Pregnancy can be an overwhelming time for every woman, especially if you go into your first prenatal care check up sonogram appointment and you see two babies with two beating hearts on that black and white screen. You might be instantly in shock, thinking, “I am going to need two of everything!” Since there are more tests and sonograms involved with multiple pregnancies – depending on the type of twins you are carrying – you are automatically considered high risk. This does not necessarily mean that you will be in and out of the hospital for the next seven to eight months, it just means that you will be watched more closely by your prenatal care doctor.
Generally, women who carry twins rarely make it to 40 weeks gestation. Many doctors advise that they should be born by 38 weeks gestation due to the placenta. This can also change depending on the type of twins the woman is carrying and the risks that are involved. Also, although twins are classified as identical (very early in development the embryo splits and two fetuses grow) and fraternal (when two eggs are fertilized by two sperm), there are three common types of twin pregnancies.
Monoamniotic-Monochorionic twins, also referred to as Mo-Mo or Mono-Mono twins, are a type of identical twins. This type of twin pregnancy is very rare, and very risky. Mono-Mono twins have as high as a 47% mortality rate (ncbi.nlm.nih.gov). This is due to a number of things that can go wrong in the womb. The twin’s cords can become tangled, cutting off the flow of nutrients from the placenta to one or both twins. Other things such as Twin-to-Twin Transfusion Syndrome (TTTS) is also to blame, this syndrome is defined as a complication of disproportionate blood supply that effects multiples that share a single placenta. Twins that have severe TTTS have a mortality rate from 60% to 100%. However, your prenatal care provider should monitor you very closely if this is the type of twins that you are carrying. They may suggest that you deliver much earlier than you would hope, some even at the highest viability level around 32 weeks.
Monochorionic-Diamniotic twins, commonly called mo-di or mono-di twins, are twins that share the same placenta, and have a small barrier between them as if there are two amniotic sacs. These types of twins are also susceptible to TTTS, and you should be monitored closely, starting at week sixteen when TTTS is known to become a risk. If your doctor suspects that twin-to-twin transfusion is happening, the earlier it is happening the worse the prognosis usually. They may suggest delivering your twins at a week that is past the viability stage (usually starting at 22 weeks). Also, because they share a placenta they will be identical twins. However, since they are in different amniotic sacs there is no risk of cord entanglement. This is considered the safer type of identical twin to carry.
Dichorionic-Diamniotic twins, or Di-Di twins, are considered the safest type of twins, and the most common type of twins today. About 1 in 30 pregnant women will carry di-di twins. These twins are most common today due to the increased use of artificial reproductive technologies. These twins have two placentas, and two amniotic sacs. Di-Di twins are fraternal twins. They are no more alike than another sibling would be to them, except that they share the same birthday. This is the only type of twin pregnancy that you will have the chance to receive a girl and boy twin, but you can also get two girls and two boys as well. Unlike the previous types of identical twins, di-di twins are the only type to be hereditary or passed on from previous family members. There are also chances that it is not hereditary and you conceived twins naturally. Age, weight, diet, and birth control pills can play a big part in the conception and have caused hyperovulation.
Carrying one baby – let alone two or more – can be a scary and exciting emotional roller coaster. Do not let the risks outweigh the benefits or cause stress to you during your pregnancy. Remember that your obstetrician or prenatal care provider is looking out for you and your babies, and they are there for you to ask questions or address your concerns, I was sure that I did when I had mine!
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