Twin Pregnancy

Twin Pregnancy

“Normally, twins occur in 1 of 80 pregnancies and triplets in 1 of 8000 pregnancies.” Is your belly larger than it ought to be in your week of pregnancy? Does your gynecologist feel more fetal parts than are normal for one baby?If so, you ought to get an ultrasound scan performed for there may be more than one in your womb.

What is a Twin Pregnancy?

Twins are produced when a single fertilized ovum divides early to form two identical embryos out of one (monozygotic) or when two or more eggs are released and fertilized by two sperms (dizygotic). In a monozygotic pregnancy,the two embryos share the same placenta and chorion, the outer membrane of the embryo that allows for the transfer of nutrients from the mother to the foetus blood. However, they have separate amnions, inner membranes of the embryos that help in development, for the most part. The amnion and chorion together form the amniotic sac.

In a dizygotic pregnancy, each twin has its own placenta and amniotic sac, leading to their growth being better than that in a monozygotic pregnancy. Additionally, in monozygotic pregnancies where the embryos have separate amnions, there are better survival rates than those in which the two embryos share both the amnion and chorion.

What Are the Chances of Having Twins?

Normally, twins occur in 1 of 80 pregnancies and triplets in 1 of 8000 pregnancies. Now, however, infertility treatments, such as IVF and ICSI, have increased the percentage of conceiving twins or other multiples.

Complications in Dizygotic and Monozygotic Twins

Up to 30% of twin pregnancies result in a twin-twin transfusion. In a twin-twin transfusion, one foetus becomes the donor, leading to them potentially having a low amount of amniotic fluid, anemia, and growing less than the other. The other foetus becomes the recipient, leading to them potentially having an excessive amount of amniotic fluid inside the womb and developing more than the other. Additionally, the recipient foetus may retain a high blood volume and face cardiac failure.Occasionally, due to this situation, the donor recipient dies early in the pregnancy for they do not receive the proper nutrition.

However, generally, if both children survive until birth, each individual baby tends to be smaller than in a pregnancy with one child due to the nutrients being shared between the two embryos. Proper monitoring and regular visits to the doctor have improved the survival rates of both babies in a twin pair. Ultrasound scans find the presence of multiple pregnancies early, before twins begin to face complications or before one of the two babies die inside the womb, which in and of itself can harm the other foetus.

Detecting Twins in the Womb

Twin pregnancy is usually detected around 18-20 weeks when an ultrasound is first offered by doctors. After twins are detected, pregnant women with twins must be reviewed twice weekly and an ultrasound scan must be conducted after every 2-3 weeks from the thirtieth week of pregnancy to prevent complications.

Management of Expectant Mother of Twins during Pregnancy

Death incidences in twins have high percentages after 35-38 weeks. Hence, proper and frequent monitoring is required for the stable and healthy delivery of the babies and the maintenance of the mother.For one, anemia must be ruled out in an expecting mother. Additionally, the risk of cardiac failure and high blood pressure ought to be dealt with. Overall, pregnant women may require extra amounts of nutrients to fulfill the demands of her twins and need special antenatal care. In terms of actual labour, both cesarean section and vaginal birth are options for delivery. However, depending upon the risks and presenting condition of the case, one option may prove to be better than the other.

Management of Twins in Labour

The actual birth of twins needs proper monitoring and an assessment of the mother (vitals, etc.) and of the foetuses (position, lie, etc.) before initiating any mode of delivery. It is crucial to analyse the position of the babies and the lies. To determine the position and the lies, the doctor does an abdominal examination followed by a vaginal exam. In 45% of multiple pregnancies, the babies are in cephalic position, where the head is towards the pelvis, and in 30%, they are in breech and cephalic position, where one foetus has feet towards pelvis and other foetus has head towards pelvis.

In around 10% of multiple pregnancies, both foetuses are breech presenting, which generally causes there to be a need for a caesarean section. For the most part, a cesarean section is performed when the feet of the baby are presented first. It is also important to look for a prolapsed umbilical cord if a vaginal birth is being done. The umbilical cord can be checked only once the membranes of the amniotic sac rupture. The first foetus is a little complicated to deliver since the location of the other baby is unknown and space is limited. Due to limited space, an episiotomy, a surgical cut at the vagina to aid in the delivery of the baby, may be required.After the delivery of the first foetus, uterine contractions may decrease. If they do not return within a few minutes, the pregnant mother may be injected with oxytocins to increase uterine contractions.

Luckily, the birth of the second foetus is usually uncomplicated. After the birth, the most common complication faced by a mother is a haemorrhage for which a medical team ought to be prepared. Additionally, the mother must decide whether she wishes to preserve the umbilical cord blood for future therapeutic use. Learn more about umbilical cord banking here.