When more than one foetus simultaneously develops in the uterus, it
is called multiple pregnancy. Two foetus are twins and the commonest.
They are of 2 types:
Binovular twins (fraternal, dizygotic)- This results from fertilization
of 2 ova (eggs), by two different sperms during same ovarian cycle.
The babies bear only fraternal resemblance to each other (That of
brother & sister of different birth). They have two separate placenta
& membranes.
Uniovular twins (identical, monozygotic)- Twinning occurs at different
periods after fertilization. The placenta & membranes are one. Uniovular
twins are always of same sex.
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Incidence
Of twins depends upon- race, hereditary, advancing age of mother,
as the number of children increase the chances of twins increase,
ovulation inducing drugs (as in infertility treatment). The commonest
presentation & lie of the foetus is longitudinal (like in normal
pregnancy). But malpresentations are quite common.
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Diagnosis:
Persons having history of taking ovulation inducing drugs (treatment
for infertility) and family history of twins. Mild ailments of pregnancy
are exaggerated like increased vomiting, breathing difficulty, swelling
of legs, unusual rate of abdominal enlargement, excessive foetal
movements. On examination abdomen is enlarged more than what it
should be at that month, multiple foetal parts are felt. Two distinct
foetal heart is heard.
Sonography confirms the diagnosis.
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Complications:
Anaemia, pre-eclampsia, hydramnios, antepartum haemorrhage, malpresentation,
preterm labour, mechanical distress, early rupture of membrane,
prolonged labour, postpartum haemorrhage. As far as foetus is concerned
chances of abortion, prematurity, intrauterine death and still birth
are seen.
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Management:
During antenatal period a good diet, supplement therapy of iron,
calcuim, vitamin & folic acid, avoid physical & mental stress, regular
& frequent antenatal check ups are a must. If position of the babies
are longitudinal (normal) normal delivery is of choice. Both babies
are delivered one by one. As the babies are relatively small there
is no difficulty in delivering them.
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Indication
of Caesarean Section:
- Problems associated with pregnancy like small pelvis, low lying
placenta (placenta previa), severe toxaemia, previous caesarean
section etc.
- Malpresentation, abnormal position of the twins or twins which
are attached to each other will require caesarean section.
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