Twin Pregnancy

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Twin pregnancy in Dubai

The frequency of a twin pregnancy (as well as higher order multiple pregnancies) have been on the rise the last couple of decades  Medical interventions, like ovulation drugs and IVF treatment have been the main reasons for twin pregnancythe increase in multiple pregnancies the recent decades.  The needs and the care of mothers who are carrying a twin pregnancy are different compared to those of a singleton (one baby ) pregnancy. Furthermore all twin pregnancies are not the same. It is very important to know the type of twin pregnancy you are carrying as this has major implications in the management and care of the pregnancy.

The best time to determine the type of twin pregnancy is in early pregnancy (usually 10-13 weeks).

 

What you NEED to know is if your twin pregnancy is monochorionic or dichorionic. Not so much if they are boys or girl, identical or not. Determining chorionicity is essential for the proper management of your pregnancy. Ask your doctor to make a clear documentation of your babies’ chorionicity.

 

The following diagrams describe the different  type of twins.

 Dizygotic Twin pregnancy

Dizygotic dichorionic twin pregnancyDizygotic (fraternal or not identical) twins are the most common type of twin pregnancy (79%). Two oocytes (eggs) are fertilized by two sperm cells and form two embryos that are like brothers or sisters. These babies although similar (as siblings) are not genetically identical. They can be either the same or different gender. Each baby has each own placenta. Sometimes the two placentas fuse as they develop one next to the other. The two placentas do not communicate between  them.

These are the type of twins you most commonly have after IVF as two fertilized embryos are returned into the womb.

 

All dizygotic twins are dichorionic

 

 

 

 

 

Monozygotic twin pregnancy

 

The frequency of monozygotic twins  is about 4.5 per 1000 pregnancies. In this case one sperm cell fertilizes one oocyte (egg). The embryo that forms subsequently splits in two. These babies are genetically identical and are always the same gender.

 

Twin pregnancy monozygotic monochorionic twin pregnancy  monozygotic dichorionic twin pregnancy monzygotic monochorionic monoamnioticThe most common type of identical twin pregnancy are monochorionic diamniotic twins (70-80%). Imagine one balloon (the chorion) containing two smaller balloons (the amnion) each one with a baby inside. The two placentae communicate between them (blood can go from one baby to the other)

In about 20-25% when the embryo splits early (days 0-3) you have monozygotic dichorionic twins. These twins although they are genetically identical each one has each own placenta and there are no   significant communications between them.

A rare type of monozygotic ( identical) twins are those who are in the same sac. They are called monoamiotic. This happens when the embryo splits in two after day 8. Only about 2% of monozygotic twins are monoamniotic. These babies share the same placenta

If the split takes place after day 12 the results are the various type of conjoined twins.

 

The reason why it is so important to determine the type of twin pregnancy you carry is a syndrome called twin to twin transfusion syndrome (TTTS).  Twin to Twin Transfusion syndrome is unique to monochorionic (MC)  multiple pregnancies. It complicates up to 1/5 of MC twin pregnancies. If severe and left untreated it leads to the loss of both babies.

Your obstetrician in Dubai should let you know from the outset the type of twin pregnancy you carry and based on that draft a plan for the management of your pregnancy.

 

The following are, in my opinion, important parts of the care of a twin pregnancy and at Genesis Perinatal Care Clinic we ensure we spent ample time to discuss them with the parents;

  • Screening for chromosomal anomalies in a twin pregnancy
  • Nutrition and diet
  • Monitoring for twin to twin transfusion syndrome in monochorionic twin pregnancies.
  • Risks and monitoring for preterm delivery for a twin pregnancy. In Dubai it can be proven very difficult (and costly) to manage very premature babies. This is an important part of you care and should be fully discussed to ensure you reach informed choices about your care.
  • Monitoring for growth for a twin pregnancy.  It is good practice each time you have an ultrasound scan to get a typed report that clearly documents the findings and type of twins.
  • Timing and mode of delivery for twin pregnancy

Further reading

American College of Obstetricians & Gynecologists Education pamphlet TWINS

twins I hope you will find this helpful

Dr George Michailidis

Fetal & Maternal Medicine Consultant

Obstetrician & Gynecologist

drgeorge@genesis-dubai.com

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