All you should know about TWIN PREGNANCY.

#twinpregnancyawareness #doublethejoy #twinpregnancysupport

TWIN pregnancy, although rare it is the most common variety of multiple pregnancies. It’s a double blessing. Twin pregnancy refers to a pregnancy where a woman is carrying two babies at the same time. This happens when two eggs are fertilized by two different sperm cells or when a single fertilized egg splits into two embryos.

When two fetuses are developing simultaneously in the uterus it is termed a Twin pregnancy. It is the commonest of multiple pregnancies.

Twin pregnancy means:

• More frequent doctor checkups.
• More than usual weight gain.
• Expect an early delivery.

Twin pregnancy is considered in HIGH-RISK pregnancy.

VARIETIES –There are 2 varieties

A) DIZYGOTIC TWINS

1. Two different sperms fertilize two ova [female eggs] during a single ovarian cycle.
2. Synonym: Fraternal/binovular twins as they have only fraternal resemblances like brother and sister from different births.
3. They can be 2 girls, 2 boys, or 1 girl and 1 boy each.
4. Each twin has his/her - separate or fused placenta & two amniotic sacs and Two chorions.

B)MONOZYGOTIC TWINS

1. A single fertilized ovum splits and develops into two fetuses.
2. Synonym: Identical/uniovular twins as they will be of the same sex and share similar physical traits and characteristics. Genetically call these babies are identical.
3. They are identical to 2 boys or 2 girls.
4. Each twin has a single placenta but amnions and chorions vary

i) diamniotic and dichorionic twins DCDA

• two chorions and 2 amniotic sacs.

ii) diamniotic and monochorionic twin MCDA

• Two amniotic sacs and one chorion.

iii) Rarely monoamniotic and monochorionic MCMA

• one amniotic sac and one chorion.

Risk of

a)CONJOINT TWINS {Siamese twins} --They are fused at some level either at thorax or cephalic or posterior fusion or at caudal.

b)Twin-twin transfusion syndrome—blood passes unequally between twins that share the same placenta. Without intervention, TTTS can be fatal.

INCIDENCES:

Estimated that 1:250 pregnancy results in twins naturally around the globe. In India, the incidence is 1:80 in pregnancy. Owing to the advancement of medical science and increase in the use of ART (Assisted Reproductive Technology) and the increased consumption of gonadotrophin drug hormone the actual number of twin conceptions has increased significantly.

What Causes birth of twins

The exact cause of twin conception is unknown. Some of the probable causes are

• Hereditary –hereditary predisposition is likely to be more transmitted through the female (maternal side).
• Race, b>w
• Age of mother –advancing age of the mother especially between 30-35 years of age chances of twin conception are increased.
• Iatrogenic causes –in females undergoing Infertility treatment owing to using ovulation-inducing drugs or use of ART( Assisted Reproductive Technology) esp. IVF’s chances of multiple pregnancy increases.
• Increasing parity ( 5th gravida onwards)

How to diagnose a Twin pregnancy:

• Past H/O –undergoing any infertility treatment.
• Family H/O--History of twin conception on the maternal side.
• Signs and symptoms --All complaints of pregnancy are exaggerated

i) Hyperemesis gravidarum-increased nausea and vomiting in early days. (morning sickness)

ii) Early bump –due to unusual weight gain

iii) Early experience of fetal movement

iv) Tenderness of the breast

v) Cravings - increased appetite

vi) Fatigue.

• Biochemical test –

HCG levels in blood and urine, alpha-fetoprotein, and unconjugated oestriol levels are nearly doubled than in a singleton pregnancy.

UPT-(Urine Pregnancy Test)---first choice in case of doubt about having a pregnancy.

Ultrasound ---

Only USG can give a confirmatory diagnosis especially as early as 10 weeks.

THINGS TO BE TAKEN CARE OF DURING TWIN PREGNANCY.

1. Diet –increased dietary intake to combat the need for growing fetuses.

2. Rest –Increase rest at home. Complete bed rest is advised after 24 weeks onwards.

3. Supplemental therapy –dosage of iron, calcium, folic acid, and other vitamins are monitored.

4. Frequent antenatal checkups-to monitor your health, and baby's growth and watch for any signs of pre-term labor.

5. Fetal surveillance is maintained----series of USG are performed every 3-4 weeks. Nowadays NT(Nuchal Translucency) Scan and Anomaly scan are also done especially in the first trimester.

6. Hospitalization ---in any case of emergency or increased distress requires urgent admission.

What are the probable Complications:

There are chances of complications even during a singleton pregnancy but chances are manifold during a twin pregnancy. 60%OF TWINS AND NEARLY ALL MULTIPLE PREGNANCY ARE PRE-MATURE (born before 37 weeks) born.

A)Maternal complications:

During pregnancy –

Hyperemesis gravidarum, excessive weight gain, back pain, abdominal discomfort, swelling in lower limbs, and difficulty in movements all complaints increased in the last trimester. Discuss with your healthcare provider to determine what is best for you.

Chances of other health disorders during pregnancy such as :

• Preterm labor and birth
• Anemia
• Subclinical thyroid disorder
• Gestational diabetes
• Gestational hypertension
• Eclampsia–pre-eclampsia.

During labor-

• An Abnormal amount of amniotic fluids is common in multiple pregnancies esp. when they share the same placenta.
• MALPRESENTATION OF BABIES also worsens the case.
• Chances of Caesarean delivery – Abnormal fetal positions increase the chances of cesarean birth.
• Postpartum hemorrhage –The large placental area and over-distended uterus places a mother at risk of bleeding after delivery in many multiple pregnancies.

B). Fetal complication –

During delivery 2nd baby is more at risk. 50% more than the first one.

Chances of

• Miscarriages
• Premature birth
• IUGR [Intra Uterine Growth Retardation]
• Intrauterine death of one fetus (vanishing twin)--Death of one fetus in the uterus.
• Fetal anomaly
• Asphyxia and stillbirth
• Cord around the neck.

TREATMENT:

Owing to recent studies and the overall maternal condition in most cases after 37 weeks or early – a planned INDUCTION LABOR or C-section in the third trimester is opted to decrease complications thereof.

Chances of Normal delivery are also there but the risks involved are high.

POINTERS: Taking care of newborn twins:

• Usually, newborn Twins are prematurely born and may need NICU afterbirth. There can be a slight difference in the birth weight of twins.
• Lactation –Mothers find it difficult to breastfeed initially. Take the help of a Lactation Consultant or nursing staff.
• Initially, you might get overstressed taking care of both babies—so ASK for HELP.
• Chances of Postpartum depression in mothers are high –do consult your doctor in case you need help.
• Take enough rest.

TAKEAWAYS:

Patience and not getting overwhelmed will help you in your motherhood journey further. TAKE HELP from spouse and family to navigate this phase. Attending prenatal classes, reading books on twin parenting, and talking to other parents who had gone through a similar experience will come to your aid. Preparing yourself mentally and emotionally for the arrival of two little ones will help you not to lose your senses. Focus on developing the mother bond –your infant wants it more to recover early. Enjoy the bundle of joy you received after enduring so much.

The journey ahead would not be easy, but with love, patience, and perseverance, “This too shall pass” so make most the of it before it passes.

Happy motherhood to twin mommies.

Share post to parents expecting twins. As awareness and necessary Knowledge will ease their pregnancy journey. Comment, share or like if you would like to hear more topics like this as it will motivate me to come with similar contents that will guide you take informed decision about your health and well-being.