Surveillance And Monitoring Of Twin Pregnancies

While twins bring double happiness and are twice as many babies as are expected from a conception, they are complicated and require extra care too. Thus, it is necessary to monitor twin pregnancies to analyze their advancement and see if they require intervention.

What are the different types of twin pregnancies?

Twin pregnancies are a lot more common than expected. The chance of conceiving twins is one in 250 pregnancies. Some circumstances that are consistent with having more than one foetus are:

  1. Early fetal movement
  2. High levels of hCG, i.e., a pregnancy hormone, also known as alpha-fetoprotein (AFP) (it is a protein created by the fetus's liver)
  3. The fetal Doppler depicts more than one heartbeat
  4. gaining weight quickly
  5. The baby bump is bigger than expected
  6. Signs of fetal movement in more than one region

There are three types of twin pregnancies. They are:

  1. Dichorionic diamniotic (DCDA) twins: These twins have separate sacs and placentas.
  2. Monochorionic diamniotic (MCDA) twins: These twins have different sacs but a single placenta.
  3. Monochorionic monoamniotic (MCMA) twins: This is a rare form of pregnancy. These twins have the same placenta and sac.

All non-identical twins are DCDA. Rarely identical twins are MCMA, and most identical twins are MCDA.

What are the methods of monitoring twin pregnancies?

For the surveillance and monitoring of twin pregnancies, various tests can be conducted. Twin pregnancies are often susceptible to high risk and have a great chance of developing trisomy. Some steps that pregnant women should follow to ensure surveillance and monitoring of twins are:

  1. Women carrying twins should have integrated serum screening with nuchal translucency measurement during the first trimester. This testing helps screen for chromosomal abnormalities.
  2. Women should also test for invasive diagnostic testing, along with chorionic villus sampling (CVS). Under this, a sample of tissue is collected from the placenta. The testing screens for genetic and chromosomal abnormalities.
  3. Cell-free fetal DNA screening from the mother's plasma is also one way of screening and monitoring. During pregnancy, some DNA from the unborn baby circulates in the mother's bloodstream. The cell-free fetal DNA screening helps the healthcare professional check for Down syndrome or any other disorder caused by a trisomy.
  4. Lastly, regular ultrasound visits with a healthcare professional are essential to ensure that any issues in the pregnancy are detected.

What are the complications associated with twin pregnancies?

Some complications associated with twin pregnancies are:

  1. Anaemia
  2. Intrauterine growth restriction (IUGR)
  3. Gestational diabetes
  4. Congenital conditions, such as spinal bifida
  5. Increased blood pressure
  6. Premature labour
  7. Low amniotic fluid (oligohydramnios)
  8. Placental abruption
  9. High amniotic fluid (polyhydramnios)
  10. Twin-to-twin transfusion syndrome, i.e., one twin receives adequate blood supply compared to the other.

Some additional complications for premature twins include:

  1. Brain bleeds
  2. Breathing issues due to underdeveloped lungs
  3. Inability to stay warm
  4. Low birth weight
  5. Vision problems
  6. Inability to feed

When do doctors suggest monitoring twin pregnancies?

Doctors prefer monitoring all pregnancies. For twin pregnancies, doctors prefer that the monitoring begins at conception. There are different recommendations for office visits scheduled by doctors based on the classification of twin pregnancy. Thus, once a doctor realises the mother is pregnant with twins, they start monitoring the pregnancy from day 1. The schedule of doctor visits based on the classification of pregnancies is as follows:

  1. Dichorionic diamniotic (DCDA) twins:
    1. From the first prenatal visit, the mother should visit the hospital every four weeks.
    2. The frequency of visits increases to every two weeks from the 28th week.
    3. From the 36th week, the mother is supposed to visit the hospital every week until delivery.
  2. Monochorionic diamniotic (MCDA) twins:
    1. From the first prenatal visit, the mother should visit the hospital every four weeks.
    2. The frequency of visits increases to every two weeks from the 16th week.
    3. From the 36th week, the mother is supposed to visit the hospital every week until delivery.
  3. Monochorionic monoamniotic (MCMA) twins:
    1. From the first prenatal visit, the mother should visit the hospital every four weeks.
    2. The frequency of visits increases to every two weeks from the 16th week.
    3. From the 24th or 28th week, the doctor recommends inpatient admission of the mother so that they can monitor fetal development daily.

What are the benefits of monitoring twin pregnancies?

There are numerous benefits to monitoring twin pregnancies. As twins are highly susceptible to congenital diseases, monitoring their health and development ensures proper treatment can be provided as and when required. The surveillance and monitoring of these pregnancies also ensure the mother's health is looked after. It ensures that the mother and baby are in good health, and if some decisions need to be made about pregnancy, there is minimum harm to the mother or twins.

If you or someone you know is having twins, it is a good idea to go and get a check-up done now. The experts at Apollo Cradle are here to help you with any concerns that you might have. 

Conclusion

Thus, monitoring twin pregnancies is essential. As there are three types of twin pregnancies and they all require different care, it is essential that their monitoring and surveillance begin from the very first day. Some complications associated with twin pregnancies are anaemia, congenital heart diseases, brain bleeds, low amniotic fluid, etc. There are also various benefits associated with monitoring these pregnancies.

Request an appointment at Apollo Cradle, Hyderabad - Jubilee Hills. Call 1860-500-1066 to book an appointment.

1. Are complications associated with singleton pregnancies similar to twin pregnancies?

Although many complications in singleton and twin pregnancies are similar, the frequency and severity of these complications vary. Twin pregnancies are more likely to face complications and greater severity.

2. Are twin pregnancies common in IVF treatment?

Yes, as a large number of embryos are implanted in a woman's uterus during IVF treatment, the chances of a mother having twins or triplets are high with IVF.

3. How common is twin-to-twin transfusion syndrome in twin pregnancies?

Twin-to-twin transfusion syndrome results from an imbalance in the blood flow of placental vessel connections. It occurs in 10 to 15 per cent of monochorionic twin pregnancies. This can cause issues for both twins, as one twin's body gets less blood, and the other gets more than their body can manage.

4. What are some extra-supplementary recommendations for twin pregnancies?

It is recommended to have the same prenatal vitamins as singleton pregnancies. However, doctors often recommend taking extra folic acid and iron to ward off the chances of developing iron deficiency anaemia.

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