Twins Pregnancy

Twin Pregnancy in Ivf

Multiple pregnancies customarily happen when more than one egg is impregnated and implanted in the uterus and it also happens in cases of In Vitro Fertilization (IVF). The incidence of Multiple pregnancies is about 2 percent but increases to 20 to 25 % in cases of IVF as per HEFA ( Human Fertilization and Embryology Authority).

Everything You Need to Know About Twins Pregnancy​

Fraternal Twins | Identical Twins | Management | Early sign | Symptoms | Causes | Techniques | Risk | Diagnosis | Prevention

Fraternal twins

This is known as fraternal twinning. Fraternal multiples are siblings that are conceived at the same time. They have a separate placenta and amniotic sac and are known as Dizygotic and diamniotic. Fraternal multiples can be non-identical twins, who may be of the same or different sex, and may or may not be similar looking just like normal siblings. Practically they are two siblings born at the same time.

Identical twins

When one egg is fertilized and divides into two or more embryos, it produces Identical twinning. Identical twins look similar and are of the same sex that is either all boys or all girls. There is no possibility of having a boy and a girl at the same time. Genetically identicals are formed in identical twinning.

However, these children don’t have the same personalities and are distinct individuals. Identical multiples often comprise commonly shared placenta with separate amniotic sacs. Identical twins infrequently share one placenta and a single amniotic sac.

Sub Treatments For Pregnancy Care

Management of multiple pregnancies

A fixed set of management for multiple pregnancies will be determined by your physician based on:

• Your pregnancy’s overall health.
• Medical history.
• The number of fetuses.
• Expectations for the course of the pregnancy.

Management of multiple pregnancies may also comprise the following:

• Increase in nutrition– Mothers carrying two or more fetuses need more calories. An adequate amount of protein and other nutrients such as iron is required. More frequent prenatal visits are advised. Multiple pregnancies have a higher risk of complications. More frequent visits may help detect complications in the early-stage, enough for essential treatment or management. The mother’s nutritional status and weight should also be monitored more closely during pregnancy.
• Referrals– Referral to a maternal-fetal medicine specialist, if there is any special testing or ultrasound evaluation. Through this visit, you can also coordinate with the specialist to manage the complications.
• Increased rest– Few women may also need bedrest during multiple pregnancies if she develops pregnancy complications or is at risk of prematurity either at home or in the hospital, depending on pregnancy complications or the number of fetuses.
• Maternal and fetal testing– To monitor the fetuses’ health, testing is needed, especially if there are pregnancy complications. Regular and more frequent follow-ups are required. Regular ultrasounds to monitor the growth and doppler blood flow of the twins will be required.
• Tocolytic medications– If preterm labor occurs, it is needed to help slow or stop contractions especially till corticosteroid cover is given for lung maturity. Medication to stop contractions is given orally or intravenously. Available drugs are Atosiban (Oxytocin antagonist ) and Nifedipine ( Calcium Channel Blocker) for controlling uterine contractions. Magnesium sulfate is used for neuroprotection the babies especially if prematurity at less than 32 weeks.
• Corticosteroid medications– Corticosteroid medications help to mature the lungs of the fetus. Lung Immaturity is a major problem with premature fetuses. Commonly used is Betamethasone 12mg intramuscular and repeat dose after 24 hours. It has been seen that babies born 48 hours after betamethasone dose have fewer chances of NICU Stay and less ventilatory support.
• Cervical cerclage– Cerclage is a procedure used to place a suture or Mersilene tape on the cervical opening like a tourniquet. It is used for women with an incompetent cervix. This is a condition in which the cervix is physically weak and opens up under the weight of developing fetuses before full term is achieved. When the cervix is unable to stay closed during pregnancy, this procedure is followed up. Some women in early pregnancy with higher-order multiples may require cerclage. Prophylactic cervical cerclage can be offered to females with multiple pregnancies especially in cases of IVF pregnancy if there is a history of early pregnancy loss due to cervical incompetence or who have uterine anomalies.

How are multiple pregnancies delivered?

There is a higher risk when multiple pregnancies delivered naturally vaginally especially if the first twin is not a cephalic presentation. There is increased chances of Caesarian delivery in case of multiple pregnancies.

An early sign of multiple pregnancies

You can’t guess whether it is a normal pregnancy or multiple pregnancies unless you go for a diagnosis. The early sign and symptoms of multiple pregnancies are similar to a normal pregnancy.

Symptoms of twins during pregnancy

These are the most common symptoms of multiple pregnancies:

• Uterus gets more extensive than expected.
• Increased morning sickness.
• Increased appetite.
• Excessive weight gain, especially in early pregnancy.
• Fetal movements felt in different parts of the abdomen at the same time

Causes of multiple pregnancies

There are many factors that are related to having multiple pregnancies. Some of the naturally occurring elements include the following:

• Heredity– The chances for twins get higher when it is in the gene.
• Older age– It is seen that women over the age of 30 have high chances of multiple conceptions. As a result of delaying childbearing until later in life, there is a high probability for twins.
• High parity– The is a high chance for multiple pregnancies if you have more than one pregnancy history. It increases the chances of having multiples.

Assisted Reproductive Techniques

In vitro fertilization (IVF) and other techniques often use ovulation-stimulating medications that lead to increased chances of multiple pregnancies due to multi follicular development. Either multiple eggs developed or multiple embryos transferred in the uterus during IVF which leads to increased chances of multiple pregnancies.

Risk of multiple pregnancies

The risks of multiple pregnancies are:

• Preterm labor and birth– Over 60% of twins born are born prematurely and 12% of them are born before 32 weeks of pregnancy. The higher the number of the fetus, the greater the risk for early delivery.
• Gestational hypertension Or Preeclampsia – Women with multiple fetuses develop high blood pressure. This condition often evolves in earlier weeks of pregnancy and is more critical than a normal pregnancy with one baby. It can also increase the prospect of placental abruption that is early detachment of the placenta.
• Gestational Diabetes: Chances of pregnancy-induced diabetes is higher in multiple pregnancies because of increased levels of pregnancy hormones which promote diabetogenic changes.
• Anemia: Women with multiple pregnancies have higher chances of suffering from anemia because of increased nutritional requirements.
• Caesarian Section: With multiple pregnancies, there is an Increased incidence of Caesarian Delivery.
• Intrauterine Growth Restriction: Baby weight and growth may be restricted in case of multiple pregnancies.
• Twin to Twin Transfusion Syndrome: Uncommon complication where one twin becomes swollen and the other shrinks leading to serious condition for the babies. It is seen in the cases with Identical Twins.
• Congenital disabilities– Twice the risk of congenital abnormalities, including neural tube defects such as spina bifida, gastrointestinal, and heart abnormalities.

Diagnosis of multiple pregnancies

Diagnosis of multiple pregnancies is mostly made in the early stages, mainly if reproductive technologies have been used. Physical examination, diagnosis may be made by:

• Pregnancy blood testing– This blood testing is mostly done if there are high levels of human chorionic gonadotrophin (hCG),
• Alpha-fetoprotein– When more than one fetus is making the protein levels of a protein are discharged by the fetal liver and found in the mother’s blood may be high.
• Ultrasound– Transvaginal sonography is helpful in early diagnosis and confirmation of twin pregnancies where twin pregnancy sacs can be identified as early as 5 weeks gestation.

Prevention of multiple pregnancies

Multiple pregnancies can be minimized by single embryo transfer when performing in vitro fertilization.

What if I want a twin pregnancy:

The relation between IVF procedures and twins is easily understood. We also need to know that couples opting for IVF treatment consider having multiple babies due to a variety of reasons including:

• Older maternity age.
• IVF is an expensive affair, many couples are skeptical regarding the success of single embryo transfer and future funds. Hence such couples prefer to transfer multiple embryos at a time.
• Some look for IVF to conceive twin babies in IVF.

It is important for you to discuss multiple pregnancies with your IVF specialist doctor. She’ll be able to counsel you with the pros-cons, risks, and benefits of IVF twins. One needs to understand that having twins is not a bed of roses and can have significant difficulties with it. There are significant innovations that can help you to avoid multiple pregnancies at Gunjan IVF World. And Also if interested in twins you can discuss in detail with or fertility expert who can guide you to make an informed decision.

Our Expert Team

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