A twin pregnancy requires special care on the part of the expectant mother and the specialist who looks after her. Find out what to look for when you're expecting twins.
The fact that twochildrenwill be born means double joy for the future mum, but also more effort and risk. What to expect intwin pregnancy , we talk to an experienced gynecologist, Dr. Jacek Lisawa, obstetrician of the Holy Family Hospital in Warsaw.
Doctor, why do some women have a greater chance of getting a twin than others?
First, of course, these chances are increased by the use of fertility drugs. This is the most common cause ofmultiple pregnanciesthese days. On the other hand, using artificial causes, genetic determinants are certainly important. There are families in which twin pregnancies and the birth of twins are recorded from generation to generation. In my practice, I often come across a situation where a woman who is pregnant in twins says that her mother or mother's sister also had twins.
Does age matter when it comes to the likelihood of a twin pregnancy?
No.
And is it true that the moment that is very favorable for getting a twin pregnancy is the period right after discontinuing the contraceptive pills?
I don't think so. This is what they actually write in academic books and information leaflets, but I do not observe it at all. I don't know if I had at least one case of a patient who got a twin after stopping the pills, and I had hundreds of multiple pregnancies.
Should the doctor responsible for such a pregnancy have any special competences? Will every gynecologist provide equally good care?
No, absolutely. Multiple pregnancy, including twin pregnancies, is a higher-risk pregnancy. This means that the risk of complications is much higher than in a normal pregnancy. Therefore, women expecting twins should be under the care of an obstetrician who has extensive experience in managing complicated pregnancies and - importantly - constantly cooperates with a hospital ward. These patients often require shorter or longer hospitalization and it would be good if it was continuous care, i.e. that the patient in the hospital was under the care ofthe same doctor as in the outpatient practice.
What do you mean by increased risk? Are these the same complications that threaten a normal pregnancy, but are more common?
The most common complication is preterm labor. The percentage of premature births in Poland is 7% among all pregnancies, while among twin pregnancies - as much as 50%, i.e. every second such pregnancy ends before the age of 36 weeks. A common problem is also cervical failure, i.e. its premature opening. Other complications are similar to those in a normal pregnancy or are slightly more frequent.
Does a woman who is expecting twins have to see the doctor more often, do more tests?
Yes, because the risk is greater and so the pregnancy control must be tighter.
This is a standard test, or some additional?
When it comes to biochemical and laboratory tests, i.e. blood tests, they do not differ from standard tests. On the other hand, the role of the attending physician is to catch all symptoms of the emerging threat of preterm labor and prevent it. The awareness that such complications may occur increases the doctor's alertness.
How is it supposed to be manifested?
For example, in such a basic matter as the recommendation of a sparing lifestyle. In normal pregnancy, it is not needed, something that is often abused by doctors. But in a twin pregnancy, the doctor should immediately ask the patient, for example, about her job. And it's not just the position in which she spends her working time. Even if it is office work, but the patient commutes to her across the city by tram - it is a great physical effort for her and should be absolutely removed from such activity. Another important issue is, for example, to consider whether there is a need to put on a cervical suture prophylactically. There are more such issues and the experience of the doctor is very important here.
Sparing lifestyle, more frequent examinations, and diet? Should a pregnant twin woman eat more?
Absolutely not, neither in terms of absolute amount, nor in terms of increased caloric content. Only the increased need for certain vitamins or microelements can be considered - mainly those related to hematopoiesis, e.g. iron or folic acid.
Coming back to the research, is it justified to perform an ultrasound even every month, because it happens? The mother may then experience anxiety as to whether it is not harmful.
If there are medical indications to perform ultrasound examinations, they should be performed. It is not dangerous, you should not be afraid of it. Testsperformed on modern cameras, lasting from a few to several minutes, they carry such a small charge of energy that they are completely safe. However, I believe that there is no need for such frequent, monthly ultrasound examinations in each twin pregnancy, but only when complications occur.
Are complications related to whether it is a monozygotic or fraternal pregnancy?
A twin pregnancy is indeed a very general term and it is essential for obstetricians what kind of twin pregnancy it is. But the term monozygotic or fraternal refers to the genetic material that a child has. From the point of view of the care of the pregnancy, it does not matter. It is more important whether it is a monomaryngeal or a two-chorionic, monohydric, or diamellar pregnancy. If the diamellar diaphragm (when each baby is in a separate amniotic sac and has a separate placenta), other complications are unlikely to occur apart from the risk of preterm labor. In a single-chorionic pregnancy, i.e. where there is usually only one placenta, the risk of complications is higher. However, if we have a monohydrate pregnancy, i.e. both fetuses are in the same bag and very often have common blood vessels, these are very difficult cases, associated with high mortality and the risk of complications is then enormous. There may be the so-called theft syndrome - common blood vessels cause blood to flow only to one fetus or asymmetrically: more to one than to the other. This poses a lethal threat to both fetuses. Such conditions sometimes require the artificial termination of pregnancy by caesarean section long before the due date, because both of these fetuses are in danger of dying.
What determines the way of terminating a twin pregnancy? How is this most often done?
Most often it is a cesarean section, because the experience of contemporary obstetrics shows that if at least one fetus is in an abnormal position, that is, other than the cephalic position, delivery is at high risk of serious complications. On the other hand, if both fetuses are in the cephalic position, vaginal delivery is possible.
And is every hospital prepared to receive such a delivery?
No. It should definitely be a hospital with a higher degree of referentiality, if only because one of the most common complications of twin pregnancy is premature delivery. And the effect of preterm labor is the birth of a premature baby, which should be de alt with by a unit specialized in the treatment of premature babies.
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