A twin pregnancy means there are two fetuses in the uterus. This is a rare occurrence that can be due to family history, fertility treatments or other factors. Healthcare providers can detect twins early using ultrasound.Twins occur naturally in 1 out of every 250 pregnancies. A twin pregnancy raises the risk of complications for the pregnant person and fetuses, which is why more frequent prenatal care is necessary.
These signs, some of which occur in the early weeks of pregnancy, include –
• Early fetal movement.
• Fetal movement in more than one area.
• Fundal height is greater than gestational age. The baby bump is measuring larger than expected.
• Gaining weight quickly.
• Having high levels of hCG, a pregnancy hormone, or alpha-fetoprotein (AFP), a protein made by the fetus’s liver.
• Hearing more than one heartbeat on a fetal Doppler.
Twin pregnancy symptoms are similar to those of a single fetus (singleton) pregnancy but may be more intense.
You may experience symptoms which includes-
• Breast tenderness.
• Frequent urination.
• Increased appetite.
• Morning sickness.
While some twins may share a placenta and an amniotic sac, that is not the case for the vast majority of pregnancies. Here are three major possibilities that exist –
• Two placentas and two amniotic sacs.
A twin pregnancy with two placentas and two amniotic sacs is the optimal twin pregnancy, as each baby has its own nutritional source and protective membrane.
• One placenta and two amniotic sacs.
In pregnancies with one placenta and two amniotic sacs, you will definitely have identical twins. Additionally, when your babies share a placenta, there is a greater risk for complications, such as twin-to-twin transfusion syndrome.
• One placenta and one amniotic sac.
This is the riskiest and rarest type of twin pregnancy. Fetal complications can arise due to tangling of the umbilical cords or an imbalance in nutrients, blood or other vital life supporting systems
Conditions that increases twins pregnancy probability –
Circumstances that increase your chances of having twins include –
• Age: People over the age of 35 are more likely to release multiple eggs during ovulation.
• Family history: If your mother’s side has a history of fraternal twins, there is a chance you could conceive twins naturally.
• Fertility treatments: Twin pregnancy is more common in people who have fertility treatments, such as in vitro fertilization (IVF).
• Having obesity: People with a body mass index (BMI) higher than 30 are more likely to conceive twins.
• Personal history: If you carried twins during a previous pregnancy, you’re more likely to conceive twins again.
Twin pregnancy complications include –
• Congenital conditions, including spina bifida.
• Gestational diabetes.
• High blood pressure during pregnancy (preeclampsia).
• Intrauterine growth restriction (IUGR).
• Low amniotic fluid (oligohydramnios).
• Placental abruption.
• Premature labor.
• Too much amniotic fluid (polyhydramnios).
• Twin-to-twin transfusion syndrome, in which only one twin receives adequate blood supply in the womb.
Premature twins are at risk for additional complications, which may include –
• Brain bleeds.
• Breathing issues from underdeveloped lungs, including apnea.
• Difficulty staying warm.
• Feeding issues.
• Low birth weight.
• Vision problems (retinopathy of prematurity).
• An ultrasound can usually diagnose a twin pregnancy. However, ultrasound is not perfect. Rarely, a sonographer may not see a second fetus, especially in early pregnancy.
• Blood tests can also help diagnose a twin pregnancy. HCG levels may be higher than usual in early pregnancy if someone has twins.
• A second trimester ultrasound can usually determine the sex by looking at the genitals of each developing fetus, but only if they are well-positioned for the ultrasound.
Differences in care
There are some differences in care for people with twin pregnancies compared to those with single pregnancies. People who are expecting twins may need to –
• have more frequent prenatal visits
• have more ultrasounds to check the position of the fetuses
• eat more calories to nourish both fetuses
• take steps to reduce the risk of complications, such as following a special diet or getting the right amount of exercise
• practice exercises to strengthen their core muscles and spine to carry the extra weight
• receive additional care for any complications, such as medications
Differences in delivery
There are several ways delivering twins can be different from the birth of one baby. These include –
▪︎ Early or induced birth
Just over half of all twins are born early. This can happen naturally, or a doctor may recommend inducing labor on a specific day if there are benefits to doing this. For example, if allowing the pregnancy to continue poses a risk, they may recommend induction.
An induced delivery may improve long-term outcomes in high-risk cases. However, it may require the babies to stay in a neonatal intensive care unit in the short term. Some twins may also have complications, such as low birth weight. Induced labor may also result in a longer hospital stay.
▪︎ Delivery method
A twin birth does not necessarily mean that the delivery method has to change. Vaginal delivery is possible — and advisable — in cases where both fetuses are head-down and there are no other safety concerns.
Cesarean delivery is a major surgery involving removing babies from the uterus by an incision along the abdomen. Cesarean deliveries have longer recovery times and a higher risk of complications than vaginal delivery.
Cesarean deliveries are extremely valuable for reducing the risk of problems and as an emergency procedure. Otherwise, they might not be necessary for twin births where both fetuses are head-down
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