Disease Description (Causes and Symptoms)
- Definition: Multiple pregnancy is a condition in which two or more fetuses are present in a single pregnancy (twins, triplets, etc.). This entry addresses clinical considerations when a multiple pregnancy continues after an attempted miscarriage or after the pregnancy has progressed.
- Causes/Pathophysiology:
- Multiple pregnancies occurring through natural ovulation (e.g., fraternal twins), with an increased incidence of multiple pregnancy after fertility treatments such as ovulation-inducing medications or assisted reproductive technology (ART).
- As the number of fetuses increases, the burden placed on the placenta and uterus also increases in proportion, raising the risk of complications for the mother and fetuses (preterm birth, fetal growth restriction, placental dysfunction, etc.).
- Main symptoms:
- Abnormal vaginal bleeding (bleeding may occur in early pregnancy), abdominal pain, a feeling of uterine distension, and signs of early contractions, etc.
- In triplet or higher-order pregnancies, more rapid cervical changes and signs of preterm birth may occur.
Treatment Methods
- General management
- Because this is classified as a high-risk pregnancy, frequent ultrasound monitoring by an obstetrician and gynecologist (number of fetuses, growth, amniotic fluid volume, and placental condition), periodic clinical tests, and monitoring of fetal movement and contractions are necessary.
- Nutrition and weight management, screening for and management of anemia, gestational hypertension, and diabetes, education about the risk of preterm birth, and preventive measures when necessary (such as progesterone) may be considered.
- Selective fetal reduction
- It may be performed to reduce the number of fetuses and improve the survival rate and prognosis of the remaining fetuses.
- Timing: It is often performed during early or early-to-mid pregnancy (generally around 8–13 weeks), although the procedure and timing are determined according to the individual circumstances.
- Method: It is performed under ultrasound guidance. The technique (gestational sac aspiration, medication, intracardiac injection, etc.) is selected according to the location of the gestational sac, whether cardiac activity is present, and the maternal condition.
- Risks/side effects: Bleeding, infection, the possibility of miscarriage of the remaining fetuses, the risk of uterine contractions and preterm delivery caused by the procedure, and emotional and ethical burdens.
- Special considerations
- For Rh-negative mothers, the need for anti-D immunoglobulin administration after miscarriage or an invasive procedure should be assessed.
- Psychosocial support and counseling (to assist with ethical and emotional decision-making) are important.
Checklist Before an Outpatient Visit (Recommended Items to Bring and Example Questions)
- Items to bring (recommended)
- A list of medications currently being taken (including prescription and nonprescription medicines, herbal medicines, and supplements)
- Previous obstetric and gynecologic test results (ultrasound images and reports, blood test results, previous pregnancy history, and surgical records)
- Symptom records: amount, color, and duration of bleeding; nature of abdominal pain; fever, discharge, etc.
- Family history (family history of twins, genetic diseases), and history of infertility treatment (clinic records)
- Your wishes (whether you want to continue the pregnancy) and the availability of family and social support
- Items to communicate to the healthcare professional in advance during the outpatient visit
- The date of the last menstrual period (LMP) and information used to calculate gestational age
- Previous miscarriage history (procedure method and outcome) and current pregnancy-related test results
Examples of General Questions to Ask the Doctor
- What are the risks and prognosis of this condition (continuation of the multiple pregnancy or selective reduction) for my pregnancy and fetuses?
- What are the indications and specific methods for selective fetal reduction, and how high are the risks after the procedure (miscarriage, infection, etc.)?
- What follow-up tests will I need after the procedure or miscarriage, and for how long?
- If I am Rh-negative, do I need an anti-D injection, and when should it be given?
- How can I receive mental and emotional support (counseling)?
Examples of Disease-Specific Questions
- If selective fetal reduction is being considered, in my case (gestational age, fetal positions, and ultrasound findings), when and by what method is it recommended that it be performed?
- After selective reduction, by how much does the risk of miscarriage of the remaining fetuses and the risks of preterm birth and growth restriction decrease (or increase)? What is the effect of the procedure on long-term prognosis?
Additional guidance: Diagnostic and treatment decisions should be made based on consultation with an obstetrician and gynecologist and the results of individualized ultrasound and blood tests. If necessary, genetic counseling and psychological counseling are also recommended.