Twins and higher-order births are fairly common today, due to an average increase in maternal age and an array of assisted reproductive therapies such as in vitro fertilisation (IVF). The chances of conceiving twins increase for women over the age of 35 and ovulation-inducing drugs, fertility treatments and IVF stack the odds in favour of multiple gestations.
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Higher-order pregnancies run a higher risk of foetal and maternal complications, warranting special attention and care. On Cloudnine, our specialised Twin Clinic is devoted exclusively to multiple pregnancies, paying close attention to key milestones and overall growth and development of each precious baby housed in your belly.
Twins are of two basic types: identical (monochorionic) and fraternal (dichorionic). Identical twins are formed when one fertilised egg (ovum) splits and develops into two babies carrying the same genetic information. Fraternal twins are formed when two separate eggs (ova) are fertilised by two separate sperm, producing two genetically unique children. Hence, identical twins are always of the same gender, while fraternal twins may be of the same or different genders.
The diagnosis of twins and multiple gestations is possible via an early ultrasound scan. We will be able to determine the type of twins you are carrying at a scan scheduled between your eleventh and thirteenth weeks of pregnancy. The inter-twin membrane that plugs into the placenta is a tell-tale sign of the type of tiny inhabitants that occupy your womb: a Lambda sign indicates a dichorionic twin pregnancy, while a T sign indicates a monochorionic twin pregnancy.
An increase in nausea, morning sickness and heartburn as well as exaggerated early pregnancy symptoms like breast tenderness, frequency of urination, constipation, constant hunger and excessive tiredness are clues that you may have conceived more than one baby.
In the second trimester, some mothers may have trouble with breathing, increased heartburn or acidity, swelling of the hands and legs, abdominal enlargement and excessive foetal movements.
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Decreased haemoglobin is common with twin and multiple pregnancies. This can lead to excessive fatigue. Other problems such as increased blood pressure and gestational diabetes may also develop during the second trimester.
Premature labour and delivery are major risk factors for higher-order pregnancies. About 10% of twins are delivered before the 32-week threshold while 50% to 70% are delivered before 37 weeks. Hence, the availability of a specialised neonatal intensive care unit is imperative for all multiple pregnancies.
Both dichorionic and monochorionic twins are at a higher risk of birth defects and chromosomal abnormalities than singleton babies. Hence, screening for potential problems via superior ultrasound routines in the first and second trimesters are vital. Interpretation of results and subsequent treatment options may be challenging in a twin pregnancy, as one twin may be normal while the other may exhibit signs of anomalies. For this reason, expert foetal medicine inputs are necessary.
On Cloudnine, our Twin Clinic features a panel of foetal medicine specialists who will keep you informed of your progress, every step of the way.
Both dichorionic and monochorionic twins may suffer from poor growth inside the womb and may be born at lower birth weights. Monochorionic twins may be susceptible to selective growth restriction, a condition which needs specialised management.
Preterm babies are at a higher risk of respiratory distress, infections, intestinal problems and low birth weight. They usually require a longer hospital stay. The Twin Clinic on Cloudnine houses a Level III neonatal intensive care unit, which is considered a gold-standard for severely preterm babies.
Many monochorionic twins share a placenta. This could lead to specific conditions like a twin to twin transfusion syndrome, acardiac twinning or selective intrauterine growth restriction, which could potentially endanger one of the twins. If one of the twins in a monochorionic pair dies in utero, it could cause neurological problems in the surviving twin.
While twin pregnancies are precious, they could cause maternal and foetal complications, especially in older expectant mothers. The Twin Clinic on Cloudnine is designed to provide expert care and intensive monitoring to these pregnancies. Our technological ecosystem is on par with the latest international innovations, ensuring maternal and foetal wellbeing and excellent outcomes even in the most complex situations.
On Cloudnine, our Level III neonatal intensive care units are managed by expert neonatologists who have years of experience managing preterm and growth-restricted babies.
Between your 11th and 13th weeks of pregnancy, you will be invited in for your first-trimester screening. This is the first checkpoint to determine whether you are in fact, carrying multiples. At this stage, your obstetrician will check the number, viability and type of multiples you are carrying. Your foetuses will also be observed for chromosomal abnormalities and major defects.
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A detailed scan will be performed between your 18th and 20th weeks of pregnancy to gauge potential malformations or birth defects. If one twin is found to have anomalies whilst the other is normal (discordant twins), expert counselling highlighting the way forward will be extended to you.
The length of the cervix is checked via a transvaginal scan to predict the risk of preterm delivery.
All twins, especially monochorionic twins must be examined for cardiac abnormalities via a special scan of the foetal heart. This scan is conducted by a foetal medicine expert and is occasionally underpinned by a paediatric cardiologist if required.
Key health parameters for dichorionic twins are monitored every 4 weeks at the Twin Clinic on Cloudnine. Any deviation from normal may necessitate a new health plan.
Monochorionic twins are more volatile in utero and need closer monitoring than dichorionic twins. This is primarily because monochorionic twins may share a placenta, giving rise to potential complications. Monochorionic twins are scanned at 2-week intervals at the Twin Clinic on Cloudnine.
Significant checkpoints for your health are established well in advance, to tide you through the course of your pregnancy. Checks on your weight, blood pressure and urine can provide considerable insights into your health.
The Twin Clinic offers you an expansive team of specialists who will coach you through your pregnancy. This team will be composed of a maternal-foetal medicine specialist, an obstetrician, a physiotherapist, a nutritionist, a lactation expert, an anesthesiologist, an endocrinologist and a neonatologist.
Embryo reduction may be opted for in two typical cases: if anomalies are detected in only one baby in a pair of dichorionic twins, or if multiple pregnancies are detected. In either case, a couple may choose to eliminate one foetus. Higher order pregnancies can pose several risks to a mother and her embryos. In situations where more than two embryos are detected, an expertly performed embryo reduction procedure may be considered at the Twin Clinic.
Amniocentesis and chorionic villus sampling are diagnostic tests that spotlight the chromosomal topography of a foetus. These tests can help to rule out infections and diseases. In general, such procedures need more expertise in twin pregnancies.
If one twin is identified as harbouring anomalies, you may decide to opt for selective foeticide, where one foetus is eliminated. The routine entails several risks and is performed only by skilled foetal medicine experts at the Twin Clinic.
Twin to twin transfusion syndrome is a serious condition that affects 1 in 5 monochorionic pairs of twins. Without treatment, 90% of foetuses perish in utero. Laser ablation can stop this condition from progressing; the technique is known to yield a positive outcome in up to 75% of cases.
Laser photocoagulation is a procedure performed under anaesthesia. A foetoscope measuring about 3 millimetres is inserted into the amniotic cavity and the connecting vessels are coagulated by laser. The excess amniotic fluid is then drained and the expectant mother is observed for up to 48 hours.
Radiofrequency ablation can be performed as a route to selective foeticide in monochorionic twins if one twin is found to be abnormal.
This method is a means to selective foeticide on monochorionic twins. This may be needed in severe selective intrauterine growth restriction cases when one twin exhibits symptoms of impending death. This procedure holds the potential to salvage the surviving twin in such a scenario.
Must Read: What are Dichorionic Diamniotic twins?