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Everything You Should Know About Twins, Triplets, and Multiple Births

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Being pregnant with and delivering more than one baby at a time is called multiple births. The below article explains multiple births in detail.

Medically reviewed by

Dr. Manwani Saloni Dilip

Published At August 18, 2022
Reviewed AtDecember 8, 2022


When the doctor delivers the big news: You are having twins! It excites many parents, whereas a few get dismayed! Carrying multiple babies has its own set of good and bad. Multiple births have become more common now than they used to be due to increased fertility treatment rates. Based on how many babies are present in the womb, they become twins, triplets, quadruplets, etc. If you are pregnant with multiple babies, this article is your holy grail.

What Are Multiple Births?

Multiple births mean delivering more than one baby in the same pregnancy. Having two babies simultaneously is named twins, and having three babies is called triplets. Although drastic medical advancements have come into play, there are still complications to the mother and the infant associated with multiple births.

What Are the Causes of Multiple Births?

Multiple births occur when more than one egg gets fertilized or when the fertilized egg undergoes division.

There are different possibilities for multiple births, such as;


Having two babies at the same time. There are two possibilities associated with having twins such as;

  • In the first type, only one egg gets fertilized and then divides into two, forming twin babies. The twins developing from the same egg are called identical twins. Identical twins share the same genes, have a very similar physical appearance, and are of the same sex.

  • Two eggs get fertilized by different sperms in the second type. The twins developing from two different eggs are called fraternal or non-identical twins. Fraternal twins differ in genes and physical appearance. As they do not share the same appearance, they are like any other two siblings born at different times. They do not necessarily have the same sex; they can be of the same sex but not always.


Having three babies at the same time. There are multiple possibilities associated with having triplets, such as;

  • The triplets can all be identical - all the three developing from a single fertilized egg.

  • All three can be fraternal - developing from three different eggs.

  • It can be a combination of two identical babies (developing from the same egg) and one unidentical baby (developing from a different egg).

Multiple births with more than three babies have also been reported. They are named high-order multiples and carry high risks during pregnancy.

Who Can Have Multiple Births?

Though any woman can have multiple births; specific criteria give the pregnant woman high chances of multiple births like;

  • Women who have late pregnancies, usually in their '30s, have higher chances of conceiving multiple babies simultaneously.

  • Women trying fertility treatments - Women who have difficulty getting pregnant are prescribed fertility medications that boost ovary production, creating higher chances for multiple births.

  • Genetics plays a major role in the incidence of multiple births; parents with twins in their families, who are one in a twin, born to a twin, have high chances of multiple births. The occurrence of multiple births is more in maternal families.

  • Research also shows that non-identical twins are common in stout and taller women.

  • IVF (in vitro fertilization), commonly called test-tube babies, is a procedure of assistant pregnancy in which egg and the sperm are extracted and combined in the laboratory. Then the fertilized egg (which can be more than one) is injected into the uterus. There is a high possibility for multiple births in IVF as more than one fertilized egg could be injected into the uterus.

What Are the Signs of Multiple Births?

  • Pregnant women with multiple babies show symptoms like severe nausea and vomiting.

  • Breast tenderness.

  • Rapid weight gain in the first trimester.

  • Feeling movement in various stomach parts simultaneously, feeling multiple heartbeats, etc.

What Are the Tests To Detect Multiple Births?

  • An ultrasound scan is the only way to confirm the number of babies present inside the uterus.

The following test reports suggest multiple pregnancies;

  • The hCG levels (human chorionic gonadotropin, which is a hormone produced by the placenta during pregnancy) are higher than those with a single baby.

  • The fetal doppler scan records additional heartbeats or more than one heartbeat.

  • The level of the protein called alpha-fetoprotein is more in the blood.

Who Are Vanishing Twins and Appearing Twins?

  • Vanishing Twin: It is a condition in which early ultrasound shows two babies whereas later shows only one baby. One baby goes through a miscarriage, or the baby's tissues get absorbed by the other twin or the mother itself.

  • Appearing Twin:

  1. On the contrary, appearing twins mean a baby that is not detected in the initial ultrasounds suddenly starts appearing in the later ones.

  2. It could happen when one of the twins gets hidden behind the other. It is more common in twins developing from the same egg.

  3. Another rare cause of appearing twins is superfetation twins. When the mother is already pregnant with one baby, an ovum from two different menstrual cycles gets fertilized. It gets implanted in the uterus- in simple terms, getting pregnant when they are already pregnant. They are categorized as twins as they get delivered at the same time. Also, if both the babies' conception period is too far, it is straightforward that the later formed baby is born preterm.

What Are the Complications With Multiple Births?

The complications associated with multiple births are relatively more than you might anticipate in a singleton (pregnant with only one baby) pregnancy. It does not mean that every woman carrying multiple babies at a time will face complications. The common complications include;

Premature Births: Women pregnant with multiple babies have a higher chance of premature delivery than those carrying a single baby. It is the most common complication in multiple births.

Gestational Hypertension: High blood pressure occurring during pregnancy is termed gestational hypertension. Though anybody who is pregnant can suffer gestational hypertension, the prevalence of gestational hypertension is more when pregnant with multiple babies.

Gestational Diabetes: The incidence of high blood sugar levels during pregnancy is gestational diabetes. It happens due to the production of hormones at elevated levels from the placenta (a temporary organ formed in the uterus that holds the baby during pregnancy). Though anybody who is pregnant can suffer gestational diabetes, its prevalence is more when pregnant with multiple babies.

Low Birth Weight: It is a common complication with multiple births. In multiple births, the babies have a lower birth weight than normal. Also, one twin may weigh normally, while the other might weigh less.

Faint Chances of Normal (Vaginal) Birth: C-section (cesarean section) is the type of delivery in which a cut is made in the stomach to deliver the baby. It is a common delivery method even in mothers carrying a single baby. Usually, in most triplet births, a planned C-section is performed. One baby delivers through vaginal birth in some twins, and C-section takes out the other. The doctors usually preplan the delivery method unless it is an emergency.

Birth Complications: The chances of complications during birth are more common in multiple births.

What Are the Ways To Have Healthy Multiple Births?

  • Eat healthy and nutritious food as recommended by your gynecologist.

  • Do not fail to remember that you are eating for more than just two people. So eat a few calories more than you would usually.

  • Stay hydrated and take plenty of rest.

  • Ask your gynecologist about it before exercising or participating in any physical activities.

  • Go for check-ups at regular intervals and as suggested.

  • The patients who are advised on bed rest are recommended not to have intercourse for the course of time.

  • Avoid stressing about the pregnancy.

  • Take the supplements prescribed by your gynecologist without fail.

Few Facts About Twins:

  • The twins usually start communicating with each other starting from the 14th week of gestation; ultrasounds have even shown twins holding hands.

  • Though the identical twins share the same features, their fingerprints do not match.

  • It is not necessary that the twins should have the same father; the father of each child in the same pregnancy could be different.

  • A term called twin talk, which means a language that most twins create for themselves.


Though delivering multiple babies at a time could be a handful, they are considered special, and most people awe looking at them. If you are pregnant with multiple babies, do not panic about the pregnancy, instead, take proper care and rest as suggested by your gynecologist.

Frequently Asked Questions


How to Call Four Twins?

Four twins are called quadruplets. These multiple births occur naturally or due to infertility treatments such as drugs and in vitro fertilization. And continuing a pregnancy with quadruplets for more than 36 weeks may be risky.


How Are Multiple Pregnancies Classified?

Multiple pregnancies are classified into three types. They are:
- Fraternal Twins: The babies share the same uterus.
- Identical Twins: The babies share the same deoxyribonucleic acid (DNA).
-Triplets and Higher Order Multiples (HOM): They combine identical and fraternal twins. They may be triplets, quadruplets, quintuplets, sextuplets, or more.


How Many Children Can One Mother Give Birth to at One Time?

A mother gave birth to 69 children in 40 years. There were sixteen pairs of twins, seven sets of triplets, and four quadruplets. As per studies, this is the maximum number of babies born to a mother.


Can the Fathers of Twins Be Different?

The twins can have different fathers but only in fraternal twins. This is because fraternal twins arise from fertilizing two different eggs with two different sperms. However, identical twins cannot have different fathers as they are born from a single fertilized egg.


Is It Possible for Identical Twins to Be of Different Genders?

Having identical twins of different genders is impossible as they come from fertilizing a single egg with a single sperm, which then splits to form the two zygotes. So, they can be either two boys or two girls.


How Many Babies Can a Woman Have In Her Lifetime?

A woman can have 15 to 30 babies in her lifetime. The count is determined by considering her recovery period. However, some studies show mothers who gave birth to 57 to 60 babies during their lifetime. And this type of multiple pregnancy puts the mothers at risk of dying every time they conceive.


What Does It Signify if a Test for Human Chorionic Gonadotropin Is Positive?

Human chorionic gonadotropin is a hormone produced by the placenta during pregnancy. A positive human chorionic gonadotropin test signifies that the woman is pregnant. However, there are chances of false positive results if the hormone levels are high due to menopause or hormone supplements.


How Does Human Chorionic Gonadotropin Affect You?

The side effects of human chorionic gonadotropin are nausea, vomiting, urinating less than usual, stomach pain, weight gain, shortness of breath, pelvic pain, and swelling of hands and legs.


Is It Possible to Become Pregnant After Receiving an hCG Injection?

A woman can become pregnant after receiving an hCG injection. This is because hCG allows the eggs to mature and release from the ovary. It also maintains high progesterone levels, which helps during pregnancy. In addition, it is a safe and effective method and can cause ovulation within 36 hours of administration.


Which Parent Determines the Twins?

The mother is responsible for fraternal twins because two eggs get fertilized in this type of pregnancy. However, both parents are not responsible for identical twins. Sometimes, twins may also run in families.


Is It Possible to Become Pregnant Without hCG?

A pregnancy test with undetectable hCG levels is possible. They may be due to early pregnancy or low levels of hCG circulating in the urine. A baby producing minimal amounts of hCG will also fail the test. And this may lead to undetectable pregnancy until delivery.


When Is the hCG Injection Administered?

The hCG injection is a trigger to stimulate ovulation and should be administered on the third day of the menstrual cycle, which shows ovulation within 36 hours. Sometimes, the injection is provided for about 12 days or until ovulation. Thus hCG helps the eggs to mature and get fertilized by the sperm.
Dr. Manwani Saloni Dilip
Dr. Manwani Saloni Dilip

Obstetrics and Gynecology


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