TWIN PREGNANCY
What is a Twin Pregnancy ?
Twins occur in about one in 80 pregnancies. The diagnosis of twins is often made quite early in pregnancy after you have a routine ultrasound scan (like a type of radar picture): two babies are seen rather than one. A twin pregnancy is sometimes suspected if the womb feels larger than expected to the doctor or midwife who examines you. Later in pregnancy, the two separate babies may be felt during an examination, and again will be confirmed by ultrasound scan. Symptoms and common problems of a single pregnancy, such as vomiting in early pregnancy, heartburn, shortness of breath, backache, ankle swelling, piles and varicose veins, may be worse in a twin pregnancy. You are also more likely to get more serious pregnancy complications. Premature labour is a major risk, and is the main reason why babies in twin pregnancies do less well than babies in single pregnancies. There is nothing that either you or your doctor or midwife can do to reduce this risk: both bed rest and a variety of drugs have been tried and found to be ineffective. You should contact your midwife or hospital labour ward if any contractions start. High blood pressure in pregnancy is about three times more common in twin pregnancies than in single pregnancies. Bleeding in late pregnancy, due either to a low-lying or partially detached afterbirth, is also more common in twin pregnancies. Too much fluid (hydramnios) around the baby can also be a problem. This, in turn, can also lead to premature labour. Anaemia is more common, as two babies make greater demands on your supplies of iron and vitamins. How does a Twin Pregnancy occur ?
Twins come about in one of two ways. In one form, they can happen when two different eggs join two different sperms. Each baby then has its own cord and afterbirth (placenta). These twins may be of the same or opposite sex. They will not be identical: indeed, they will be no more alike than brothers or sisters born into the same family. This type of twin is more common if there is a family history of twins. They are also more likely to occur if you are over age 35, or if fertility drugs have been used to help you become pregnant. In the other form, twins are produced when an egg and a sperm join together, but then divide into two once they have joined. Such twins will be identical, and may share a single afterbirth. Very occasionally, twins will also share the same sac (fluid cavity). What does treatment involve ?
During a twin pregnancy you will be checked out more carefully than in a single pregnancy, to be sure that any complications are detected and treated as soon as possible. A good diet and extra rest are important. You will be given iron and vitamins to stop anaemia developing. Regular antenatal visits will allow the growth of your womb to be checked. To make sure that both babies are growing, several ultrasound scans will be performed throughout the pregnancy. When twins share either a sac or an afterbirth, you will be offered particularly careful ultrasound scans between 18 and 24 weeks, as a fast build-up of fluid can occur at this time. If the twins share an afterbirth but are in different sacs, a build-up of fluid is usually due to one twin getting a better blood supply than the other. This is called twin-to-twin transfusion syndrome. The condition must be treated, usually by withdrawing some of the fluid through a needle. Some doctors are also using laser treatment to try and divide the afterbirths. Both ways will improve the chances of the babies, and reduce the risk of premature labour. . Your babies will be delivered in a hospital with a special care baby unit. Whether you have a vaginal delivery or a Caesarean section depends on which way round the first baby is lying. In most twin pregnancies, both babies are delivered head-first, although breech (or bottom-first) babies are more common than in single pregnancies. If the first baby is breech, then a number of decisions need to be made. It may be helpful for you to read the section dealing with this problem. If the baby is head-first, a vaginal delivery is usually planned. In labour, the first twin is handled no differently from a single pregnancy. As soon as your waters break, your midwife or doctor will examine you vaginally to check that the baby's cord is not down by the side of the first twin. The heart rates of both babies will be measured during labour. You may be advised to have an epidural anaesthetic (an injection into the lower back which will not put you to sleep). As well as providing pain relief, this sometimes helps with the delivery of the second twin. In order to look after both you and your babies, there will be several doctors, midwives and nurses present at the delivery. After the first baby has been born, a doctor or midwife will examine you to check that the second twin is in either the head-first or bottom-first position. If not, the second twin will be gently turned. Sometimes fluid containing a hormone is dripped into a vein through a needle to make sure that the womb contracts properly after the first twin has been born. The membranes around it are then broken. The second twin will usually be born soon after the first, usually within 20 minutes. After the second twin is born, an injection will be given to make the womb contract, as bleeding after delivery is more common in twin pregnancies. What to watch out for after a Twin Pregnancy ?
Breast-feeding is possible and time-saving. This is particularly so after the first few days, if you can feed both babies together (one twin held on each side with their heads pointing together). You may prefer to bottle feed, as you will be able to share feed time with your partner or someone else. Try and get some help in the house, especially during the first few days after leaving hospital. It is easy to get over-tired, as there always seems to be a baby crying and wanting attention! You are entitled to claim for an additional maternity grant for the second twin. |
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