Have you seen two little heartbeats flickering on an ultrasound screen?  Double the love, double the joy – that’s the exciting surprise many parents experience with a twin pregnancy!

The chance of having twins in India has gone up dramatically! Currently, estimates suggest 9-16 out of every 1,000 births are twins, a tenfold increase compared to just twenty years ago. While most are uneventful, some mothers with multiple pregnancies may face challenges along the way. 

At Renew Healthcare, one of the best IVF clinics in Kolkatta, we understand the complexities of high-risk pregnancies, including twins.  Our team of experienced high-risk pregnancy specialists and compassionate staff are dedicated to providing personalised care and expert guidance throughout your twin pregnancy journey. 

Types of Twin Pregnancies 

The most common question about multiple pregnancies is – how does this happen? Let’s understand the process. 

Source: https://www.genome.gov/genetics-glossary/Fraternal-Twins

1. Fraternal (Dizygotic) Twins:
     This is the more common type of twinning, accounting for about 70% of all twin pregnancies.  Here’s how it works:

• Your ovaries typically release one egg per cycle. However, in fraternal twinning, your ovaries release two separate eggs during the same ovulation cycle.
• A separate sperm then fertilises each of these released eggs. Simply put- two eggs meet two sperm, resulting in two fertilised eggs.
• These fertilised eggs develop independently inside separate placentas and amniotic sacs. Fraternal twins can be of the same or different sexes, like any other siblings.

1. Identical (Monozygotic) Twins:

     These twins form from a single fertilised egg.  

• Early in embryonic development, the fertilised egg (zygote) divides into two separate cell masses. This split can occur at different stages.
• Depending on when the split happens, the two cell masses may or may not entirely separate. This can influence whether the twins share the same placenta and amniotic sac or have separate ones. 
• Identical twins will always be of the same sex and share similar genetic makeup.

• Conjoined Twins: A Rare Occurrence:

  Conjoined twins are an even rarer form of twinning, estimated to occur in about 1 in 200,000 births.  

• Here, the single fertilised egg splits incompletely, resulting in twins physically connected at some point, commonly at the chest, abdomen, spine, pelvis, trunk, and head. 
• The degree of connection can vary depending on where the incomplete separation occurs.
• Conjoined twins require specialised medical care throughout pregnancy and delivery and sometimes even separation surgery after birth.

The Role of Family History and Genetics:

While the exact cause of spontaneous twinning is still being researched, certain factors may increase the chances:

• Family History: Having twins in your close family (mother, sister) slightly increases your odds.
• Maternal Age: Women over 35 may be more likely to release multiple eggs during ovulation.
• Fertility Treatments: Treatments like ovulation-stimulating medications used in IVF can increase the likelihood of multiple egg releases. Naturally, identical twins occur in about 1 in 250 births. However, the use of assisted reproductive technologies (ART) has increased the rate of identical twins by 60%,

High-Risk Factors in Twin Pregnancies

Carrying twins presents an increased risk for certain complications. The good news is that these risks can be managed effectively with proper prenatal care and close monitoring by your doctor.

1. Gestational Diabetes: The risk of gestational diabetes (pregnancy-induced diabetes) is slightly higher with twins. Your doctor will likely recommend additional screening for this condition.
2. Preeclampsia: This pregnancy complication involving high blood pressure and other issues is also a potential concern. Regular prenatal care allows for close monitoring and early intervention if needed.
3. Preterm Delivery: The increased pressure in the uterus from carrying twins can lead to earlier delivery. Your doctor will monitor for signs of preterm labour and may recommend strategies to help prolong the pregnancy.

 Are You at Risk for Preterm Labor? Find out in this blog. Understand the increased risks of preterm labour in twin pregnancies and how to better prepare. Learn more now. 

1. Low Birth Weight: Babies born prematurely are likelier to have a lower birth weight. Proper prenatal nutrition and monitoring fetal growth are crucial in promoting healthy weight gain for your twins.
2. Intrauterine Growth Restriction (IUGR) occurs when one or both twins don’t receive adequate nutrients or oxygen in the womb. Regular ultrasounds can help detect IUGR early, allowing for interventions if needed.

Ensure the health of your twins with our checklist tailored for high-risk pregnancies involving intrauterine growth restriction. : The Essential Checklist for a High-Risk Pregnancy with IUGR. 

Diagnosing a Twin Pregnancy

1. Early Signs and Symptoms 

While not a definitive diagnosis, some early pregnancy symptoms may be more pronounced with twins. It’s important to remember that these can vary from woman to woman, and experiencing some of them doesn’t necessarily mean twins:

• Increased nausea and vomiting: 
• Rapid weight gain in early stages: 
• More fatigue and food aversions 

1. Medical Diagnosis:

• Ultrasound Findings show one or two sacs and at least two heartbeats, confirming multiple pregnancies. 

 Learn about the critical role of ultrasound in monitoring twin pregnancies. Dive into the details now Decoding Baby’s First ‘Photograph’: The Power of Ultrasound in High-Risk Pregnancies.

• Human chorionic gonadotropin (hCG) hormone can be elevated in some twin pregnancies.

• A twin IVF pregnancy calculator is a specialised tool designed to estimate the due date for twins conceived through in vitro fertilisation (IVF). These calculators usually require inputting the embryo transfer date and will use this to calculate the expected due date. This is particularly helpful for expectant parents and healthcare providers in planning the birth, as twins often arrive earlier than the standard 40-week gestation period for singletons. Typically, many twins are delivered around 37 weeks to minimise risks associated with later-term twin pregnancies. Using a due date calculator for twins by IVF can help parents better prepare for their babies’ arrival, ensuring they are informed and ready for a potentially earlier birth date.

Taking Care During a Twin Pregnancy

A twin pregnancy requires extra care and attention to ensure the health of both mother and babies.  Here are some key aspects:

1. Nutritional Requirements and Dietary Adjustments:

Carrying twins requires more fuel! Your doctor or a registered dietitian can help you create a personalised plan to meet your increased calorie and nutritional needs. 

1. Physical Activity and Rest:

• Regular, moderate exercise is beneficial for twin pregnancies. Walking, swimming, and prenatal yoga are great options. Always consult your doctor before starting any new exercise routine.
• Listen to your body and prioritise getting enough sleep. Twins can drain your energy, so don’t hesitate to take naps and delegate tasks when needed.

Planning the Delivery:

• Due to the increased risk of complications, twin deliveries often happen earlier than singleton births. Your doctor will carefully monitor fetal development and determine the optimal delivery time.

• The decision of vaginal delivery versus cesarean section for twins will depend on several factors, including:
  • Position of the Babies: The ideal position for vaginal delivery is for both babies to be head-down (cephalic presentation).
  • Health of the Mother: Your overall health and potential complications will be considered.
  • Previous Obstetric History: Your doctor will consider your history of previous deliveries.

• However, due to the increased risk factors, cesarean sections are more common for twin births. Your doctor will discuss all options and factors influencing the safest delivery method for you and your babies.

The Expertise of Renew Healthcare

At Renew Healthcare, we understand the unique challenges and joys of a twin pregnancy.  Our team of experienced high-risk pregnancy specialists is dedicated to providing you with exceptional care throughout your journey.  We offer comprehensive prenatal care, advanced monitoring techniques, and personalised support to ensure the healthiest outcome for you and your twins.

Remember: Early diagnosis, regular checkups, a healthy lifestyle, and a strong support system are all key ingredients for a successful twin pregnancy.  We’re here to guide you every step of the way!

Key Takeaways:

• There are different types of twins, including fraternal (dizygotic), identical (monozygotic), and conjoined twins, each arising from unique biological processes.
• Assisted reproductive technologies like IVF are linked to an increased occurrence of twin pregnancies due to factors like multiple embryo transfers.
• Twin pregnancies come with increased risks, including gestational diabetes, preeclampsia, and preterm delivery, which require careful management and monitoring.
• Twin pregnancies demand higher nutritional intake and appropriate physical activity to support the health of both the mother and the babies.
• The delivery of twins often involves special considerations such as the babies’ positions and the mother’s health, influencing the decision between vaginal delivery and cesarean section.