What to know about triplet pregnancy?
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| Triplet pregnancy |
Triplet pregnancy: everything you need to know
Multiple pregnancies differ from normal pregnancies with a single baby in many ways: monitoring, ultrasounds, risks and complications, rights, etc. And even more so when it comes to triplets. We tell you everything about triplet pregnancies, from conception to childbirth, including maternity leave.
Multiple pregnancies are always a big surprise for future parents. This involves a new organization to put in place, as well as a whole medical follow-up that differs from that of a single pregnancy.
Multiple births: how are triplets made?
Triplets don't necessarily mean three eggs and three sperm. In reality, it's a little more complex. Because, as in a twin pregnancy with real twins, an egg can be fertilized by a sperm and result in an egg that will split into two, and give rise to two embryos.
Conception of triplets: three scenarios
Conception of triplets can occur in three different ways:
- An egg is fertilized by a single sperm and the resulting egg splits into three embryos, giving rise to identical triplets, like real twins. Very rare, this possibility is most often the result of a spontaneous pregnancy, without medical intervention.
- Three eggs can be released from the ovary at the time of ovulation, particularly in the context of simple ovarian stimulation (without in vitro fertilization ) and be fertilized by three spermatozoa, resulting in three completely different embryos, each with its own genetic heritage, which will develop side by side in utero. In the same way that we speak of fraternal twins, we could speak of fraternal triplets, having no more resemblance than brothers and sisters who simply share the same uterus.
- Two eggs can be fertilized by two different sperm, resulting in two embryos. But one of them can split into two to result in identical twins. A triplet pregnancy then consists of homozygous twins and a third child who is different from the other two.
The medical literature reports extremely rare cases where an egg is fertilized by two sperm, and the resulting embryo splits into two. Usually, the embryo resulting from one egg and two sperm does not survive. If it does survive, we speak of semi-identical twins, sharing the same genes inherited from their mother, but different genes from their father. No case of viable birth of semi-identical triplets (where one egg has been fertilized by three sperm) has been observed to date.
The increase in the use of medically assisted procreation, where it is not uncommon to implant two or three embryos in the uterus during in vitro fertilization, partly explains the observed increase in the number of multiple pregnancies, twins, triplets, and more rarely quadruplets. Late pregnancy, after the age of 35 to 40, also increases the risks (or chances, depending on your point of view) for women of having twins or triplets.
Pregnancy test: when to detect a true triplet pregnancy?
While “abnormally” high beta-HCG levels may suggest that the pregnancy is multiple, twins, triplets, or more, only ultrasound can confirm or rule out this possibility. On palpation, a uterus larger than for a normal pregnancy also suggests the possibility of a multiple pregnancy, but without certainty.
It is during the first ultrasound scan , or even the dating ultrasound scan , from 5 weeks of amenorrhea , that we can see three gestational sacs, corresponding to three embryos. But other ultrasound scans will then have to refine the diagnosis , in order to be able to say if there are real twins, real triplets, or if they are three separate babies. Which is very important for the further monitoring of the woman pregnant with triplets.
Pregnant with triplets: pregnancy monitoring and ultrasounds
Pregnancy monitoring and ultrasound monitoring are closer together in a multiple pregnancy, whether twins or triplets. Generally carried out by a specialized obstetrician, monitoring differs depending on the configuration of the triplet pregnancy . As is the case for a twin pregnancy, complications and monitoring are adapted to the number of placentas: the fewer placentas there are, the higher the risk of the pregnancy.
Thus, a triplet pregnancy with true triplets, or twins with a third baby (i.e. only one or two placentas), requires closer monitoring than a triplet pregnancy with three placentas. Ultrasound monitoring will be one ultrasound per month – compared to only three ultrasounds in total for a normal pregnancy – if there are three placentas, or even one ultrasound every two weeks if babies share the same placenta.
Other examinations ( fetal Doppler , blood tests , blood pressure measurements, urine analysis ) are carried out regularly, in addition to the standard medical visits during pregnancy.
I'm expecting triplets: what are the risks?
Overall, all the risks and complications that exist during a normal pregnancy are increased. Fatigue is therefore greater, as is the risk of anemia (because the volume of additional blood is greater), high blood pressure, even preeclampsia, gestational diabetes , premature delivery , intrauterine growth retardation, congenital malformations, etc.
If two fetuses share the same placenta (monochorionic pregnancy), the main risk, besides prematurity, is twin-to -twin transfusion syndrome . To put it simply, this is a poor distribution of blood between the babies, which leads to various consequences, including growth retardation of the so-called “transfusing” twin.
What kind of delivery is it like when you are pregnant with triplets?
A scheduled cesarean section is recommended and preferred by doctors during a triplet pregnancy. Vaginal delivery is extremely rare. Triplet, quadruplet or other pregnancies require not only close and specific monitoring, but also the use of a maternity ward with a large pediatric team and a neonatal resuscitation service. In other words, in the vast majority of cases of triplet pregnancies, choosing a type 3 maternity ward is strongly recommended, otherwise a transfer of the mother and/or babies could take place.
How many triplet pregnancies go to term? At how many weeks can you give birth to twins or triplets?
20 to 30% of twin pregnancies do not reach the 32nd week of amenorrhea . The greater tension of the uterus, the lack of space for the fetuses in utero and the insufficiency of placental exchanges are the main factors that can lead to premature birth. In France, medical teams generally prefer to induce labor before the expected date of delivery (EDD), rather than risk an emergency cesarean section and complications. A scheduled cesarean section is generally planned for the birth of triplets.
Multiple pregnancy: focus on your rights and CAF assistance
Pregnancy with triplets: how long is maternity leave?
For the birth of triplets or more, maternity leave is 46 weeks in total, divided as follows: 24 weeks of prenatal leave and 22 weeks of postnatal leave . As in the case of a normal pregnancy, it is possible to take sick leave, or to postpone part of the prenatal leave to postnatal leave, with the approval of your gynecologist or midwife.
What help for triplets? We are getting closer to the CAF
Whether you are expecting one or several children at once, it is always advisable to register with the Family Allowance Fund, in order to benefit from assistance, if you are entitled to it. But this is even more true if you are expecting twins, triplets, or even quadruplets or more, because the CAF offers more assistance the larger the family. Thus, couples and future mothers of twins, triplets, or more, will certainly be entitled to the Young Child Reception Benefit (or Paje) , which includes four types of assistance:
the birth bonus ;
the basic allowance;
shared child education benefit, in the event of parental leave;
and the free choice of childcare method supplement .
By contacting your CAF, you can also, if you pay rent, apply for housing assistance. There are three types, which cannot be combined: personalized housing assistance (APL), family housing allowance (ALF) and social housing allowance (ALS). This support can also take the form of home help, in the first few weeks, to help you take care of newborns.
Mutual insurance, municipality, works council, PMI , etc. Do not hesitate to contact the various structures to which you are entitled, because some provide specific arrangements for multiple births.
