Expect triplets, a pregnancy like no other

Being pregnant with triplets … a real epic! This type of pregnancy requires special monitoring and very safe supervision during childbirth. We take stock with Dr. Laura Miquel, obstetrician gynecologist, reproductive doctor and sexologist at the Conception Hospital in Marseille.

The triplets: less than 200 births per year in France

In 2019, there were 181 births of triplets in France. This figure has been rather stable in recent years, whereas it had increased in recent decades due to the increasing use of Assisted Reproduction. But now, doctors are increasingly reluctant to transfer more than one embryo in order to avoid a multiple pregnancy, which is difficult for parents to assume. Despite everything, the majority of triplet (or even quadruplet!) Pregnancies still occur in the context of assisted reproduction. " This will not apply to IVF, but rather to cases in which ovulation is stimulated in order to synchronize it with intercourse or insemination. The goal of ovarian stimulation is to obtain a dominant ovarian follicle (it is he who contains the oocyte, editor's note). However, when a woman has experienced many failures, we will tolerate the presence of two, even exceptionally three follicles. », Explains Dr Miquel.

Late pregnancies are more prone to twins or triplets

After the age of 38, doctors typically no longer perform simple stimulation or insemination, and turn more to IVF to optimize parents' chances of conceiving children. This is when two embryos can be implanted, resulting in the birth of triplets if one of the two embryos divides in a twin pregnancy. " In late pregnancy outside IVF, the chances of having twins or triplets are also increased, as double ovulations are more frequent », Notes the gynecologist.

True or false triplets?

Most of the time, unborn babies are false triplets. But all combinations are possible! For example: 3 oocytes and 3 sperm with false triplets, or 2 oocytes and 2 sperm with one of the oocytes which divides into identical twins. " And sometimes we even find an oocyte and a sperm that produce true triplets, but this is extremely rare. Because of all the risks involved in a triple pregnancy, embryonic reduction is often offered in the first trimester of pregnancy in order to achieve a twin or even monofetal pregnancy. », Adds the specialist.

Small ailments often exacerbated

When a mother is expecting triplets, the little ailments of pregnancy are often exacerbated such as nausea or vomiting because the level of the hormone HCG is increased due to the presence of more placenta. From the first 4 or 5 months, the mother's belly is similar to that of a full-term woman who is expecting only one child, with back pain, a frequent urge to urinate or even a feeling of heavy legs. Expecting triplets is not easy! " If the mother feels healthy early in the pregnancy, she can still exercise normally and does not have to stay in bed if there is no threat of premature labor. Of course, she has to be relatively quiet », Advises the doctor.

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A pregnancy at risk for the mother

When expecting triplets, pregnancy is necessarily considered to be at risk. " Complications can also be seen in a singleton pregnancy, but the risks of their occurrence are increased since the mother is expecting three babies. », Notes Dr Miquel.

-Treat of late miscarriage (up to 22 weeks)
-Risk of premature delivery (due to uterine distension induced by the volume of babies)
– High blood pressure or pre-eclampsia (drug treatments are then administered but a premature birth can also be indicated)
-Gestational diabetes (if monitoring of food is not sufficient, insulin may be given)
-Cholestasis of pregnancy (liver disease that is treated with medication, but which sometimes requires giving birth to the child earlier)

Risks for babies

  • The prematurity, whether spontaneous or induced due to preeclampsia, or cholestasis of pregnancy. " We may indeed have to give birth to babies earlier to care for the mother or the babies. Often times, triplets suffer from associated growth retardation. It is extremely rare for a pregnancy of this type to go beyond 37 weeks », Says the specialist. But then, triplets born prematurely are no more at risk than other premature babies.
  • The transfusion-transfused syndrome is another risk in the case of identical twins or even true triplets. It occurs when babies share the same placenta but in different pouches. As a result, they eat from the same "plate" with the risk that one of them will eat more than the other. " We can observe "shunts", that is to say abnormal vascular exchanges between babies », Reports Dr Miquel. In this case, one of the babies may receive more blood and end up with heart failure because their cardiac output is increased. And the other does not get enough blood and therefore ends up with hypotrophy. " This can be treated with laser via a fetoscopy. We put the camera in the water bag and we will coagulate the vessels that pose a problem. But this is an intervention that is only performed in some very specialized centers », Warns the gynecologist.

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Close monitoring

If a woman is expecting triplets, she cannot be followed by a midwife but necessarily by an obstetrician-gynecologist. Regarding the choice of maternity, the couple can turn to a type 2B maternity (which houses a neonatal department), and ideally type 3 (presence of a resuscitation unit) depending on the place of life of the future mom. " Fortunately, not all babies from a triple pregnancy are born before 34 weeks even though the average delivery time is 32 weeks. They don't necessarily need resuscitation. If the babies are at a good weight and the mother's history allows it, a type 2B maternity delivery is possible. ”Says Dr Miquel.

Caesarean section or vaginal birth?

Vaginal birth is possible under certain conditions, but is offered in very few maternity hospitals in France. The mother must then be aware of all the risks involved. “Most often, the doctor performs a cesarean section scheduled between the 35th or 37th week maximum in order not to take any risk for the mother or the babies. ", Says the expert.

Babies can actually present themselves in the head, seat or transverse position. " In addition, when the baby in the first position is born, there is a risk that the placentas of the other babies will come off, and therefore that the other two babies will no longer be fed. The time between each birth must therefore be very short », Adds Dr Miquel. It should also be noted that the risk of bleeding during delivery is higher for a triplet delivery, since the uterus is more distended. On the other hand, overall, there is always a greater risk of bleeding by cesarean section than by vaginal route.

Triplets … and after?

The arrival of triplets represents a great upheaval for the family, both psychological and material. You will need to buy many products in triplicate, but also equip yourself with a special stroller. When it comes to breastfeeding, this is quite possible. But very often, babies are fed a minimum by mixed breastfeeding as the mother's fatigue is intense. The dad is therefore also called upon to give the bottles! The mother will of course be able to benefit from extended maternity leave: 46 weeks, including 24 weeks before the expected date of delivery and 22 weeks after. Enough to quietly adapt to these multiple life changes.