Premature Birth and Twin/Multiples Pregnancy

A premature birth occurs when an infant is born before 37 weeks gestation (1). Premature delivery is one of the most common complications of twin and multiples pregnancies. Roughly 60% of twins are delivered preterm, and about 90% of triplets are delivered preterm (2).

Infants that are born prematurely are at a higher risk for birth injuries because of their low birth weight/underdeveloped organs and weak immune systems. They often have issues with basic functions such as respiration, blood circulation, and temperature control, and are prone to infections. The earlier a child is born, the higher the risk. (1).

Causes of premature birth

The following are some of the risk factors for premature birth (1):

    • History of preterm birth, either with twins or a single baby. History is the biggest risk factor for premature birth of a single baby or twins.
    • A short interpregnancy interval. The sooner a mother becomes pregnant after a previous pregnancy, the higher the risk of preterm delivery.
    • Assisted reproduction. Pregnancies conceived with assisted reproductive technology, such as in-vitro fertilization, are at a higher risk of preterm delivery.
    • Being pregnant with twins, triplets or more.
    • Vaginal bleeding caused by partial shedding of the uterine lining in early pregnancy (decidual hemorrhage).
    • Infection. This includes chorioamnionitis, which is inflammation of the placenta and fetal membranes caused by infections in the mother, such as Group B strep (GBS), urinary tract infection (UTI), bacterial vaginosis (BV), and E coli. Even if maternal infections don’t cause chorioamnionitis, they are still risk factors for preterm delivery. Having a short cervix is an independent risk factor for both infection and premature birth.
    • African American race.
    • Low or high maternal age.

Complications associated with multiples

twins, premature birth and birth injury

Multiples are associated with higher risks of the following complications:

    • Low birth weight: Infants that are born premature tend to have lower birth weights than those born at term. A weight of less than five and a half pounds is considered low birth weight. Infants that are born earlier than 32 weeks and weigh less than three and a third pounds are at a substantially greater risk of infection or permanent disabilities such as cerebral palsy (2). Even multiple birth infants that are carried closer to full term are typically smaller than single birth babies, which is likely due to the fetal growth restriction.
    • Intrauterine growth restriction: The growth rate of twins begins to slow at around 30-32 weeks, and the growth rate for triplets begins to slow at around 27-28 weeks (2). This occurs most often because the babies will be competing for nutrients. This can lead to intrauterine growth restriction (IUGR).
    • Placental abruption: Placental abruption is three times more likely to occur when a woman is pregnant with multiples.
    • Preeclampsia: Preeclampsia is high blood pressure associated with pregnancy. It is twice as likely in twin pregnancies than in singleton pregnancies.
    • Cord prolapse: Umbilical cord prolapse occurs when the umbilical cord slips ahead of the fetus and moves into the cervical canal or exits entirely. This can lead to cord compression, which is an obstetrical emergency. In one study, twin pregnancies represented 23.4% of 47 cases of cord prolapse, and 91% of the fetuses affected were the second twin (3).
    • Hypoxic-ischemic encephalopathy (HIE): HIE is a type of brain damage caused by inadequate oxygenated blood flow that occurs at or near the time of delivery. Studies have found an increased risk for HIE in cases of acute obstetrical events, such as placental abruption and cord prolapse, both of which have increased risks associated with twins/multiples pregnancies (4).

Birth injuries caused by premature birth and/or mismanaged twin pregnancy

The underdeveloped organs and lower birth weight associated with preterm birth make babies more susceptible to serious conditions. Conditions that can occur when preterm birth isn’t prevented or when premature babies or twins have mismanaged medical care include the following:

Treating prematurity in twin/multiples pregnancies

There are many treatments to prolong pregnancy in singleton pregnancies, including progesterone treatments, bed rest, and cervical cerclage.

Several recent studies have shown that cervical cerclage significantly benefits twin pregnancies (5,6). One study found that cerclage was associated with delivery at a later gestational age as well as fewer admissions for antenatal care (5). Of the 96 babies born alive, 54 of them were from mothers who underwent a cerclage.

Another study found that the placement of cervical pessaries (devices commonly used to treat incompetent cervixes) at 22 weeks reduced the rate of delivery in women with short cervixes carrying twins before 34 weeks by 23.2% (7).

A common treatment option for women who are at risk of preterm birth and have multiples is the administration of corticosteroids. Corticosteroids reduced the risk of infant death, respiratory distress syndrome (RDS), and PVL. Magnesium sulfate has also proven to protect the baby’s brain.   

Legal help for mismanaged twin pregnancy and premature birth injuries

If you went into preterm labor and your physician did not try to prolong the pregnancy, or if unnecessary complications arose resulting in injury, you may be eligible for compensation. The award-winning birth injury lawyers at ABC Law Centers have helped dozens of children affected by hypoxic ischemic encephalopathy (HIE), periventricular leukomalacia (PVL), and cerebral palsy.

ABC Law Centers is a national birth injury law firm that has been helping children since its inception in 1997. While our team is based in Michigan, we handle cases all over the United States. Many of our clients have hailed from Michigan, Ohio, Washington D.C., Arkansas, Mississippi, Pennsylvania, Tennessee, Texas, Wisconsin and other states. The Reiter & Walsh, P.C. birth trauma team has also handled FTCA cases involving military medical malpractice and federally funded clinics.

Contact ABC Law Centers to begin your free case evaluation. Our award-winning birth trauma lawyers are available 24/7 to speak with you, and we do not charge fees for any of the legal process unless we win.

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Video: birth injury lawyers discuss premature birth, twin pregnancies & birth injuries

Watch a video of birth injury lawyer Jesse Reiter discussing premature birth, twin and multiples pregnancies, and how medical mismanagement can cause birth injuries such as cerebral palsy.

Related Articles and Blogs from Reiter & Walsh ABC Law Centers


  1. Premature birth. (2017, December 21). Retrieved May 17, 2019, from
  2. Complications in a Multiples Pregnancy. (2016, September 03). Retrieved May 17, 2019, from
  3. Traore, Y., Dicko, T. F., Teguete, B., Mulbah, J. K., Adjobi, R., N’Guessan, E., . . . Toure Coulibaly, K. (2006). Frequency of cord prolapse: Etiological factors and fetal prognosis in 47 cases in a health center. Retrieved May 22, 2019, from
  4. Cecilia Lundgren, Lars Brudlin, Anna-Stina Wanby & Marie Blomberg (2018) Ant- and intrapartum risk factors for neonatal hypoxic ischemic encephalopathy, The Journal of Maternal-Fetal & Neonatal Medicine, 31:12, 1595-1601, DOI:10.1080/14767058.2017.1321628
  5. Roman A, Rochelson B, Martinelli P, et al. Cerclage in twin pregnancy with dilated cervix between 16 to 24 weeks of gestation: retrospective cohort study. Am J Obstet Gynecol 2016;215:98.e1-11.
  6. Roman A, Rochelson B, Fox NS, et al. Efficacy of ultrasound-indicated cerclage in twin pregnancies. Am J Obstet Gynecol 2015;212:788.e1-6.
  7. Goya, M., Calle, M. D., Pratcorona, L., Merced, C., Rodó, C., Muñoz, B., . . . Cabero, L. (2016). Cervical Pessary to Prevent Preterm Birth in Women With Twin Gestation and Sonographic Short Cervix. Obstetric Anesthesia Digest,36(4), 208-209. doi:10.1097/01.aoa.0000504739.20530.02