Having twins

Posted on 20 February 2014

Dr Christie Van Wyk, obstetrician and gynaecologist at Mediclinic Panorama, tells us all about twin pregnancy. Here’s what to expect when you’re expecting two.

How does having twins differ from a single pregnancy?
The major difference between singleton and multiple pregnancies is the faster growing volume inside the uterus. There are also specific foetal risks in twin pregnancies, like twin-to-twin transfusion syndrome. The pregnancy with the most risk for this condition is a mono-amniotic pregnancy (where the babies share the same amniotic fluid). It’s important to diagnose a mono-amniotic twin pregnancy as early as possible, preferably in early first trimester. Therefore, twin pregnancy should be followed up more carefully. It’s also much more uncomfortable with the faster growing pregnancy and the mother in a healthy pregnancy should be motivated to try, despite discomfort, to continue to 38 weeks.

Why can’t I carry to full term with twins?
The risk of premature labour, premature rupture of membranes or premature dilatation of the cervix is greater and can lead to premature delivery. However, it is possible in a healthy twin pregnancy to continue to 38 weeks, which is regarded as full term and guarantees full maturity in the babies.

Is it still possible to have a natural delivery with twins?
Theoretically it’s possible to have natural delivery with a twin pregnancy. There is more risk to the safety of the second baby developing feotal distress in the time frame between the two births. The widely accepted norm is to deliver twin pregnancies by means of an elective caesarean section.

What are some of the complications for twins?
The most common complications of twin pregnancies are premature labour, premature rupture of membranes, or growth restriction that can affect one baby more that the other. Twin-to-twin transfusion is a major risk factor in mono amniotic pregnancies. There’s also a higher risk of hypertensive disorders and gestational diabetes for the mother.

What is your advice to patients having twins?
In any pregnancy, it’s sensible to get a confirmation of gestation midway through the first trimester at about 8–10 weeks. If a twin pregnancy is diagnosed at that time it’s possible to already exclude mono-amniotic twin pregnancy. If a mono amniotic pregnancy is diagnosed it should be followed up very carefully with the help of a feotal specialist since these babies often have to be delivered before 34 weeks of pregnancy. If you have any concerns or questions, it’s best to talk to your obstetrician and gynaecologist.

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Published in Pregnancy

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