Healthy pregnancy twins

Twin Pregnancy: Answers from an Expert

Twin Pregnancy: Answers from an Expert | Johns Hopkins Medicine

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When you’re expecting twins, you know you’ll need two of everything for your registry. But what about staying healthy during your pregnancy? Do you need to double your food intake, weight gain and visits to the doctor? With regard to the babies, are there two placentas and two amniotic sacs, or can they share these?

Johns Hopkins maternal-fetal medicine specialist Jeanne Sheffield answers eight commonly asked questions.

Do twins share a placenta and an amniotic sac?

While some twins may share a placenta and an amniotic sac, that is not the case for the vast majority of pregnancies. Here are three major possibilities that exist:
- Two placentas and two amniotic sacs. A twin pregnancy with two placentas and two amniotic sacs is the optimal twin pregnancy, as each baby has its own nutritional source and protective membrane.
- One placenta and two amniotic sacs. In pregnancies with one placenta and two amniotic sacs, you will definitely have identical twins. Additionally, when your babies share a placenta, there is a greater risk for complications, such as twin-to-twin transfusion syndrome. Your physician will closely monitor your pregnancy to check for potential problems.
- One placenta and one amniotic sac. This is the riskiest and rarest type of twin pregnancy. Fetal complications can arise due to tangling of the umbilical cords or an imbalance in nutrients, blood or other vital life supporting systems.
Do I need to double my caloric intake during a twin pregnancy?

A common misconception surrounding twin pregnancy is that you need to double your caloric intake to provide your babies with enough nutrients. However, pregnancy nutrition guidelines aren’t simply based on the number of babies you’re carrying. Instead, they’re based on your body mass index at the time you became pregnant.

Your doctor will make individualized recommendations based on your starting weight. On average, it’s estimated that a woman’s caloric requirements will increase about 40 percent for a twin pregnancy. What’s most important, though, is that a woman eats as healthy as possible.
Do I need to take different prenatal vitamins for twins?

If you’re pregnant with twins, you should take the same prenatal vitamins you would take for any pregnancy, but your physician will recommend extra folic acid and iron. The additional folic acid and extra iron will help ward off iron-deficiency anemia, which is more common when you’re pregnant with multiples.
Will I need to visit my doctor more frequently?

While every pregnancy is different, most women carrying twins will have more frequent prenatal visits than women carrying only one baby. If your twins are sharing one placenta, you will automatically have a more frequent monitoring schedule.

If your pregnancy doesn’t have complications, your prenatal visits may not differ much from a singleton pregnancy until you get to the end of your second trimester. At that point, you’ll be seen more frequently because there is a higher risk of pre-eclampsia and preterm labor.
Do I have to see a maternal-fetal medicine specialist for a twin pregnancy?

Maternal-fetal medicine specialists see high-risk pregnancies, but not every twin pregnancy will fall into this category.

To find the best care provider for your twins, make sure that the physician is comfortable managing twins, including vaginal delivery of twins rather than only offering a cesarean section (C-section) for delivery.
Are all twin pregnancies delivered preterm?

A little more than half of twin pregnancies end in preterm delivery (before 37 weeks). While 40 weeks is the full gestation period of the average pregnancy, most twin pregnancies are delivered at approximately 36 weeks (range 32-38 weeks depending on the type of twin pregnancy).

Unfortunately, preventing preterm labor with multiples is more challenging than with a singleton pregnancy because the interventions used with singleton pregnancies are not as effective with multiples.
Can bed rest reduce the risk of preterm delivery?

Scientific data show that bed rest does not prevent preterm delivery. In fact, bed rest can increase your risk of developing blood clots and have negative financial and social consequences.

Although bed rest is not prescribed as frequently as it once was, your doctor may suggest reducing your activity level if you’re showing signs of early labor at the end of your second trimester or early in your third trimester.
Is labor and delivery significantly different with twins?

Labor is generally the same whether you’re having one baby or two. During delivery is when things differ significantly.

When it’s time to deliver your twins, you will go to an operating room even if you are delivering vaginally. This is a safety precaution known as a double setup. Following the vaginal delivery of the first baby, there is a small risk of an emergency cesarean section for the second baby. There is also the possibility of the second twin being delivered breech, which is a safe form of vaginal delivery if the obstetrician is experienced in this type of delivery.

Of women giving birth to twins over 32 weeks, only about 4 percent who try for a vaginal delivery will have a combined vaginal and cesarean section delivery. While it doesn’t happen very often, by delivering both babies in the operating room, physicians are better prepared to protect the health of the mother and the babies.

Although being pregnant with twins can seem very different, your doctor will treat your pregnancy like any other unless a complication occurs.

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Having Twins? How to Stay Healthy

The fact that you are carrying more than one baby does place you in a special category in the eyes of obstetricians. Many would call a twin pregnancy a high-riskpregnancy, but don’t be scared by this categorization. High risk does not automatically translate into your pregnancy having problems. Rather, high risk can be translated as, “We will need to follow this pregnancy more closely.” Also in the high-risk category are mothers with diabetes, those with a history of preterm labor with prior pregnancies, or those who have other major health issues themselves. The majority of twin pregnancies progress smoothly, and the odds of a healthy pregnancy increase if you take better care of yourself.

The most important step to care for your pregnancy is proper nutrition. Ideally, pregnant mothers should take a prenatal vitamin with folic acid starting from 3 months prior to conception. Folic acid has definitively been proven to reduce the chances of neural tube defects such as spina bifida. If you haven’t started taking the vitamin daily yet, don’t fret about the missed time—but do start now. Take the vitamin with food to reduce nausea, and applaud yourself for taking yet another step to keep your babies as healthy as possible. Moms of twins don’t need 2 prenatal vitamins a day—one is enough.

In addition to the extra calories, it is important to sip on water throughout the day. Keeping well hydrated may drive you crazy in later months when it seems like you’re running to the bathroom every 5 minutes; however, your babies’ extra blood flow and removal of wastes depends on it! It may help to drink more water earlier in the day and then stop after 8:00 pm so that you can sleep longer stretches at night between bathroom breaks.

Proper nutrition and hydration is important for your twin pregnancy, as is listening to your body. Any new pregnancy symptoms you notice must be brought to your obstetrician’s attention.

Twin pregnancies can also increase the chances of preeclampsia, a condition in which the mother has increased blood pressure, protein in the urine (detectable by urinalysis), and more swelling than is normal in pregnancy. If you notice rapid weight gain or headaches, alert your obstetrician so you may be examined as soon as possible. Depending on the severity of the situation, treatment may range from bed rest, to hospital-administered medications, to immediate delivery of the babies (the only “cure” for preeclampsia).

An optimistic yet careful attitude during your pregnancy will help your mental state and hence help your babies thrive during pregnancy as long as possible. Take things one day at a time and one week at a time. Eat well and pay attention to what your body and your twins are telling you. Every extra day that your babies spend inside the womb will help them once delivery day arrives. The bigger your belly gets, the bigger your smile should be, since you’re creating 2 miracles!

Last Updated: 11/21/2019

Source: Raising Twins: From Pregnancy to Preschool (Copyright © 2010 American Academy of Pediatrics)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

how to prepare for pregnancy with twins

Pregnancy

Twin birth: how to prepare for twin pregnancy

The birth of twins is a unique experience full of positive emotions, but parents have many questions: discover tips and advice from the experts of the Chicco Children's Research Center.

Birth of twins: a flood of emotions and many questions

First trimester ultrasound came with a surprise: two heartbeats, two babies. Double happiness for future parents, but also anxiety and many questions about pregnancy and childbirth and, above all, how to manage life in the first few months after the birth of babies. From a physiological point of view, pregnancy with two babies has a higher degree of risk and requires extra care and attention, especially in the third trimester of pregnancy.

Pregnancy with twins: some tips

Rest is crucial: women pregnant with twins should make sure they are not too tired and should be even more careful to avoid stress as they are more at risk of preterm labor . In general, multiple fetuses result in a shorter pregnancy, and for twins, this usually lasts around 36-37 weeks. The option of allowing vaginal delivery instead of caesarean section is evaluated at the end of pregnancy based on the health and well-being of the mother, the growth of the fetus, and the position of the children in the womb.

Organization is a key factor

As in the case of pregnancy with one baby, the moral and material preparation for childbirth in advance prevents unnecessary stress, especially in the first year of life. Tidying up the house is the first thing to decide: two cribs in the bedroom, a well-equipped changing table with cleaning products , diapers and linen changes, a double bath tub and two high chairs in the kitchen. Not to mention the many pacifiers , as well as bed linen .

Hint: pack maternity bag in advance so that you are ready to go to the hospital at any time and not worry about forgetting something important.

To get out of the house, you need a baby carriage

To get out of the house with two children, you need a set of necessary things, starting with a double or two strollers . The market offers a wide range of models that meet all requirements. You can choose from side-by-side, front-to-back or with fixed or removable seats, in a classic or more sporty style. How to choose? It's important to take into account your personal needs, from where you live - whether you have an elevator, for example - and your lifestyle.

Expecting twins is a special experience full of emotions. By preparing ahead of time, you can safely approach the upcoming event to fully enjoy this amazing adventure. Follow the advice from the Chicco Children's Research Center to prepare for this incredibly important milestone in your life.

Similar

What is a multiple pregnancy?

This is pregnancy, when not one fetus develops in the mother's body, but several at once. A multiple pregnancy is identical or dizygotic twins (triplets and more children).

Monochorionic monoamniotic twins - when there is a common placenta and there is no septum between the twins, it is always identical twins.
Monochorionic diamniotic twins - when the common placenta and septum, i.e. each fetus has its own amniotic sac.
Dichorionic diamniotic twins - when each fetus has its own placenta and its own amniotic bladder.

What are the features of identical twins, how do they differ from fraternal twins?

Identical twins are always the same sex, have the same blood type, and are very similar in appearance. Accordingly, the opposite is true for fraternal twins. They have phenotypic differences (eye color, facial features), there may be a different blood type. Fraternal twins may be of different sexes.

What are the causes of multiple pregnancy with fraternal twins?

Fraternal twins are formed when different eggs are fertilized by different spermatozoa. Most often, this occurs under the influence of hormonal ovarian stimulation (ovulation stimulation, assisted reproductive technologies), when several follicles with eggs are formed at once or one follicle with several eggs at the same time. Accordingly, each egg will be fertilized by a separate sperm.

What are the causes of multiple pregnancy with identical twins?

The development of identical twins occurs when one egg is fertilized by one sperm, but in the process of division of the fetal egg into two, three or four parts at different stages of its development. In this case, each part develops as a separate organism. It is assumed that such separation can occur when the implantation (attachment) of the fetal egg is delayed due to oxygen deficiency. Also, the occurrence of identical twins is also associated with the fertilization of an egg that had two or more nuclei.

Most often, identical twins do not have a septum between them and the fetuses have one common placenta. But depending on the stage of development, separation has occurred; identical twins can be separated by a septum from each other and may have different placentas or one common placenta, but each is in its own amniotic bladder.

Is it possible to re-fertilize if the pregnancy has already begun?

Theoretically, it is possible to fertilize two eggs of different ovulation periods. That is, in the first weeks of a pregnancy that has already occurred, if ovulation occurs again (an extremely rare case), the sperm enters the fallopian tubes and fertilizes a new egg.

In this situation, multiple uterine pregnancy may develop, but it is possible to have both uterine and ectopic pregnancies at the same time.

Is it possible to predict multiple pregnancy?

The chance of multiple pregnancies increases if pregnancy occurs with the help of drugs that stimulate ovulation, or with the help of assisted reproductive technologies (IVF), as well as when pregnancy occurs immediately after discontinuation of hormonal contraceptives.