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Contents 14
- Twin Pregnancies
- Common Complications in Twin Pregnancies
- 3. Intrauterine Growth Restriction (IUGR)
- 4. Preeclampsia
- 5. Gestational Diabetes
- 6. Placental Abruption
- 7. Fetal Loss
- 8. Cesarean Delivery
- 9. Twin-to-Twin Transfusion Syndrome (TTTS)
- TTTS
- Signs Seen in the Mother
- TTTS Treatment Options
- Findings
- TTTS Treatment Options
Twin Pregnancies
Risks, Complications, and Management Methods
Twin pregnancies are among the conditions that heighten a couple's excitement but also require greater medical attention and care. While most twin pregnancies result in healthy outcomes, certain risks and complications are seen more frequently in these pregnancies compared to singleton pregnancies.
Common Complications in Twin Pregnancies
1. Preterm Labor and Delivery
Preterm birth is defined as delivery occurring before week 37. While delivery in singleton pregnancies generally occurs after week 39, in twin pregnancies this average drops to around week 36. The risk of preterm birth is higher in twin pregnancies, and this situation generally begins with premature rupture of membranes. Preterm births can lead to various health problems in babies.
2. Low Birth Weight
Low birth weight refers to babies weighing less than 2500 grams at birth and is generally associated with preterm delivery. In births occurring before week 32, babies' weight may be under 1500 grams, and complications such as intellectual disability, cerebral palsy, and vision and hearing problems are more common in these babies.
3. Intrauterine Growth Restriction (IUGR)
In twin pregnancies, the babies' growth may proceed normally up to weeks 30-32. However, after these weeks, since the placenta cannot adequately nourish the babies, growth slows down. For this reason, the development of babies in twin pregnancies should be closely monitored.
4. Preeclampsia
Preeclampsia is a condition that occurs in the second half of pregnancy and presents with symptoms such as high blood pressure and protein loss in the urine. The risk of preeclampsia is twice as high in twin pregnancies. In triplet pregnancies, this rate can rise to as much as 50%. Preeclampsia poses serious risks for both the mother and the babies, so regular follow-up and adequate care are necessary.
5. Gestational Diabetes
Gestational diabetes is a type of diabetes that first appears during pregnancy and is more common in twin pregnancies. This is because the increase in placental volume causes placental hormones to increase insulin resistance. This situation can make it more difficult to regulate blood sugar levels and poses a risk for both the mother and the babies.
6. Placental Abruption
Placental abruption is the premature separation of the placenta from the uterine wall and is three times more common in twin pregnancies. It generally occurs in the third trimester and may require emergency medical intervention.
7. Fetal Loss
Although fetal loss is rare in twin pregnancies, when it does occur in dichorionic pregnancies (where each baby has a separate placenta), intervention is generally not required. However, in monochorionic pregnancies (where the babies share the same placenta), the risk of fetal loss can be serious and may require early delivery.
8. Cesarean Delivery
Cesarean delivery is not mandatory in twin pregnancies. However, depending on the babies' presenting position, cesarean delivery may be preferred. Some criteria for vaginal delivery are as follows:
The pregnancy must be greater than 32 weeks.
The leading baby should be larger.
The first baby's head should be positioned down.
The second baby may be in a head-down or breech position.
The second baby should be smaller.
There should be no cephalopelvic disproportion (CPD).
9. Twin-to-Twin Transfusion Syndrome (TTTS)
TTTS is a complication seen in twins who share the same placenta. Due to the blood vessel connections in the placenta, one baby (the recipient) receives more blood while the other (the donor) receives less. This can result in excessive blood volume, heart failure, and polyhydramnios (excess amniotic fluid) in the recipient baby, while anemia and oligohydramnios (insufficient amniotic fluid) may develop in the donor baby. TTTS occurs at a rate of 15% and is a serious condition.
TTTS
TTTS diagnosis is generally made during an ultrasound examination. Diagnostic signs include the sex of the fetuses, differences between measurements, differences in amniotic sac size, differences in cord thickness, a single placenta, and polyhydramnios in the recipient baby with oligohydramnios in the donor baby.
Signs Seen in the Mother
A feeling of rapid uterine growth
Excessive increase in abdominal size relative to gestational week
Abdominal pain, tightness, and contractions
Sudden excessive weight gain
Early swelling of the hands and feet
TTTS Treatment Options
Findings
A feeling of rapid uterine growth
Excessive increase in abdominal size relative to gestational week
Abdominal pain, tightness, and contractions
Sudden excessive weight gain
Early swelling of the hands and feet
TTTS Treatment Options
TTTS, which had no treatment options in the past, can now be managed with certain medical interventions. Treatment options include draining excess amniotic fluid and laser therapy. With laser therapy, the connections between placental blood vessels are severed, and success can be achieved in 60% of affected babies. Monitoring lung maturity and performing delivery at the earliest appropriate time is also among the treatment options.
Twin pregnancies are special situations that require greater follow-up and care for both the mother and the babies. Risks may be higher in these pregnancies, but with regular medical check-ups and appropriate treatment methods, a healthy pregnancy process and delivery are possible. Regular ultrasound examinations throughout the pregnancy allow for early detection of possible complications and timely intervention when necessary. It is extremely important for expectant mothers experiencing a twin pregnancy to stay in close communication with their doctors and to follow all necessary medical recommendations during this process.