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Two's Company: What you can expect when pregnant with twins

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Most, but not all, twins are delivered by Caesarean section. The ESPRiT study showed that 35pc of twins in Ireland have a vaginal birth.

Most, but not all, twins are delivered by Caesarean section. The ESPRiT study showed that 35pc of twins in Ireland have a vaginal birth.

If your twins are ‘independent’ of each other (diochorionic) and each has their own placenta, the risks are substantially less, so you can expect to have fewer ultrasounds.

If your twins are ‘independent’ of each other (diochorionic) and each has their own placenta, the risks are substantially less, so you can expect to have fewer ultrasounds.

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Most, but not all, twins are delivered by Caesarean section. The ESPRiT study showed that 35pc of twins in Ireland have a vaginal birth.

With the rate of twin pregnancies standing at 1.5pc of all pregnancies in Ireland, there is a misperception that the growing twin population is due to the increasing use of assisted reproductive therapies like IVF.

In fact, most twin pregnancies in Ireland occur spontaneously.

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If your twins are ‘independent’ of each other (diochorionic) and each has their own placenta, the risks are substantially less, so you can expect to have fewer ultrasounds.

If your twins are ‘independent’ of each other (diochorionic) and each has their own placenta, the risks are substantially less, so you can expect to have fewer ultrasounds.

If your twins are ‘independent’ of each other (diochorionic) and each has their own placenta, the risks are substantially less, so you can expect to have fewer ultrasounds.

Dr Fionnuala Breathnach, consultant obstetrician gynaecologist with the Rotunda Hospital and member of the Institute of Obstetricians and Gynaecologists, says that while couples who achieve pregnancy through fertility treatment are more likely to have twins, approximately three in four twin pregnancies happen without assistance. And, she says, the twin population has remained steady at 1.5pc over the past decade.

Author of the national guidelines on twin pregnancy management, Breathnach also led the largest national prospective study of twin pregnancies ever to take place in Ireland.

Carried out between 2007 and 2009, the ESPRiT study looked at the factors affecting twin growth in utero, and the effect that different growth patterns had on twin health in infancy and beyond. Upon publication, it received international attention.

At her clinical practice in the Rotunda, Breathnach deals with a large number of twin pregnancies. She says for women who become pregnant with twins, there is an increased obstetric risk.

“To a very significant extent, the degree of increased risk is driven by the number of placentas within the pregnancy,” she adds.

Approximately one fifth of all twins will share a single placenta (these are called monochorionic twins). Most – although not all – identical twins share one. “This shared placenta can be problematic because communications inevitably exist between the two circulations within their shared placenta,” says Breathnach. For those twins who share one placenta, if one baby runs into trouble during the pregnancy, their twin can be affected.

Breathnach says identifying the number of placentas in a twin pregnancy is “critically important”, and most reliably achieved before 14 weeks’ gestation. Sometimes it’s not possible to determine the number of placentas after 14 weeks. “This issue underpins the importance of access to quality ultrasound services early in all pregnancies,” she adds.

 

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OUTCOMES

Fetal medicine has moved on a lot in Ireland over the past century, and the ESPRiT study showed “excellent” pregnancy outcomes for both kinds of twin pregnancies.

If you are pregnant with identical twins who share the placenta, you should expect a lot of ultrasounds throughout your pregnancy. Breathnach says ultrasounds are generally required every two weeks from 16 weeks of pregnancy until delivery.

If your twins are ‘independent’ of each other (diochorionic) and each has their own placenta, the risks are substantially less, so you can expect to have fewer ultrasounds.

Breathnach says as with all pregnancies, when it comes to having twins, optimising pre-pregnancy health is important. She adds that mothers should expect a twin pregnancy to take its toll on their pelvis, particularly when it’s not their first pregnancy.

“For first pregnancies, the pelvis, the uterus itself and its support ligaments are more robust than with subsequent pregnancies, such that a first-time mother carrying twins can weather the weight and pressure of the pregnancy very well.

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Most, but not all, twins are delivered by Caesarean section. The ESPRiT study showed that 35pc of twins in Ireland have a vaginal birth.

Most, but not all, twins are delivered by Caesarean section. The ESPRiT study showed that 35pc of twins in Ireland have a vaginal birth.

Most, but not all, twins are delivered by Caesarean section. The ESPRiT study showed that 35pc of twins in Ireland have a vaginal birth.

“In contrast, a woman carrying her third or fourth pregnancy can find the third trimester in particular very tough, by virtue of the weaker support structures in the pelvis.”

Physiotherapy can be invaluable in improving comfort levels, says Breathnach. “I usually encourage women to take a good long walk daily throughout the pregnancy for as long as their comfort levels will allow. Swimming can also be enormously beneficial. I advise women to avoid weighing themselves in pregnancy in general. Weight changes are impossible to interpret.”

Most twins will be delivered before full term. Standard practice is to strive for a delivery date of 37 to 38 weeks for those twins with their own placentas, and 36 to 37 weeks for those who share the one placenta. Sometimes spontaneous preterm labour, fetal growth complications or pre-eclampsia may intervene and drive an even earlier delivery.

Breathnach says the drive for early delivery is because the placenta has a limited life-span, and blood supply to a twin placenta will mature sooner than for a singleton pregnancy. This, she says, results in increased complication rates if twin pregnancies are prolonged.

 

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C-SECTION

Most, but not all, twins are delivered by Caesarean section. The ESPRiT study showed that 35pc of twins in Ireland have a vaginal birth.

The vast majority of Caesarean deliveries are either elective (scheduled) or emergency pre-labour deliveries. Vaginal births of twins have a high success rate, at 77pc.

Breathnach says the least desirable of all delivery options (both for the patient and the obstetrician) tends to be a combined approach, where the first twin delivers normally but a caesarean is required for the second.

“Our research described that, where the leading twin delivered by the vaginal route, the prospect of requiring Caesarean delivery for twin two was 4pc. Ultimately, when it comes to the best and safest birth option for a particular set of twins, an important principle to remember through pregnancy is that circumstances at the time of delivery may very well dictate the route of delivery.”

For example, the leading twin may be in a breech position, which represents an automatic requirement for C-section. Or spontaneous labour may be rapid and at an advanced stage, so a vaginal birth may be necessary.

Breathnach says that, such situations notwithstanding, if you are weighing up whether to go for a vaginal or Caesarean birth, you should take a number of factors into consideration.

“Ultimately, the decision on optimal route of delivery should take into account the degree to which the pregnancy is uncomplicated, the woman’s prior obstetric background and the couple’s preference,” she says.


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