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How are triplets formed?
Who says triplets does not necessarily say three eggs and three sperm. In reality, it is a bit more complex. Because, as in a twin pregnancy with identical twins, an egg can be fertilized by a sperm and result in an egg which will split into two, and give rise to two embryos.
Designing triplets: three scenarios
There are three ways to design triplets:
- An egg is fertilized by a single sperm, and the egg formed splits into three embryos, giving rise to identical triplets, like identical twins. Very rare, this possibility is most often the result of a spontaneous pregnancy, without medical intervention.
- Three eggs can be expelled by the ovary at the time of ovulation, especially as part of simple ovarian stimulation (without in vitro fertilization), and be fertilized by three sperm, resulting in three completely different embryos, each with its own 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 false triplets, having no more similarities 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 end up with identical twins. The triple pregnancy then consists of two homozygous twins and a third child who differs from the other two.
Note that if the literature reports extremely rare cases where an egg is fertilized by two spermatozoa, and where the resulting embryo splits in two, this case has been observed only very exceptionally. Usually, the embryo from one egg and two sperm does not survive. If he survives, we are talking about 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 to three embryos in the uterus during in vitro fertilization, partly explains the observed increase in the number of multiple pregnancies and twins. , triplets, or even more rarely quadruplets. Late pregnancy, over the age of 35 to 40, also increases a woman’s risk (or chance, it depends) of having twins or triplets.
When to detect a pregnancy of triplets?
If “abnormally” high beta-HCG levels may suggest that it is a matter of multiple pregnancies, 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, or even the dating ultrasound, from 5 weeks of amenorrhea, that we can see three gestational bags, corresponding to three embryos. But other ultrasounds will then have to refine the diagnosis, in order to be able to tell if there are identical twins, true triplets, or if they are three separate babies. This is very important for the follow-up 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 it is twins or triplets. Usually performed by a specialized obstetrician, however, the follow-up differs depending on the configuration of the triple pregnancy. As with a twin pregnancy, complications and follow-up differ depending on the number of placentas: the fewer the placentas, the more risky the pregnancy is.
Thus, a triple pregnancy with true triplets, or twins with a third baby (so only one or two placentas), requires closer follow-up than a triple pregnancy with three placentas. Ultrasound follow-up will be one ultrasound per month – compared to only three ultrasounds in all 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, urinalysis) are carried out regularly, in addition to the classic medical check-ups for pregnancy.
Note also that the weight gain is 20,5 to 23 kg on average for a triple pregnancy, against 15,5 to 20,5 for twins, and ideally between 9 and 12 to 16 kg for a single pregnancy.
I’m expecting triplets: what are the risks?
Overall, all the risks and complications that exist in a normal pregnancy are increased. Fatigue is therefore greater, as is the risk of anemia (because the additional blood volume is greater), arterial hypertension, even preeclampsia, gestational diabetes, premature delivery, intra-growth retardation. uterine, congenital malformations …
If two fetuses share the same placenta (monochorionic pregnancy), the main risk, besides prematurity, is that of a transfusion-transfused syndrome. To put it simply, it is about a bad distribution of the blood between the babies, which involves various consequences, of which a delay of growth of the twins known as “transfusionist”.
What childbirth when you are pregnant with triplets?
The scheduled cesarean section is recommended and favored by doctors, vaginal delivery is extremely rare. Pregnancies of triplets, quadruplets or others require not only close and specific follow-up, but the use of a maternity unit with a large pediatric team and a neonatal intensive care unit. In other words, in the vast majority of cases of triple pregnancy, the choice of type 3 maternity is strongly recommended, otherwise a transfer of the mother and / or babies could take place.
How many triplet pregnancies come to term?
20 to 30% of twin pregnancies do not reach the 32nd week of amenorrhea. The increased tension of the uterus, the lack of room for the fetuses in utero and the insufficiency of placental exchanges are the main factors that can give rise to a premature birth. In France, medical teams generally prefer to induce delivery before the expected date of delivery (APD), rather than risk an emergency cesarean section and complications. A scheduled cesarean is usually scheduled for the birth of triplets.
Multiple pregnancy: focus on your rights and CAF aid
Pregnancy of triplets: how long does maternity leave last?
For the birth of triplets, or more, maternity leave is 46 weeks in total, broken down as follows: 24 weeks prenatal leave and 22 weeks postnatal leave. As in the case of a normal pregnancy, it is possible to have recourse to a pathological leave, or to postpone part of the prenatal leave in postnatal, with the approval of his gynecologist or his midwife.
Triplets: get closer to CAF
Whether you are expecting one or more 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 it is all the more true if one expects twins, triplets, even quadruplets or more. Because the CAF includes all the more help as the family is large. Thus, couples and future mothers of twins, triplets, or even more, will certainly be entitled to the Childcare Benefit, or Paje, which includes four aids:
- the birth bonus;
- the basic allowance;
- the shared child education benefit, in the event of parental leave;
- and the complement of free choice of childcare.
By getting closer to 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). Support that can also take the form of home help, the first few weeks, to help you take care of newborns.
Mutual, municipality, works council, PMI… Do not hesitate to contact the various structures to which you are entitled, because some provide specific measures for multiple births.
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