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Twins | Twin Pregnancy

Twin Pregnancy Complications

Finding out that you are expecting twins can be daunting, because carrying two babies rather than one is commonly associated with increased complications such as miscarriages and preterm labour and birth. Let’s take a closer look at the most common problems related to a twin pregnancy. But rest assured that most twin pregnancies are uncomplicated and progress just as well as singleton pregnancies, so don’t get your knickers in a twist and start worrying about everything and nothing. Get a lot of rest and follow a healthy lifestyle, and before you know it you’ll be holding your two perfect little miracles in your arms!


High blood pressure and anaemia
High blood pressure and anaemia are both common twin pregnancy complications that mom might have to deal with. When high blood pressure is combined with protein in the urine, the condition is known as preeclampsia and careful monitoring is needed to prevent serious problems. When two babies feed on your vitamins and iron supplies, anaemia can occur – which is why it’s important to eat healthy throughout your twin pregnancy.

Gestational diabetes
This is a type of diabetes that occurs only during pregnancy, and is more common in multiple pregnancies. It can be detected through a glucose tolerance test taken from week 24 through week 28. Gestational diabetes can damage the placenta and increase the risk of your babies’ breathing problems at birth. Symptoms of gestational diabetes can be excessive thirst, hunger, urination and weight gain as well as recurrent vaginal infections.

Preterm labour and birth
An average pregnancy lasts between 38 and 42 weeks, but for a twin pregnancy 37 to 39 weeks is more normal. Preterm labour occurs when your cervix starts to open any time before week 37. Although it can at times be stopped with medication, your babies can be born early – a common risk related to a twin pregnancy. Complications associated with preterm birth are low birth weight, breathing and digestive difficulties, underdeveloped organs and learning disabilities.

Caesarean delivery
Although it’s possible to deliver twins vaginally, a Caesarean delivery is more common – especially when your babies aren’t in the head-down position. In some cases you might have to deliver your second baby by a Caesarean even though you managed to give birth naturally to your first.

Twin-to-twin transfusion syndrome
Monozygotic twins who share a placenta can develop twin-to-twin transfusion syndrome. This condition means that blood from one twin is being diverted into the other twin. One twin, the ‘donor’ twin, is small and anaemic, the other, the ‘recipient’ twin, is large and polycythemic. The lives of both twins are endangered by this condition.

Monoamniotic twins
Unfortunately monoamniotic twins face a lot of potential health hazards throughout pregnancy and need special care and monitoring. Complications include cord entanglement (as the twins have no amniotic membrane separating them), cord compression (one baby’s cord can compress the other’s and result in foetal death), twin-to-twin transfusion syndrome (as explained above) and preterm birth (all monoamnitoic twins are delivered by Caesarean early, always before 34 weeks, as risks of cord entanglement and compressions are too great).

Unfortunately your chances of having a miscarriage are higher when you are carrying more than one baby, as the risk of chromosomal abnormalities is higher in a multiple pregnancy. Occasionally a woman will suffer a miscarriage early in pregnancy, yet the pregnancy will continue; one twin was miscarried but the other was able to be carried to term. This occurrence is similar to the vanishing twin syndrome (explained below), but typically occurs later. As for statistics, the chances that you’ll lose one baby after 20 weeks or in the first month after birth are more than twice as high, and a miscarriage is more likely if you are pregnant with identical twins. But if you do miscarry one twin, the chances are low that something will go wrong with the surviving baby. The earlier the loss, the less likely you are to develop complications. In fact, the majority of remaining twins survive.

Vanishing twins
Researchers suspect that as many as 1 in 8 pregnancies start out as multiples but only a single foetus is brought to full term, because the other has died very early in the pregnancy and has not been detected or recorded. Early obstetric ultrasonography exams sometimes reveal an “extra” foetus, which fails to develop and instead disintegrates and vanishes. This is known as vanishing twin syndrome. When one of a twin conception fails to survive at this early stage, the twin remaining continues to develop and its sac spreads to fill the uterus. The contents of the other sac are absorbed and the vanishing lost twin is reabsorbed into the mother’s body or miscarried with little or no warning and few or no symptoms.

Conjoined twins
Conjoined twins (or Siamese twins) are monozygotic twins whose bodies are joined together during pregnancy. This occurs where the single zygote of monozygotic twins fails to separate completely, and the zygote starts to split after day 12 following fertilisation. This condition only occurs in about 1 in 50 000 pregnancies. Most conjoined twins are now evaluated for surgery to attempt to separate them into separate functional bodies. The degree of difficulty rises if a vital organ or structure is shared between twins, such as the brain, heart or liver.


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