TWINS’S PREGNANCY-JOYS & SORROWS EXPLORED

TWINS’S PREGNANCY-JOYS & SORROWS EXPLORED

Today, we will start an exciting journey which is like a roller coaster ride for the reader.

Journey of twins’ pregnancy is like that for both mother and the fetuses.

On one hand, parents are happy that that they will have two bundles of joy in their family.

On other hand, this journey can post medical challenges for both, pregnant mother as well as her twin fetuses.

Let us begin by understanding the origin of twins.

MECHANISM OF TWIN PREGNANCY

Twin pregnancy may result from two or more fertilization events in that index ovulation cycle.

What this means is that there are two eggs and two sperms and after fertilization they will make two embryos which will develop into two foetuses.

These two foetuses can be of same gender on different gender and in characteristic they are as different from each other as any two siblings can be.

There is one more process by which twin pregnancy can happen and that is after single ova, single sperm and single fertilization one zygote (early embryo) Is formed. And then some erroneous splitting happened and women got twin pregnancy.

These babies are of same gender and what we call them as identical twins in layman’s language.

There is one more man-made reason for twin pregnancy and that is advanced fertility treatment, whether it is ovulation induction protocols or various IVF techniques.

CAN WE CALL TWIN PREGNANCY, A NORMAL PREGNANCY...?

Twin pregnancy is associated with increased risk for both mother and child.

If the talk statistically, 60% of twins are born preterm or premature.

What do we mean by that? –

Foetus is supposed to have achieved its growth potential between 37 to 40 weeks of gestation.

If delivery happens between 37 to 40 weeks of gestation, babies are born with normal weight, normal survival and life span

Any delivery happening before 37 completed weeks of gestation is known as preterm and there are multiple medical challenges associated with managing the babies.

Although when we took around twins are seen as novelty or miracle but twins’ pregnancy presents a potentially difficult journey for both mother and her unborn children

Maternal bodily changes in twin pregnancy

When a lady carries twin pregnancy, her body undergoes many changes.

Placental changes

Placenta secretes a hormone called Beta HCG. It circulates in mother's blood.This hormone is responsible for nausea & vomiting of pregnancy.

In twin pregnancy, the amount of this hormone is more, leading to excessive nausea & vomiting.

This clinical condition is know as Hyperemesis Gravidarum.

To manage this firstly oral tablets are given.

If response is not optimal, anti-emetic injections are given.

If still the clinical condition is seen worsening, lady may need to be admitted in the hospital & IV Fluids/Saline therapy needs to be started.

Blood volume changes

It is normal physiological response of pregnant woman to increase blood volume .

Two factors are responsible for this

-Increase in Red Blood Corpuscles (RBC )

-Increase in plasma volume

The blood volume increase is 40-50% in singleton pregnancy

It is 50-60 % in twin pregnancy.

Requirement of Iron and Folic acid is also more in twin pregnancy

If this demand is not met, maternal anemia will develop and Hemoglobin level will drop.

Some other blood parameters like

-Cardiac output

-Stroke volume

-Heart rate

-Arterial blood pressure

also increase more in twin gestation as compared to singleton pregnancy.

To put it in layman's language-

Mother's heart needs to work more in twin gestation as compared to singleton pregnancy.

Pressure symptoms in twin pregnancy

With advancing pregnancy,pressure on mother's abdomen increase.

There are three factors responsible for this-

Increasing weight of fetus

Increasing volume of Amniotic fluid

Growth of uterus

It is but obvious that in twin pregnancy, pressure symptoms are going to be more as compared to singleton pregnancy.

This increased weight compresses down the abdominal organs on one hand and pushes the diaphragm up on other hand, leading to compression of lungs.

In advanced stages of pregnancy say 8th & 9th month these pressure changes are so severe that they hamper in sitting, walking, climbing stairs, sleeping etc.

Polyhydramnios in twin pregnancy

In polyhdramnios, the amniotic fluid around fetus increase disproportionately for many reasons.

If this clinical condition is encountered in twin pregnancy, it makes it even worse for the pregnant woaman.

This extra weight can compress ureters and may lead to kidney dysfunction.

In this severe situation repeated Amniocentesis- removal of Amniotic fluid under Ultrasound guidance is the only treatment to provide relief.

Ultrasound in first trimester of twin pregnancy

Radiology gives valuable information regarding twin pregnancy & helps in many ways

-Sonography is a safe investigation in pregnancy

-Helps in diagnosis of twin / multi-fetal pregnancy

-Determines Amnionicity & Chorionicity of twins pregnancy

-Early diagnosis of congenital abnormalities in twins

-Growth monitoring of twins pregnancy

-Diagnosis of IUGR -Intra Uterine Growth Restriction in twins

-Diagnosis of Oligohydramnios in twins

-Interventional ultrasound in twins

-Dating scan in twins

-Singleton/Twins/Triplets/Quadruplets-pregnancy detection

-Detecting Gestational Sac, Yolk Sac & Amniotic sac in early twin pregnancy detection

-CRL- Crown Rump Length of twins

-Detecting FHR- Fetal Heart Rate, Sub Chorionic Hematoma, Sub Chorionic Bleeding in twins pregnancy

-Limitations of ultrasound also needs to be understood

-Detection of Vanishing twin

-NT- Nuchal Translucency , NB- Nasal Bone (11-13) weeks scan

-Detection of aneuploidies-Detection of chromosomal anomalies

TO BE CONTINUED….8.1.22

TO BE CONTINUED….22.11.21

Written by

Dr Himani Gupta

Consulting Gynecologist in Kharghar, Navi Mumbai

STAY SAFE

Safe Normal Delivery & Caesarean-Excellent Pregnancy Care

GYNAECOLOGIST IN KHARGHAR

TWINS’S PREGNANCY-JOYS & SORROWS EXPLORED

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