Dou­ble joy or dou­ble trou­ble?

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

The Star Malaysia - - Nation - By Dr JAPARAJ PETER

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.

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