A multiple birth occurs when more than one fetus is carried to term in a single pregnancy.

Different
names for multiple births are used, depending on the number of offspring. Common multiples are two
and three, known as twinsand triplets. These and other multiple births occur to varying degrees in
most animal species, although the term is most applicable to placental species.
Multiple birth siblings are either monozygotic or dizygotic. The former result from a single
fertilized egg or zygote splitting into two or more embryos, each carrying the same genetic material
(genes). Siblings created from one egg are commonly called identical. Since identical multiples share
the same genetic material, they are always the same sex. Dizygotic or fraternal multiples instead
result from multiple ova being ripened and released in the same menstrual cycle by a woman's
ovaries, which are then fertilized to grow into multiples no more genetically alike than ordinary full
siblings. Multiples calledpolyzygotic represent some combination of fraternal and identical siblings.
For example, a set of triplets may be composed of identical twins from one egg and a third sibling
from a second egg.
The most common form of multiple births for humans is twins. Many placental species give birth to
multiples as a matter of course, with the resulting group called a litter.
Terminology
Monozygotic multiple (typically two) fetuses produced by the splitting of a singlezygote
Dizygotic multiple (typically two) fetuses produced by two zygotes
Polyzygotic multiple fetuses produced by two or more zygotes
Terms used for the order of multiple births in human beings are largely derived from theLatin names
for numbers. Two offspring (twins) is the most common form, eight (octuplets) is the largest number
ever successfully carried to full term with all children surviving.
One offspring singleton
Two offspring twins
Three offspring triplets
Four offspring quadruplets
Five offspring quintuplets
Six offspring sextuplets
Seven offspring septuplets
Eight offspring octuplets
Nine offspring nonuplets
Ten offspring decaplets
Eleven offspring undecaplets
Twelve offspring duodecaplets
Thirteen offspring tridecaplets
Fourteen offspring quadecaplets
Fifteen offspring quindecaplets
Sixteen offspring sexdecaplets
Seventeen offspring sepdecaplets
Eighteen offspring octdecaplets
Nineteen offspring nondecaplets

Higher order multiple
High orders of multiple births (three or more offspring in one birth) may result in a combination of
fraternal (genetically different) and identical (genetically identical) siblings. The latter are also
called super twins. For example, a set of quadruplets may consist of two sets of identical twins; in
such a case each child has one identical and two fraternal siblings. This happens when multiple eggs
are fertilized and one or more these subsequently divides into two fetuses. By analogy with
monozygotic and dizygotic twins, such a combination is called dizygotic triplets. The Kbler triplets
(see Elisabeth Kbler-Ross) were of this type.
[1]

Identical triplets or quadruplets are very rare and result when the original fertilized egg splits and then
one of the resultant cells splits again (for triplets) or, even more rarely, a further split occurs (for
quadruplets). Alternatively the original fertilized egg can split twice (to produce four embryos) and all
four may survive, to produce identical quadruplets, or one of the embryos may not survive and result
in triplets.

Human multiple births
Twins are by far the most common multiples born live. Multiple births of as many as eight babies have
been born alive, the first set on record to the Chukwu family in Texas in 1998; one died and seven
survived. In 2009, a second set, the Suleman octuplets, was born in Bellflower, California. To date, all
eight have survived.
[2][3]

There have been a few sets of nonuplets (nine) in which a few babies were born alive, though none
lived longer than a few days. There have been cases of human pregnancies that started out with ten,
eleven, twelve or fifteen fetuses, but no instances of live births. The pregnancies of the 10, 11 and 15
fetuses have all resulted from fertility medicationsand assisted reproductive technology (ART).
However there has been one documented case when 12 children were conceived naturally.
[4]

Multiple pregnancies in humans are usually born prior to 38 weeks of gestation
[dubious discuss]
, the
average length of pregnancy. Thirty-six weeks is average for twin births, thirty-two weeks for triplets
and thirty weeks for quadruplets.
[edit]Quadruplets
Quadruplets result from the rare occurrence when four eggs are released and fertilized at once, or
when one egg splits into four, or one egg splits into three with the fourth one fertilized, two eggs split
into two, or one egg splits and two are fertilized. One famous set of quadruplets includes the Genain
quadruplets who were identical quadruplets who all developed schizophrenia.

Causes and frequency
According to Hellin's law, multiple births occur naturally at approximately the rate of:
Twins: 1/89 (about 1.1%) of singleton births,
Triplets: 1/89
2
= 1/7921 (about 0.013%) of singleton births, and
N-tuplets: 1/89
N-1
(app. 0.000142% for quadruplets, i.e. fewer than 1 quadruplet per 700,000
singleton births; even lower for higher N-tuplets)
North American dizygotic twinning occurs about once in 83 conceptions, and triplets about once in
8000 conceptions. In the US, there were over 136,000 multiple human births in 2003.
[5]
A traditional
approximation of the incidence of multiple pregnancies is as follows:
[6]

Twins 1:80
Triplets 1:80 = 1:6400
N-tuplets 1:80
N-1

[6]

Human multiple births can occur either naturally (the woman ovulates multiple eggs or the
fertilized egg splits into two) or as the result of infertility treatments such as IVF(several
embryos are often transferred to compensate for lower quality) or fertility drugs (which can
cause multiple eggs to mature in one ovulatory cycle).
For reasons that are not yet known, the older a woman is, the more likely she is to have a
multiple birth naturally. It is theorized that this is due to the higher level offollicle-stimulating
hormone that older women sometimes have as their ovaries respond more slowly to FSH
stimulation.
[7]

The number of multiple births has increased over the last decade. For example, in Canada
between 1979 and 1999 the number of multiple birth babies increased 35%. Before the
advent of ovulation-stimulating drugs, triplets were quite rare (approximately 1 in 8000 births)
and higher order births much rarer still.
[citation needed]
Much of the increase can probably be
attributed to the impact of fertility treatments, such as in-vitro fertilization. Younger patients
who undergo treatment with fertility medication containing artificial FSH, followed by
intrauterine insemination, are particularly at risk for multiple births of higher order.
Certain factors appear to increase the likelihood that a woman will naturally conceive multiples. These
include:
mother's age women over 35 are more likely to have multiples than younger women
[citation needed]

mother's use of fertility drugs approximately 35% of pregnancies arising through the use of
fertility treatments such as IVF involve more than one child
The increasing use of fertility drugs and consequent increased rate of multiple births has made the
phenomenon of multiples increasingly visible in the public eye. In 2004, the birth of sextuplets to
Pennsylvania couple Kate and Jon Gosselin helped them to launch their own highly popular television
series, originally Jon & Kate Plus 8 and now (following their divorce) Kate Plus 8, which is the highest
rated show on the TLC network.
Risk
Premature birth and low birth weight
Babies born from multiple-birth pregnancies are much more likely to result in premature birth than
those from single pregnancies. 51% of twins and 91% of triplets are born preterm, compared to 9.4%
in singletons.
[8]
14% of twins and 41% of triplets are even born very preterm, compared to 1.7% in
singletons.
[8]

The preterm births also result in multiples tending to have a lower birth weight compared to
singletons.
Some evidence
[who?]
indicates that only 1.10% of singletons are born with a very low birth weight and
10.12% twins and 31.88% triplets were found to be born with very low birth weight. This
Study
[who?]
was conducted by looking at the statistics from the U.S. Natality Files (5).
Among the exceptions are the Kupresak triplets of Mississauga, Ontario, Canada; their combined
weight at birth in 2008, of 17 lbs, 2.7 ounces, set a world record.
[9]

[edit]Cerebral palsy
Cerebral palsy is more common among multiple births than single births, being 2.3 per 1,000
survivors in singletons, 13 in twins, and 45 in triplets in North West England.
[10]

[edit]Incomplete separation
Further information: Twin#Degree of separation
Multiples may become monochorionic, sharing the same chorion, with resultant risk of twin-to-twin
transfusion syndrome. Monochorionic multiples may even become monoamniotic, sharing the
same amniotic sac, resulting in risk of umbilical cord compression and entanglement. In very rare
cases, there may be conjoined twins, possibly impairing function of internal organs.
[edit]Mortality rate (stillbirth)
Multiples are also known to have a higher mortality rate. It is more common for multiple births to be
stillborn, while for singletons the risk is not as high. A literary review on multiple pregnancies shows a
study done on one set each of septuplets and octuplets, two sets of sextuplets, 8 sets of quintuplets,
17 sets of quadruplets, and 228 sets of triplets. By doing this study, Hammond found that the mean
gestational age (how many weeks when birthed) at birth was 33.4 weeks for triplets and 31 weeks for
quadruplets. This shows that stillbirth happens usually 35 weeks before the woman reaches full term
and also that for sextuplets or higher it almost always ends in death of the fetuses.
[11]
Though
multiples are at a greater risk of being stillborn, there is inconclusive evidence whether the actual
mortality rate is higher in multiples than in singletons.
[edit]Fertility therapy problems and selective reduction
Today many multiple pregnancies are the result of fertility therapy. Elsner
[12]
studied 42 months of IVF
(in vitro fertilization) procedures, and related the number of embryos transferred and the pregnancy
outcome. In this time, they found that of the 2,173 embryo transfers performed, 734 were successfully
delivered pregnancies (33.8%). These were analyzedthe overall multiple pregnancy rate was 31.3%
(24.7% twins, 5.8% triplets, and .08% quadruplets). Because IVFs are producing more multiples, a
number of efforts are being made to reduce the risk of multiple births- specifically triplets or more.
Medical practitioners are doing this by limiting the number of embryos per embryo transfer to one or
two. That way, the risks for the mother and fetuses are decreased. De Sutter
[13]
found by looking at a
previous study done in 1997, that by using SET (single embryo transfer) the twin birth rate dropped
from 30% to 21%. Sutter also found that the use of this transfer method increased from 1.5% to
17.5%. So limiting the number of embryos transferred can reduce the risks of having multiples and so
reduce the risks associated with multiple pregnancies.
Another procedure that the medical world is using today is known as selective reduction, i.e. the
termination of one or more, but not all, of the fetuses. This is often done in pregnancies with multiple
gestations to increase the likelihood that one child may live a healthy life. Armour
[14]
found by looking
at a review of a series of 1,000 selective reduction cases, there has had a loss rate of 5.4% in
pregnancies. Many of the losses (15%) occurred within 4 weeks of the procedures and more than
50% occurred after 8 weeks. This suggests that the reduction was successful at reducing the
embryos from multiple gestations to single.
Though selective reduction seems to be working, mothers of multiples who undergo this procedure
are at a higher risk of miscarrying compared to that of an unreduced multiple pregnancy. A study
done by looking at 158 pregnant women who underwent selective reduction from higher order
multiples to twins showed that the mother had a 10.6% chance of miscarriage. Mothers of twin
pregnancies without reduction only had a 9.5% chance of miscarriage. Antsaklis
[15]
shows that there
is a small increase in mortality for reduced twin pregnancies versus unreduced twin pregnancies.
Competition among fertility clinics does not appear to increase rates of multiple births from fertility
treatment by promoting more aggressive embryo transfer decisions.
[16]

[edit]Birthing process and neonatal intensive care
When it comes to the birthing process of multiples, mothers are more likely to receive
a Caesarean (C-section) delivery than natural. Michael Kogan
[17]
found that between 19891991 and
1995-1997 the cesarean delivery rate for mothers of multiples increased from 21.9% to 27%. Kogan
discovered this evidence by looking at the National Center for Health Statistics, births and infant death
records for twins in the United States.
Multiple-birth infants are usually admitted to neonatal intensive care immediately after being born. The
records for all the triplet pregnancies managed and delivered from 1992-1996 were looked over to
see what the neonatal statistics were. Kaufman
[18]
found from reviewing these files that during a five
year period, 55 triplet pregnancies, which is 165 babies, were delivered. Of the 165 babies 149 were
admitted to neonatal intensive care after the delivery(90%).
[edit]Cultural aspects
Certain cultures consider multiple births a portent of either good or evil.
[19]

Mayan culture saw twins as a blessing, and was fascinated by the idea of two bodies looking alike.
The Mayans used to believe that twins were one soul that had fragmented.
In Ancient Rome, the legend of the twin brothers who founded the city (Romulus and Remus) made
the birth of twin boys a blessing, while twin girls were seen as an unlucky burden, since both would
have to be provided with an expensive dowry at about the same time.
In Greek mythology, fraternal twins Castor and Polydeuces, and Heracles and Iphicles, are sons of
two different fathers. One of the twins (Polydeuces, Heracles) is the illegitimate son of the god Zeus;
his brother is the son of their mother's mortal husband. A similar pair of twin sisters
are Helen (of Troy) and Clytemnestra (who are also sisters of Castor and Polydeuces). The theme
occurs in other mythologies as well, and is called superfecundation.
In certain medieval European chivalric romances, such as Marie de France's Le Fresne, a woman
cites a multiple birth (often to a lower-class woman) as proof of adultery on her part; while this may
reflect a widespread belief, it is invariably treated as malicious slander, to be justly punished by the
accuser having a multiple birth of her own, and the events of the romance are triggered by her
attempt to hide one or more of the children.
[20]
A similar effect occurs in the Knight of the
Swan romance, in the Beatrix variants of the Swan-Children; her taunt is punished by giving birth to
seven children at once, and her wicked mother-in-law returns her taunt before exposing the
children.
[21]