Friday 23 March 2018

Pregnant with twins: Twice as nice

Twin pregnancies are generally viewed as higher risk, but try not to worry twice as much, as you and your babies will be well monitored, writes Sorcha Corcoran

Generic picture of twins
Generic picture of twins

EATING for two is a common misconception around pregnancy in general, but when it comes to having twins, it's true that you can expect to be looked after twice as much.

For a start, says Judy Buckley, chairwoman of the Irish Multiple Births Association, typically with twins you're scanned much more regularly – once every six weeks or so, and towards the end this is likely to get more frequent.

The Esprit study, one of the biggest studies of twins in the world which took place in eight hospitals around Ireland, had its first big publication last month, highlighting a particular area for increased vigilance.

" The study shows that a difference of 18pc or more between weights of twin foetuses is significant and warrants close surveillance," says Professor Fergal Malone, consultant obstetrician at the Rotunda Hospital and the Royal College of Surgeons in Ireland, who is involved in the study.

" This is a lot stricter than our previous management strategy, where patients with up to 25pc discrepancy in foetal weights might be tolerated."

Over the past decade, there has been a big increase in the incidence of twins in Ireland, likely due to a general increase in the average maternal age, but also due to the increasing availability of assisted fertility programmes, according to Malone.

In general, a twin pregnancy involves higher risks for both the mother and the babies. For the mother, pre-eclampsia is the most significant risk, affecting about 20pc of twin mothers, compared to 5–7pc of mothers of singletons, he notes.

There are various other conditions your doctor will look out for, such as gestational diabetes and anaemia, while Malone says the Caesarean section rate for twins is around 50pc, compared to the overall rate of 20–25pc.

NO CAUSE FOR ALARM While the risks are higher, there's no cause for alarm if you find out you're expecting twins though, says Buckley. She had a natural birth with no epidural for her twin girls, Lara and Emma, now aged four.

"I wasn't really sick with the girls. A common thing people think is that you'll be twice as sick expecting twins, but it's not true. Towards the end it got hard as I wasn't able to carry the weight. I ended up on crutches and couldn't drive and I had a two year old (Cathal) at the time," she says.

"I was very lucky overall though with the pregnancy – I had no blood pressure problems and the babies were never in danger. I had them at 38 weeks, which is the full term for twins."

Pre-term delivery (ie earlier than 38 weeks) is more common with twins than singletons. However, Malone notes that neonatal care in Ireland is of a very high standard. " The high survival rates of even prematurely delivered twins reflects in large part the superb centralised neonatal care available in this country. Almost all babies born at 36 weeks, the average gestational age for delivery of twins, will do absolutely fine.

" What we do worry about is extreme pre-term deliveries, at 24–28 weeks, which happen among 2–3pc of our twin patients, compared to about 1pc of patients with singleton pregnancies."

The other big worry with twins is twin-to-twin transfusion syndrome ( TTTS). This affects about 20pc of monochorionic twins, identical twins that share one placenta.

It means more blood is going in one direction than the other, so one baby sends a lot of its blood supply to the other baby, who doesn't need it. One twin then ends up getting too little. If it goes untreated, the babies are very likely to die.

" The primary therapy for severe cases of TTTS is laser therapy when the patient presents by 24 weeks. Optimal therapy for mild TTTS remains unclear, ie expectant management until things get worse, or immediate laser," explains Malone.

Laser for TTTS in the past year has been centralised in Ireland at a new joint foetal therapy programme being delivered by the Rotunda and the National Maternity Hospital (NMH) together.

"I have been joined by Fionnuala McAuliffe and Stephen Carroll from NMH in creating a joint team that manages all the Irish cases now, with the cases being alternately operated on at the Rotunda or at NMH, by our joint team. This has been working well and increases the expertise in the team available to Irish patients," says Malone.

Buckley adds that one of IMBA's committee members had TTTS. "If you have this, you'll be monitored every week to two weeks. If one baby isn't growing as much as the other, the hospital might decide to take them out. This isn't very common though."

She is keen to stress to anyone expecting twins that they are part of a lucky group and to focus on the positives. "It's a miracle really. We are very special. It's amazing the attention you get from people. It's true you'll put in a few tough years, but I genuinely feel it's brilliant and wouldn't change things for the world. It's so lovely to see them together and interacting."

Mother & Babies

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