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Neonatal complications, outcome, and management of multiple births

George T Mandy, MD
Section Editor
Leonard E Weisman, MD
Deputy Editor
Melanie S Kim, MD


Multiple births are increasing in the United States and contribute disproportionately to perinatal and neonatal mortality and morbidity. (See "Perinatal mortality", section on 'Multifetal pregnancies'.)

The complications, outcome, and pediatric management of multiple births are reviewed here. The antenatal management of twins and triplets, and monoamniotic twin pregnancy are discussed separately. (See "Twin pregnancy: Prenatal issues" and "Twin pregnancy: Labor and delivery" and "Monoamniotic twin pregnancy (including conjoined twins)" and "Triplet pregnancy".)


Twins and triplets naturally occur in approximately 1 in 80 and 1 in 8000 pregnancies, respectively, in the United States [1,2]. The incidence of spontaneous twins varies by country and is lower in Canada and South China [3,4].

Multiple pregnancies has comprised an increasing proportion of the total pregnancies in the developed world due to older maternal age at childbirth and the expanded use of fertility treatments [5,6]. In the United States, 36 percent of twin pregnancies and 77 percent of triplet and higher order pregnancies occur after infertility treatment [5]. (See "Twin pregnancy: Prenatal issues", section on 'Prevalence and epidemiology'.)

In the United States, twin births account for 3.4 percent of live births and over 96 percent of multiple births [7]. The number of twin pregnancies increased by 76 percent from 1980 through 2009 and stabilized with a birth rate of 33.7 per 1000 births in 2013 [7]. The peak incidence of triplets, quadruplets, or higher order pregnancies occurred in 1998 with a rate of 193.5 per 100,000 live births in 1998, and has decreased to a rate of 119.5 per 100,000 births in 2013 [7]. The decline in triplet and higher order multiple birth rates is due to changes in assisted reproductive technology. (See "Strategies to control the rate of high order multiple gestation", section on 'Limiting the multiple gestation risk of ART' and "In vitro fertilization", section on 'Embryo transfer'.)

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Literature review current through: Nov 2017. | This topic last updated: Oct 24, 2017.
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