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Multiple Pregnancies
Explanation of cellular division in twinsThe following pictures and text explain the different ways that cellular division can occur in twins.
What's happening in each scenario? The Monozygotic twins are derived from only one egg and only one fertilization. Scenario 1: If the separation takes place just after the first cellular division, then in this case both of the twins will have their own placenta and an amniotic sac each. Scenario 2: The separation can also take place a little later in the development of the embryonic cells but before the blastocyte has fully defined the roles of each type of cell. At that moment, twins will be in the same placenta, but they will have 2 amniotic sacs. Scenario 3: In the last of the identical twin scenarios, if the separation takes place at the stage when the amniotic bag is already being formed, then the twins will be in the same placenta, and in the same amniotic sac. Scenario 4: Dyzygotic twins (fraternal twins), as shown in the diagram, are descended from a double ovulation and a double fertilization. The 2 eggs are completely independent. This configuration represents two thirds of all twin pregnancies. Scenario 1 and Scenario 4 clearly have the same configuration at implantation into the uterus wall (bi-chorial and bi-amniotic) yet they are very different in that when the twins derive from one egg (monozygotic) they will be identical and the twins coming from two separate eggs will be fraternal.
Possible complications with a multiple pregnancy
There are other very rare problems that can occur with multiple pregnancies. Doctors will keep a very close check on the progress of multiple pregnancies and can discover any problems very early. Remember, one of the most important pieces of advice given to mothers of multiple pregnancies is to avoid stress both physically and mentally. Put simply, this means DON'T WORRY. If there are any complications, then deal with them when they arrive, otherwise, don't spend your time thinking about what 'may' happen. The implications of a multiple pregnancyPersonal/family implications: Very clearly, there are direct financial implications when twins are due. You need to buy two of everything, you need double size push-chairs, double up on the supplies, double food to buy, two car seats, etc. This can be especially difficult if you are moving onto a single wage to support all four of you. As if the stress of financial support for twins was bad enough, you then also need to cope with double the number of nappies to change, double the crying (in volume or in time), double the late night wake up calls, (the list goes on all the way through until they leave home). Having said all that, there are upsides too. After all, if you were planning to have two kids anyway, then you only have to go through the whole pregnancy thing once (him through the stress and her through the birth, backaches, pains, hormones.) Also don't forget that you will get double the enjoyment whilst they grow up together. Medical implications: Although multiple pregnancies are automatically classified as "high risk", the first thing to emphasize is that most women go through a twin pregnancy with no serious complications. The problems of back pains and mood changes can be amplified a little but generally, all goes well. However there are some factors that need to be remembered with multiple pregnancies. The most important is that the nutritional intake of the mother needs to be increased but without excessive weight-gain (this should be discussed in detail with your doctor). In general, most practitioners suggest an extra 250 to 350 calories per day (with higher levels of protein intake) as well as higher dosage vitamin supplements (but never simply double up on the standard vitamin/mineral intake for a single pregnancy, this can be harmful). The obstetrician will almost certainly want to see the mother of a multiple pregnancy more times during the nine months than is usual for a single. There will certainly also be more ultrasound sessions to attend so that progress of the development of both babies can be closely followed. Under certain conditions when there is a concern over the efficiency of the placenta and the over-stressing of the womb, a woman carrying multiple babies may be ordered to take bed rest during the last few months of the pregnancy. This can be a difficult thing to handle for both her and her partner. Luckily a long bed-rest is a rare occurrence whereas a short bed-rest over the last couple of weeks can be required often. Implications for the delivery of multiples: Many doctors presume that twins are at full term about two weeks before the standard due date. Not all, but most multiple pregnancies arrive early. An early delivery is mainly caused by the fact that multiple babies will stretch the womb quicker than a single child and the cervix may begin to loosen up earlier than would be expected. If the twins are born very early (before 32 weeks after conception) then it is likely that they will need a little time in an incubator to help the lungs to finish full development. If the birth is after 32 weeks from conception then just a few days in hospital is often all that is required. Cesarean section delivery is an option that will be prepared in advance at the birth of multiples. If any complications are found with ultrasound in either of the twins (stressful heart rate or bad position) then a cesarean delivery is often the best way to ensure a satisfactory conclusion. In many locations around the world, a normal vaginal birth is encouraged as the preferred option. There are good medical reasons for this but spare a thought for the poor mother that has a vaginal birth with the first baby then the second decides that it wants to change position and a cesarean is ordered for the second.
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The chances of complications occurring in a multiple pregnancy are slightly higher than in a single pregnancy. Also, the more foetuses there are the higher the risks involved. The list below outlines some of the main problems:
Pre-eclampsia and high blood pressure are more often found in multiple pregnancies.
