Twin Miscarriage Concerns

My wife is 14 weeks along with twins. She has had severe morning sickness and constant cramping that started five weeks ago. An ultrasound showed both hearts are beating strong. When can we stop worrying about miscarriage?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

The actual statistics for miscarriage among twin pregnancies vary according to the type of twinning. If the babies share the same placenta and sac (monochorionic), the rate is twice that of the type which has separate placentas and separate sacs.

Frequencies of twin "disappearance," or the loss of one baby but not the other, reportedly ranges from 15 to 70 percent if an ultrasound is performed before 14 weeks. Generally, it is considered to be about 20 percent.

Like singleton pregnancies, the risk of miscarriage declines with ultrasound observation of the fetal hearts and goes down again after completion of the first trimester. It does appear as if those two landmarks have been reached in your case.

But due to the inherent placental circulation demands of twinning, the spontaneous loss rate is still high and does extend until the 20th week of pregnancy, where it falls off. As the third trimester approaches, your wife will be watched closely due to an increased risk of preterm labor. In general, though carrying twins make it a high-risk pregnancy, there is great potential to progress uneventfully without complication.

If your wife has no other health problems such as cervical incompetence, autoimmune problems or severe anemia, which would increase her chances of pregnancy loss, she should be in a good position to have a healthy pregnancy.

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