Potential risks of carrying twins

Many expectant mothers are confused and worried when they learn they are carrying twins because they face significantly more risks compared to mothers carrying a single baby. Recently, two twins at Quang Ngai General Hospital died due to twin-to-twin transfusion syndrome. To broaden public understanding and help women better comprehend the dangers of twin pregnancies, the Health & Life newspaper publishes the following article.

Risks to the mother

According to medical experts, when carrying multiple fetuses, pregnant women are most susceptible to miscarriage in the first three months of pregnancy, and the rate of fetal abnormalities and birth defects is also higher compared to single pregnancies. Women carrying twins are more likely to experience early signs of edema due to the enlarged uterus compressing the circulation in the lower limbs. Pregnant women also experience fatigue and difficulty walking due to increased workload on organs, mobilizing muscles, joints, and bones. The rapid enlargement of the uterus can also cause shortness of breath in pregnant women.

Premature birth is a common complication in twin pregnancies. Preeclampsia also occurs more frequently and earlier than in single pregnancies. The risk of intrauterine growth restriction is 10 times higher than in single pregnancies. The rate of stillbirth is also higher due to circulatory imbalance between the two fetuses. Another risk in twin pregnancies is polyhydramnios, which often occurs in the late second trimester. Low-lying placenta, due to increased placental surface area, increases the risk of premature birth, placental abruption bleeding, and abnormal fetal presentation. High risks during labor include: difficult delivery due to uterine contractions; difficult delivery of the second fetus; entanglement of the two fetuses; obstetric trauma; and postpartum uterine atony.



Twin transfusion syndrome.

Twin pregnancy and risks to the fetuses.

Twin pregnancies often lead to asymmetrical development and weight differences between the two fetuses due to one fetus experiencing intrauterine growth retardation. If the weight difference exceeds 25% between the smaller and larger fetus, it increases the risk of respiratory distress, intracranial hemorrhage, seizures, infections, and necrotizing enterocolitis in the fetus. Furthermore, twin pregnancies are more prone to stillbirth, premature birth, fetal malformations, and growth retardation. Notably, premature births are more common in twin pregnancies than full-term births.

Twin pregnancies also increase the risk of twin-to-twin transfusion syndrome (TTTS). Approximately 90% of these cases, if not detected early, result in the death of one twin. 25% of twin pregnancies that survive TTS but do not receive treatment will suffer neurological damage. Unequal twin-to-twin development is due to abnormalities in the blood vessels of the placenta, leading to uneven blood supply to each twin. Medically, this is called TTS, meaning one twin gives blood and the other receives. This condition is dangerous for both twins but does not affect the mother's health.

Unequal blood transfusion between twins only occurs in monozygotic twins that develop from a single egg, sharing a placenta and amniotic sac. Monozygotic twins are defined as twins where one sperm fertilizes only one egg, resulting in two fetuses of the same sex (male or female), sharing physical characteristics (skin, hair, eye color, body structure) and genetic traits (blood type, serotype, tissue compatibility, and therefore the ability to receive tissue grafts).

Evidence of developing twin-to-twin transfusion syndrome includes: uneven fetal growth (one fetus larger than the other) - too much amniotic fluid in one fetus or too little amniotic fluid in the other.

What are the solutions for twin-to-twin transfusion syndrome?

To date, there is no specific treatment, only several temporary treatments have been described: puncturing the septum to create communication between the two amniotic sacs; laser ablation of the connecting blood vessels in the superficial part of the placenta; fetal reduction by terminating the severely affected fetus; and periodic amniocentesis. Laser ablation of the blood vessels transmitting blood from one fetus to the other has been applied in France, with a failure rate of 25%. French professors have also come to Vietnam to instruct on this method, but due to the high failure rate, it is not currently applied in Vietnam.

Is it possible to take precautions?

There is no way to prevent twins or multiple pregnancies, but if there is a risk, it is crucial to determine early on via ultrasound whether there are separate or shared placentas. Twin-to-twin transfusion syndrome is a high-risk condition that can occur suddenly at any time during pregnancy, therefore it requires regular ultrasound checks, once a week, starting from week 16 (approximately 4 months). However, a pregnant woman may suspect a twin pregnancy if: she gains excessive weight; her uterus is larger than expected for her gestational age; she experiences severe morning sickness: severe nausea and projectile vomiting; or she notices fetal movements earlier than normal.

Regular prenatal check-ups and examinations are necessary.

Although carrying twins can somewhat affect the health of both mother and fetuses, these risks can be controlled if pregnant women have early check-ups and regular monitoring at medical facilities. Doctors will provide advice and appropriate guidance to pregnant women.

Medical experts advise that pregnant women, especially those carrying multiple fetuses, should visit healthcare facilities for check-ups and monitoring. If any abnormalities are detected, doctors will consult and discuss options to minimize harm to the woman's health and mental well-being. Each check-up should include an ultrasound to monitor fetal development. Because twin pregnancies can easily result in one fetus being larger than the other, and variations in amniotic sac size are also common... Close monitoring is especially crucial during the last three months to ensure the pregnancy lasts at least 37 weeks, as premature birth is a risk factor.

During labor, pregnant women must go to medical facilities with neonatal intensive care units. They should have adequate rest and nutrition. It is crucial for women carrying twins to receive counseling beforehand, be informed of all the risks and difficulties to prepare psychologically, and receive encouragement, comfort, and support from family members.

According to Health and Life - NT