Potential risks of twin pregnancy

Many pregnant women are confused and worried when they know they are pregnant with twins because the mother has to face more risks than single mothers. Recently, 2 twins at Quang Ngai General Hospital died due to twin-to-twin transfusion syndrome. To broaden public opinion and help women understand more about the dangers of twin pregnancy, SK&DS newspaper published the following article.

Risk to mother

According to medical experts, when pregnant with multiple pregnancies, pregnant women are most likely to have miscarriages, especially in the first 3 months of pregnancy, and the rate of abnormal and malformed fetuses is also higher than with single pregnancies. Women carrying twins have more early signs of edema due to the large uterus compressing the circulation of the lower limbs. Pregnant women are also tired and have difficulty walking because the organs work harder, mobilizing the muscles, joints, and bones. The rapidly enlarging uterus makes pregnant women feel short of breath.

Premature birth is a common complication of twin pregnancy. Preeclampsia symptoms also occur more frequently and earlier than in singleton pregnancies. The risk of fetal growth retardation in the uterus is 10 times higher than in women carrying one fetus. And the rate of stillbirth is also higher due to the circulatory imbalance between the two fetuses. Another risk of twin pregnancy is polyhydramnios, which often occurs in the late 3rd trimester of pregnancy. Low placenta due to increased surface area of ​​the placenta, increases the risk of premature birth, bleeding due to placental abruption, and abnormal fetal position. High risks during labor include: difficult labor due to uterine contractions; difficult labor of the second fetus; 2 fetuses attached to the placenta; obstetric trauma; uterine atony after birth...



Twin-to-twin transfusion syndrome.

Twin pregnancy and risks to the fetus

Twin pregnancy often leads to asymmetrical development and weight difference between the two fetuses because one fetus is slow to develop in the uterus. If the weight difference is more than 25% between the small fetus and the large fetus, it can easily lead to an increased risk of respiratory failure, intracranial hemorrhage, convulsions, infection, and necrotizing enterocolitis of the fetus. In addition, twin pregnancy is also prone to stillbirth, premature birth, fetal malformation and slow development. In particular, in twin pregnancy, the tendency to give birth prematurely is higher than full-term birth.

Twin pregnancies are also susceptible to fetoplacental transfusion syndrome. In which, about 90% of these cases are not detected early, leading to the death of one fetus. 25% of twins who survive fetoplacental transfusion syndrome but are not treated will have neurological damage. When pregnant with twins but the two fetuses do not develop evenly, it is due to abnormalities in the blood vessels in the placenta, leading to an uneven blood supply to each fetus. Medicine calls it fetoplacental transfusion syndrome, meaning one fetus donates blood and the other receives blood. This condition is dangerous for both fetuses but does not affect the mother's health.

The abnormality of uneven blood reception in 2 fetuses only occurs in twins that develop from 1 egg and share 1 placenta, 1 amniotic sac. It is called monozygotic twins when 1 sperm fertilizes only 1 egg (ovum) and will develop into 2 fetuses of the same sex (male or female), sharing physical characteristics (skin, hair, eye color, body structure) and genetics (blood type, serum group, tissue tolerance so can receive grafted tissue).

Evidence of the development of twin-twin transfusion syndrome includes: uneven growth of the twins (one is larger than the other) - too much amniotic fluid in one twin or too little amniotic fluid in the other twin.

What is the solution for twin-to-twin transfusion syndrome?

Up to now, there is no specific treatment but only some temporary treatment methods have been described: puncture of the septum to create communication between the two amniotic sacs; laser burning of the blood vessels connecting in the superficial part of the placenta; fetal reduction by killing the fetus in a serious condition; periodic amniocentesis. The method of laser burning to ligate the blood vessels passing 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 this method but due to the high failure rate, it has not been applied in Vietnam at present.

Can it be prevented?

There is no way to prevent twins or more, but if there is, it is important to determine early by ultrasound whether the placenta is separate or shared. Fetal transfusion syndrome is a high-risk problem and can occur suddenly, at any time during pregnancy, so it is necessary to check by ultrasound regularly, once a week, from the 16th week onwards (about 4 months). However, pregnant women can suspect twins if: they gain too much weight; the uterus is larger than the month of pregnancy; severe morning sickness: nausea and vomiting a lot; there are fetal movements earlier than normal.

Regular monitoring and pregnancy check-ups are needed.

Although, carrying twins affects the health of the mother and fetus, these risks can be controlled if the pregnant woman has early examination and regular monitoring at medical facilities. Doctors will advise and give appropriate instructions to the pregnant woman.

According to medical experts, when pregnant in general and pregnant with multiple pregnancies in particular, pregnant women need to go to medical facilities for examination and monitoring. If there are any unusual signs, doctors will advise and discuss to choose the decision that causes the least harm to health and spirit. At each examination, an ultrasound is needed to monitor the development of the fetus. Because twins are prone to having large fetuses, small fetuses and amniotic sacs as well... The last 3 months must be monitored closely to be able to maintain the pregnancy for at least 37 weeks because it is easy to have premature birth.

When in labor, pregnant women must go to medical facilities with neonatal intensive care units. Have a reasonable rest and nutrition regimen. It is important for women carrying twins to be counseled and informed of all risks and difficulties in order to prepare psychologically and receive encouragement, comfort, and help from relatives.

According to Health and Life - NT