September 14th, 2011 by Hasham

Pregnancy Complications

Carrying more than one baby can put an extra strain on your body’s resources. We give you the lowdown on the complications which can occur when you’re pregnant with twins or more.

When you’re pregnant with multiple babies, many of the usual physical problems of pregnancy can start sooner or be exaggerated. Nausea may be more bothersome because of the higher level of circulating hormones. Heartburn, indigestion and the need to urinate frequently are more likely as the enlarging uterus presses on other organs. Back pain is common because of the extra load combined with the ligament-relaxing effects of pregnancy hormones. Sleep problems, piles and varicose veins are all more likely to develop.

More serious complications of pregnancy are also possible. Threatened miscarriage occurs more often and, according to some studies, so does vaginal bleeding, perhaps partly because one or both placentas are lying low in the uterus.

It is now known that in some cases a twin dies in the womb in the early weeks, leaving a healthy survivor. An ultrasound at four to six weeks reveals two tiny pregnancy sacs but by 12 weeks one of the sacs has been reabsorbed back into the body.

Until around 28 weeks, twins’ growth rate is usually normal. But then some babies do not grow as fast as they should. Intrauterine growth retardation is carefully monitored by ultrasound scans.

In a few multiple pregnancies, too much amniotic fluid builds up (polyhydramnios), making life very uncomfortable for the mother. The fluid can be drawn off by amniocentesis but a premature labour may follow or bed rest may be advised.

Pregnancy hypertension (high blood pressure) and pre-eclampsia are also more frequent, and may mean that the babies need to be delivered early.

Premature labour is the main risk of twin pregnancy, probably caused by the uterus overstretching. Four out of ten twin pregnancies (more with identical twins) go into labour before 37 weeks. Going into hospital means that the condition of the babies can be monitored but preventing a premature birth may not be possible.

A rare complication that can occur in identical twins when they share a chorion (the outer membrane) is twin to twin transfusion syndrome (TTTS). Some blood from the placenta passes from one twin to the other, potentially leaving one twin thin and undernourished while the other grows at his expense. This can be extremely serious but many TTTS babies are only mildly affected and born slightly different in size and colour. If this happens to your babies, you can get advice and support from the UK Twin 2 Twin Transfusion Syndrome Association.

Preterm Birth

If the early labor cannot be stopped through medications or bedrest, then your twin babies might be born too early. This is probably the most serious risk about having a twin pregnancy and one of the most common. Once in the hospital, you may need injections of a steroid to hasten the lung development of your babies. Depending on how old they are, and how small they might be, they may have to really fight just to survive. They may suffer from low birth weights, have breathing or digestive problems, they may have underdeveloped organs, learning disabilities, vision or hearing problems and developmental delays.

There are rare incidents when one twin is born prematurely, and the other babies stays in the womb to continue developing longer. This is called delayed-interval delivery

premature baby in the neonatal intensive care unit

High Blood Pressure

Twin mothers are more likely to experience high blood pressure during their pregnancy. If the high blood pressure is combined with too much protein in the urine, the condition is known as preeclampsia.

Very careful management of this condition is necessary to prevent more serious twin pregnancy complications to both the mother and the babies. Babies are often delivered prematurely if the condition worsens to protect the health of the mother and the twins.

The First Trimester
Please don’t hit me, or to be more accurate, risk bodily harm to yourself by thumping your computer screen repeatedly if I say that I found the first trimester easy.

Anxiety was the only symptom I appeared to have of pregnancy, albeit unusually rabid in intensity. As soon as I knew I could see a fetal heart beat (or two!) on transabdominal ultrasound scan, I was skulking into my own radiology department and borrowing the machines for a quick self-scanned fix of “Yep Still Alive!” on at least a once a week basis. Sometimes more often.

carefree pregnancy
If you’ve just found out you’re having twins and you’re reading this with your head firmly resting over an emesis basin (or your toilet bowl, should you actually take a PC in the loo), please don’t send me emails of hate for lacking the Spew Gene. Read on.

I thought multiple pregnancy was going to be an utter doddle. I’d be in heels still working at 38 weeks when I gently started contracting. My skin would be blemish-free. My hair would be lush. I would wear make-up every day. I wouldn’t put on weight ANYWHERE apart from my beautifully un-stretch-marked belly.

What are twin pregnancy complications?

watch videoA single placenta normally supports a single fetus. When the situation arises in which two fetuses have to share a single placenta, complications may sometimes develop. Identical twins that share a single placenta are called monochorionic twins (MC). “Chorion” is the Latin root that refers to the placenta, while the word “amnion” refers to the sac, or “membranes” that surround each fetus. While fraternal twins (2 eggs and 2 sperm) are always surrounded in their own sacs and have their own individual placentas, 70% of identical twins may end up sharing a single placenta. Only 1% of identical twins share both a single placenta and a single sac, and this poses significant risk.

medical illustration of normal monochorionic twins – two fetuses share one placenta, their umbilical cords may implant anywhere – there is no set or predictable pattern – and depending on where they implant, one fetus may get less of a ‘share’ of the placenta than it’s co-twin, resulting in less blood flow and nutrition to one fetus, with more to the other (unequal placental sharing). As a result, although identical twins usually share the same genetic material, they may actually grow differently. Like the roots of a tree, the blood vessels that run from each implanted cord may connect with each other beneath the surface, as there is nothing separating them within a single placenta. Depending on which types of vessels connect to which, one fetus may transfuse blood to the other. We will discuss each of these complications, their risks, and potential treatments, below.