned vaginal delivery. In this study, 44% of the women planned for vaginal delivery still ended up having Cesarean section for unplanned reasons such as
pregnancy complication Complications of pregnancy are health problems that are related to pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal di ...
s. In comparison, it has been estimated that 75% of twin pregnancies in the United States were delivered by Cesarean section in 2008. Also in comparison, the rate of Cesarean section for all pregnancies in the general population varies between 40% and 14%. Fetal position (the way the babies are lying in the womb) usually determines if they are delivered by caesarean section or vaginally. A review of good quality research on this subject found that if the twin that will be born first (i.e. is lowest in the womb) is head down there is no good evidence that caesarean section will be safer than a vaginal birth for the mother or babies.
Monoamniotic twins Monoamniotic twins are identical or semi-identical twins that share the same amniotic sac within their mother's uterus. Monoamniotic twins are always monochorionic and are usually termed Monoamniotic-Monochorionic ("MoMo" or "Mono Mono") twins. ...
(twins that form after the splitting of a fertilised egg and share the same amniotic fluid sac) are at more risk of complications than twins that have their own sacs. There is also insufficient evidence around whether to deliver the babies early by caesarean section or to wait for labour to start naturally while running checks on the babies’ wellbeing. The birth of this type of twins should therefore be decided with the mother and her family and should take into account the need for good neonatal care services. Cesarean delivery is needed when first twin is in non cephalic presentation or when it is a monoamniotic twin pregnancy.


Neonatal intensive care

Multiple-birth infants are usually admitted to neonatal intensive care immediately after being born. The records for all the triplet pregnancies managed and delivered from 1992 to 1996 were looked over to see what the neonatal statistics were. Kaufman found from reviewing these files that during a five-year period, 55 triplet pregnancies, which is 165 babies, were delivered. Of the 165 babies 149 were admitted to neonatal intensive care after the delivery.


Society and culture


Insurance coverage


United States

A study by the U.S. Agency for Healthcare Research and Quality found that, in 2011, pregnant women covered by private insurance in the United States were older and more likely to have multiple gestation than women covered by Medicaid.


Cultural aspects

Certain cultures consider multiple births a portent of either good or evil.
Mayan Mayan most commonly refers to: * Maya peoples, various indigenous peoples of Mesoamerica and northern Central America * Maya civilization, pre-Columbian culture of Mesoamerica and northern Central America * Mayan languages, language family spoken ...
culture saw twins as a blessing, and was fascinated by the idea of two bodies looking alike. The Mayans used to believe that twins were one soul that had fragmented. In Ancient Rome, the legend of the twin brothers who founded the city (
Romulus and Remus In Roman mythology, Romulus and Remus (, ) are twin brothers whose story tells of the events that led to the founding of the city of Rome and the Roman Kingdom by Romulus, following his fratricide of Remus. The image of a she-wolf suckling the ...
) made the birth of twin boys a blessing, while twin girls were seen as an unlucky burden, since both would have to be provided with an expensive
dowry A dowry is a payment, such as property or money, paid by the bride's family to the groom or his family at the time of marriage. Dowry contrasts with the related concepts of bride price and dower. While bride price or bride service is a payment b ...
at about the same time. In Greek mythology, fraternal twins
Castor and Polydeuces Castor; grc, Κάστωρ, Kástōr, beaver. and Pollux. (or Polydeukes). are twin half-brothers in Greek and Roman mythology, known together as the Dioscuri.; grc, Διόσκουροι, Dióskouroi, sons of Zeus, links=no, from ''Dîos'' ('Z ...
, and
Heracles and Iphicles Heracles ( ; grc-gre, Ἡρακλῆς, , glory/fame of Hera), born Alcaeus (, ''Alkaios'') or Alcides (, ''Alkeidēs''), was a divine hero in Greek mythology, the son of Zeus and Alcmene, and the foster son of Amphitryon.By his adoptive ...
, are sons of two different fathers. One of the twins ( Polydeuces,
Heracles Heracles ( ; grc-gre, Ἡρακλῆς, , glory/fame of Hera), born Alcaeus (, ''Alkaios'') or Alcides (, ''Alkeidēs''), was a divine hero in Greek mythology, the son of Zeus and Alcmene, and the foster son of Amphitryon.By his adoptive ...
) is the illegitimate son of the god
Zeus Zeus or , , ; grc, Δῐός, ''Diós'', label=Genitive case, genitive Aeolic Greek, Boeotian Aeolic and Doric Greek#Laconian, Laconian grc-dor, Δεύς, Deús ; grc, Δέος, ''Déos'', label=Genitive case, genitive el, Δίας, ''D ...
; his brother is the son of their mother's mortal husband. A similar pair of twin sisters are
Helen Helen may refer to: People * Helen of Troy, in Greek mythology, the most beautiful woman in the world * Helen (actress) (born 1938), Indian actress * Helen (given name), a given name (including a list of people with the name) Places * Helen, ...
(of
Troy Troy ( el, Τροία and Latin: Troia, Hittite language, Hittite: 𒋫𒊒𒄿𒊭 ''Truwiša'') or Ilion ( el, Ίλιον and Latin: Ilium, Hittite language, Hittite: 𒃾𒇻𒊭 ''Wiluša'') was an ancient city located at Hisarlik in prese ...
) and
Clytemnestra Clytemnestra (; grc-gre, Κλυταιμνήστρα, ''Klytaimnḗstrā'', ), in Greek mythology, was the wife of Agamemnon, king of Mycenae, and the twin sister of Helen of Troy. In Aeschylus' ''Oresteia'', she murders Agamemnon – said by Eu ...
(who are also sisters of
Castor and Polydeuces Castor; grc, Κάστωρ, Kástōr, beaver. and Pollux. (or Polydeukes). are twin half-brothers in Greek and Roman mythology, known together as the Dioscuri.; grc, Διόσκουροι, Dióskouroi, sons of Zeus, links=no, from ''Dîos'' ('Z ...
). The theme occurs in other mythologies as well, and is called ''
superfecundation Superfecundation is the fertilization of two or more ova from the same cycle by sperm from separate acts of sexual intercourse, which can lead to twin babies from two separate biological fathers. The term superfecundation is derived from fecund, ...
''. In certain medieval European
chivalric romance As a literary genre, the chivalric romance is a type of prose and verse narrative that was popular in the noble courts of High Medieval and Early Modern Europe. They were fantastic stories about marvel-filled adventures, often of a chivalric k ...
s, such as
Marie de France Marie de France ( fl. 1160 to 1215) was a poet, possibly born in what is now France, who lived in England during the late 12th century. She lived and wrote at an unknown court, but she and her work were almost certainly known at the royal court ...
's '' Le Fresne'', a woman cites a multiple birth (often to a lower-class woman) as proof of adultery on her part; while this may reflect a widespread belief, it is invariably treated as malicious slander, to be justly punished by the accuser having a multiple birth of her own, and the events of the romance are triggered by her attempt to hide one or more of the children. A similar effect occurs in the
Knight of the Swan The story of the Knight of the Swan, or Swan Knight, is a medieval tale about a mysterious rescuer who comes in a swan-drawn boat to defend a damsel, his only condition being that he must never be asked his name. The earliest versions (preserved ...
romance, in the Beatrix variants of the Swan-Children; her taunt is punished by giving birth to seven children at once, and her wicked mother-in-law returns her taunt before exposing the children.


Ethics of multiple births


Medically assisted procreation

In vitro fertilization In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova (egg or eggs) ...
: In vitro fertilization (IVF) was first successfully completed in the 1970s as a form of assisted reproductive technology. Out of all the assisted reproductive technology available that is currently in practice, in vitro fertilization has the highest chance of producing multiple offspring. Per each female egg, IVF currently has a 60-70% chance of conceiving. Fertilization is made possible by administering a fertility drug to the eggs or by directly injecting semen into the eggs. There is an increased chance for women over the age of 35 to have multiple births. IVF is a common genetic and ethical topic. Through IVF individuals can produce offspring successfully when natural procreation is not viable. However, in vitro can become genetically specific and allow for the selection of particular genes or expressible traits to be dominantly present in the formed embryo. Ethical dilemmas arise when determining health care coverage and the deviation from natural selection and gene variations. In regards to multiple births different ethical concerns arise from the use of in vitro fertilization. Overall, multiple pregnancies can cause potential harm to the mother and children due to potential complications. Such complications can include uterine bleeding and children not receiving equal nutrients. IVF has also revealed some pre term deliveries and lower birth weights in babies. While some view medically assisted procreation as a saving grace to have children, others consider these procedure to be unnatural and costly to the community.


Multifetal pregnancy reduction

Multifetal pregnancy reduction is the reduction of one or more embryos from the bearing woman.
Selective reduction Selective reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. The procedure is also called multifetal pregnancy reduction. The procedure is most commonly don ...
usually occurs for pregnancies assisted by assisted reproductive technology (ART). The first multifetal pregnancy reductions to occur in a clinical setting took place in the 1980s. The procedure aims to reduce pregnancies down to approximately one to two fetuses. The overarching purpose of the procedure is not primarily to simply terminate life, but to increase the survival and success of the mother and babies. However, multifetal pregnancy reduction raises some ethical questions. The main argument is similar to abortion ethics (
Abortion debate The abortion debate is a longstanding, ongoing controversy that touches on the moral, legal, medical, and religious aspects of induced abortion. In English-speaking countries, the debate most visibly polarizes around adherents of the self-describ ...
) in reduction of fetus versus fetus life. The protection of maternal well being versus harm of newly formed fetal life is an extension of the aforementioned ethical question. It can be viewed that all life is important and that no life should be terminated without consent from the life that is being terminated. A polar opposite viewpoint advocates for the right of choice, that being the choice to terminate a pregnancy due to desire or pregnancy risks. Overall, most multifetal pregnancy reductions that occur as a result of ART are being done for the protection of the child-bearer's health and to maximize the health of the remaining fetuses.


See also

*
Biological reproduction Reproduction (or procreation or breeding) is the biological process by which new individual organisms – "offspring" – are produced from their "parent" or parents. Reproduction is a fundamental feature of all known life; each individual org ...
*
Conjoined twins Conjoined twins – sometimes popularly referred to as Siamese twins – are twins joined ''in utero''. A very rare phenomenon, the occurrence is estimated to range from 1 in 49,000 births to 1 in 189,000 births, with a somewhat higher incidence ...
*
Feodor Vassilyev Feodor Vassilyev (russian: Фёдор Васильев, older spelling: Ѳеодоръ Васильевъ) (c. 1707 1782) was a peasant from Shuya, Russia. His first wife is said to have lived to be 76, and between 1725 and 1765, have had 69 ch ...
* "Grávida de Taubaté" (pt), a Brazilian woman who pretended to be pregnant with quadruplets in 2012 and gained national media attention before her pregnancy was revealed to be a hoax * ''
Half a Dozen Babies ''Half a Dozen Babies'' (also known as ''Life's Little Struggles'') is a 1999 ABC television film. It stars Scott and Melissa Reeves. Plot A young couple have been struggling to have a baby for years, unsuccessfully. Then, suddenly, one day, the ...
'', a 1999 drama film about the 1993-born
Dilley sextuplets The Dilley sextuplets (born May 25, 1993) are the United States' first set of surviving sextuplets, born to Becki and Keith Dilley in Indianapolis, Indiana, United States. They are, in birth order: Biography The siblings were the first surviving ...
*
List of multiple births This is a list of multiple births, consisting of notable higher order (4+) multiple births and pregnancies. Twins and triplets are sufficiently common to have their own separate articles. With the use of reproductive technology such as fertility ...
*
List of twins This is a list of notable twins, siblings resultant from a multiple birth. Actors * Kaya and Sarp Akkaya (1980–) * Shawn and Aaron Ashmore (1979–) * Conrad (1923–2013) and Bonar Bain (1923–2005) * Gayle and Gillian Blakeney (1966–) ...
*
Only child An only child is a person with no siblings, Birth, by birth or adoption. Children who have half-siblings, step-siblings, or have never met their siblings, either living at the same house or at a different house—especially those who were born con ...
* ''
Quints ''Quints'' is a 2000 Disney Channel Original Movie starring Kimberly J. Brown as the older sister of a set of quintuplets. One of the quints was played by Kimberly J. Brown’s real-life brother Dylan Brown.https://www.yahoo.com/lifestyle/form ...
'', a Disney Channel movie about a teenage girl becoming the older sister to quintuplets *
Superfecundation Superfecundation is the fertilization of two or more ova from the same cycle by sperm from separate acts of sexual intercourse, which can lead to twin babies from two separate biological fathers. The term superfecundation is derived from fecund, ...
(multiple pregnancy resulting from separate acts of sexual intercourse) * ''
Three Identical Strangers ''Three Identical Strangers'' is a 2018 documentary film directed by Tim Wardle, about the lives of Edward Galland, David Kellman, and Robert Shafran, a set of identical triplet brothers adopted as infants by separate families. Combining archival ...
'' *
Twin Twins are two offspring produced by the same pregnancy.MedicineNet > Definition of TwinLast Editorial Review: 19 June 2000 Twins can be either ''monozygotic'' ('identical'), meaning that they develop from one zygote, which splits and forms two em ...


References


External links


Facts About Multiples


*
D. L. Ashliman Dee L. Ashliman (born January 1, 1938), who writes professionally as D. L. Ashliman, is an American folklorist and writer. He is Professor Emeritus of German at the University of Pittsburgh and is considered to be a leading expert on folklore an ...

Multiple Births in Legend and Folklore

Twins and Multiple Births Association
{{DEFAULTSORT:Multiple Birth Sibling Zoology Women's health