Triplets

What are triplets?

Triplets are a type of multiple pregnancy that produces three fetuses.

How do triplets happen?

Triplets can occur when:

• You produce and release three eggs at ovulation and all three eggs are fertilized by sperm.
• A fertilized egg splits into three separate fertilized eggs.

What are the different types of triplets?

Types of triplets include:

• Fraternal triplets: When three separate eggs become fertilized. Fraternal triplet pregnancies result in babies that might not all be the same gender or look the same. Their DNA is like that of a biological sibling.
• Identical triplets: They occur when one fertilized egg splits into three embryos. They almost always result in babies that are the same gender. Identical triplets also have nearly identical DNA, so they’re more likely to resemble one another. This type of triplet is rare.
• Mixed triplets: When two babies are identical and one is fraternal.

Depending on how and when the triplet pregnancy occurs, they may share a placenta and gestational sac:

• Monochorionic: All three fetuses share the same placenta and gestational sac.
• Dichorionic: Two fetuses share a placenta and gestational sac. The third has its own placenta and gestational sac. The sacs are separated by a thin membrane.
• Trichorionic: Each triplet has their own placenta and gestational sac.

Who gets pregnant with triplets?

You’re more likely to have a triplet pregnancy if you:

• Are older than 35. Your chances increase even more if you’ve already had multiple pregnancies.
• Have a personal or family history of multiple pregnancy.
• Use fertility treatments like IVF (in vitro fertilization).

How will I know if I’m pregnant with triplets?

The first signs that you may be carrying more than one fetus include having extremely sore breasts. You may also gain weight quickly or experience severe morning sickness.

Your healthcare provider may notice signs of more than one fetus during a prenatal checkup. The signs include:

• High levels of pregnancy hormones (human chorionic gonadotropin or HCG) in your blood.
• High levels of alpha-fetoprotein, a protein that develops in the fetus’s liver.
• Hearing more than one heartbeat.
• A prenatal ultrasound (a test that uses sound waves to capture real-time images of your uterus) will confirm a triplet pregnancy by showing three fetuses.

Is prenatal care different for triplet pregnancies?

Prenatal care includes regular checkups to assess fetal development. Triplet pregnancies have a higher risk of complications. Your pregnancy care provider will also monitor your health for complications. Because you’re at risk for potential complications, your provider will see you more frequently. You’ll need more frequent checkups depending on how far along you are in your pregnancy:

• First trimester (through the 12th week of pregnancy): Every two to three weeks.
• Second trimester (weeks 13 through 26): Every two weeks.
• Third trimester (week 27 and beyond): Weekly until you go into labor.

Do I need a special diet if I’m pregnant with triplets?

A special diet isn’t necessary. But you’ll need to get enough calories to support three developing fetuses. Your obstetrician-gynecologist (OB/GYN) will let you know how many calories you need or if you should alter your diet in any way.

You should also take a prenatal vitamin to ensure you receive essential nutrients. These include:

• Calcium.
• Folic acid.
• Iron.

How can carrying triplets affect my pregnancy?

Carrying more than one fetus makes your pregnancy higher risk. This means you have higher-than-normal chances of experiencing complications.

These potential complications include:

• Anemia: Low levels of red blood cells.
• Cholestasis of pregnancy: Buildup of bile in your liver that causes acid to spill over into your blood or other tissue.
• Gestational diabetes: High blood sugar levels in a pregnant person with no history of diabetes.
• Hyperemesis gravidarum: Severe morning sickness that may include ongoing nausea or frequent vomiting.
• Polyhydramnios: Too much amniotic fluid.
• Preterm labor: When labor occurs before 37 weeks.
• Preeclampsia: High blood pressure starting after the 20th week of pregnancy.
• Premature birth: When babies are born before they reach full term.

What types of complications are babies at risk for during a triplet pregnancy?

Complications can affect one or more babies and include:

• Congenital conditions: Babies may be born with conditions that affect the appearance and function of different areas of their body. These conditions can occur in their heart, brain, face, limbs and more.
• Twin-to-twin transfusion syndrome: In this serious disorder, two or three fetuses share the same placenta and blood supply. When the blood isn’t shared equally, one fetus gets too much blood and another gets too little.
• Low birth weight: Babies weighing less than 5 pounds, 8 ounces at birth (2.5 kg) have low birth weight. This raises the risk of health issues, including difficulty breathing.
• Placental abruption: The placenta detaches from your uterus, disrupting the flow of blood and nutrients. This is a rare complication and requires immediate medical attention.

What happens if there are complications?

If there are complications, you may need to see a maternal-fetal medicine specialist.

This type of provider cares for high-risk pregnancies with services that include:

• Advanced prenatal testing and fetal monitoring.
• Diagnosing congenital conditions.
• Delivery planning and specialized childbirth services.
• Coordination of emergency treatment (if necessary) immediately after delivery.

Will I need to go on bed rest?

Bed rest includes limiting physical activity when the pregnancy is at high risk for complications. Many people with triplet pregnancies end up on bed rest in the late stages of pregnancy.

It includes:

• Modified bed rest: Spending most of your time in bed. You can have limited periods of sitting, standing or walking.
• Full bed rest: Always staying in bed except to bathe or use the bathroom.

What is labor and delivery with triplets like?

Delivery for triplets often occurs via C-section. This type of delivery is necessary:

• If the fetuses are breech or in any other position than head down.
• To ensure specialists are on standby if you or the babies need emergency treatment for a complication.

Preterm delivery is also common with triplets, especially if:

• You go into labor early and medications to stop it aren’t successful.
• You have dangerously high blood pressure or other complications that improve after delivery.
• A fetus stops growing.

It’s important to note that multiple pregnancies typically don’t last as long as singleton pregnancies (one fetus). The average pregnancy lasts 37 to 40 weeks when there’s one fetus. As the number of fetuses increases, the duration of the pregnancy decreases. The average duration for triplets is 32 weeks to 35 weeks.

A note from Cleveland Clinic

If you’re pregnant with triplets, you’re carrying three fetuses. A triplet pregnancy raises the risk of complications during both pregnancy and delivery. Frequent prenatal care and a maternal-fetal medicine specialist, when necessary, can help you stay as healthy as possible.