Twin Pregnancy

‘The Good News’ is a harbinger of joy and happiness in individuals’ lives and this joy and happiness become twice if it is a ‘Twin News’. Having twins is always fun. The thought of two similar babies and completing the family in one go make the parents more excited than the usual pregnancy. However, as most people say with happiness comes pain, the twin pregnancy comes with double responsibilities, care, stress, doctor visits, and double the complications. It is seen that women with twins are more likely to experience an early increase in the amount of hormonal and physical changes with a higher risk of delivery and pregnancy complications. Thus, frequent visits to a gynaecologist and proper knowledge about all the facts of a twin pregnancy are a must.

How to Recognize It’s ‘the Twins’?

A twin pregnancy can be easily determined by the variety of signs and symptoms which it produces. It brings forth a chain of changes that are distinctive to it and can act as an indicator of it. These include:

• Hypertension
• Gestational Diabetes
• Gaining more weight than expected
• Severe nausea and  more tenderness in breasts since the first trimester
• Severe morning sickness
• Swollen ankles, Haemorrhoids, fatigue, and headache during the second trimester
• More mood swings, stretch marks, and varicose veins are common

Although, all the symptoms can give a slight indication, an ultrasound scan at 10-12 weeks of pregnancy is the definite way of knowing whether you are having twins or not.

How are Twins made?

Generally, a twin pregnancy can occur when:

• Two eggs are released during the time of ovulation and are fertilized at the same time by the sperm.
  One egg is fertilised but splits into two embryos later on.
• However, it is the number of amniotic sacs, placentas, and embryos that helps in determining whether the twins are fraternal or identical.

Types of Twin Pregnancies

Depending upon the chronicity or the number of placentas, the twin pregnancy can be of the following types:

• Dichorionic Diamniotic: This type is characterised by two embryos, each one of having its own placentas, chorion, and amniotic sac.
• Monochorionic Diamniotic: In this type, embryos have a common placenta and chorion but two amniotic sacs. This is where identical twins are made.
• Monochorionic Monoamniotic: It is the rarest type of pregnancy and it occurs when the embryos have a shared chorion, placenta, and amniotic sac.

Factors Increasing the Chances of a Twin Pregnancy

Several factors play an important role in increasing the chances of multiple or twin pregnancies. These include:

• Age: Women who are in their 30s are most likely to have twins because the body starts to release multiple eggs at once.
• Heredity or if you have prior twins in the family
• Use of Fertility Drug or fertility procedures might end up transferring multiple eggs into the womb thus, increasing the probability of having twins.

Risks related to Twin pregnancy

A number of possible risks and complications associated with a twin pregnancy are as follows:

• Deficiency of iron due to high consumption by the twins
• Gestational Diabetes because of the abrupt production of sugar in the body
• Hypertension or Preeclampsia might happen and can cause harm if not treated on time
• Intrahepatic Cholestasis of pregnancy
• Formation of blood clots in the legs or pelvic region
• Depression, anxiety, or stress
• Either of the baby can be underweight or can suffer from restricted foetal growth
• Premature delivery may result in limited organ development and breathing problems in either baby
• Twin to Twin Transfusion Syndrome (TTTS), in which one of the twins receives less blood than the other one. This situation generally occurs in the case of Monochorionic pregnancies.
• More chances of miscarriage due to chromosomal abnormalities, growth delays, TTS, or vanishing twin syndrome.

However, with proper guidance and regular checkups and appointments with a Women’s Health Educator and physiotherapist, all of the above risks can be avoided in most cases.

Frequency of Prenatal Visits and the Mode of Delivery

The chronicity of the twins determines the number of prenatal visits one needs to make:

• If the babies are sharing a placenta, ultrasounds are required every fortnight from the 16th week
• If the babies have their own placenta, then ultrasounds are required every week from the 20th week
• For babies who share an amniotic sac special care advice is given by the foetal medicine specialists and their pregnancy is closely monitored by the maternity team as well thus, increasing the visits to the maternity centre or hospital.

The alignment or presentation of the twins in the womb specifies the type of delivery suggested or recommended.

• If the twins are in a head-down position and seem to be in perfect health then vaginal delivery is preferred.
• In cases of medical complications, abnormal presentation, discordant growth, and Monochorionic monoamniotic twins, a caesarean is highly recommended.
• However, in some cases when the second baby changes its position after the first one is delivered, both the vaginal and caesarean take place.

Steps and Ways to get a Normal and Healthy Delivery

• Eating a Healthy and Balanced Diet: It is advised to take a proper and healthy diet full of vitamins and minerals such as protein, carbohydrates, iron, calcium, iodine, etc. The nutritional requirements are defined by BMI and one should not believe in the fact that a twin pregnancy requires double dietary intake.
• Exercise: Women with multiple pregnancies are advised to do low-impact exercises like swimming, walking, and prenatal yoga. These help in maintaining body shape and developing physical endurance.
• Regular Checkups:  Frequent visits to the maternity centre and doctor and regular appointments with checkups help your doctor in keeping track of the condition and in resolving any problem or complication that occurs.

As twin pregnancy can be quite stressful and challenging due to the increase in the burden of the care and responsibility of children, it is advised that communicating with your partner is very essential to get relive of all the anxiety and pressure. Sometimes, doctors advise counselling and birth classes for the couple to shake off the fear and anxiety of delivery and pregnancy, as it is very essential for the mother to be mentally healthy and strong to have a safe and healthy delivery.