Double joy or double trouble?

A twin pregnancy can bring with it unique challenges that give rise to problems for both mother and babies.

IPOH: Statistically speaking, twin pregnancy occurs at a frequency of one in 80 pregnancies.

This incidence differs in different parts of the world, with the highest incidence being in Nigeria, where the incidence is around one in 25 pregnancies.

You have a higher chance of having a twin pregnancy if you have had a previous twin pregnancy, if you have a family history of twin pregnancy, if you are older than 35 years of age or if you are undergoing fertility treatment.

Are all twin pregnancy the same?

No, they are not. In general, there are two types of twin pregnancy. An identical twin pregnancy occurs when one ovum (egg) is fertilised by a sperm which later splits into two embryos.

A non-identical twin pregnancy occurs when two ovum are fertilised by two sperms, producing two embryos.

The risks and complications of twin pregnancy occur more frequently in the identical twin pregnancy, especially when the babies are sharing only one placenta.

How can I find out what type of twin pregnancy I have?

An ultrasound scan before the 14th week of pregnancy can usually tell you what type of twin pregnancy you are having. This ultrasound scan can tell you how many placentas and sacs there are, and if there are any obvious abnormalities with the babies.

What are the complications of a twin pregnancy?

Complications to a mother who is pregnant with twins include increased pregnancy symptoms during the early part of pregnancy like excessive vomiting and lethargy. They are also at a higher risk of miscarriage, anaemia (low blood levels), high blood pressure, gestational diabetes, placenta previa (placenta which is in the lower part of the womb) and antenatal vaginal bleeding.

The most common complication of twin pregnancy to the babies is premature delivery.

Up to 60% of all twin pregnancy will end up as premature delivery (birth before 37 weeks of pregnancy).

If the babies are born before 34 weeks, they have a higher chance of being affected by complications of premature delivery which include breathing difficulties, infection and prolonged stay in the neonatal intensive care ward.

There is also a higher risk of structural abnormalities to the babies, such as defects of the heart, in twin pregnancy.

Another common complication that can occur in twin pregnancy is intrauterine growth restriction, giving rise to birth of small babies.

This may affect both the babies or one of the babies.

Apart from the above complications, twin pregnancy (especially the identical twin pregnancy with a single placenta) can also give rise to unique complications such as conjoined twins, Twin Reversed Arterial Perfusion (TRAP) and Twin to Twin Transfusion Syndrome.

What is Twin to Twin Transfusion Syndrome (TTTS)?

TTTS occurs in 10-15% of identical twin pregnancies, or one in 4,000 pregnancies.

TTTS occurs when there is an unequal sharing of blood between the two babies due to blood vessels that communicate between them on the surface of the single placenta.

Due to these communicating vessels, one twin (known as the donor twin) transfuses its blood to the other twin (known as the recipient twin). This puts both the babies at risk of death.

Another effect of TTTS is the sudden increase in the amniotic fluid in the sac of the recipient twin. This makes the mother’s tummy increase in size rapidly and causes tightness across the belly and sometimes difficulty in breathing on lying down.

TTTS tends to occur at around the 4th to the 6th month of pregnancy. Without timely treatment, the chance of survival for both the babies is less than 5%.

What is the treatment for TTTS?

The effective treatment for TTTS is fetoscopic laser photo coagulation.

This “key-hole surgery” is performed at around the 4th to the 6th month of pregnancy.

It involves the insertion of a small telescope into the womb. The communicating blood vessels between the two babies on the surface of the placenta is then inspected and lasered with laser beams via the telescope to seal off these communicating blood vessels.

How can I prepare myself if I am having a twin pregnancy?

Preparation for any pregnancy starts before pregnancy. Ensure you have a healthy lifestyle (no smoking or use of illicit drugs), and take folic acid and multivitamin supplements and a healthy diet to minimise the chances of adverse outcomes to the babies.

Make sure you have an early ultrasound scan (before 14 weeks of pregnancy) that can tell you what type of twin pregnancy you are having.

It is important that your doctor tells you this so that you are better prepared to anticipate the risks and complications, which is increased in identical twin pregnancy.

Make sure you are regularly followed up by your doctor. This may vary from fortnightly to monthly appointments, depending on the type of twin pregnancy and complications that you may have.

Regular check-ups will make it easier for your doctor to pick up any problems or complications that may appear during the course of your pregnancy, so that effective and timely treatment can be given.

Dr Japaraj Peter is an Obstetrician & Gynaecologist and Maternal Fetal Medicine Specialist from Hospital Raja Permaisuri Bainun Ipoh.