Facts About Twin Pregnancies in pregnant women

Gemeli is the medical term for a twin pregnancy or more than one fetus. The number of fetuses carried can be two, three, or even four fetuses at once or more. To make your friends more comfortable and safe in experiencing a twin pregnancy, let’s find out the following important facts about twin pregnancies.

Types of Multiple Pregnancies

Twin pregnancies can be classified as follows:

1. Identical twin pregnancy
   Is a twin pregnancy that occurs from one egg fertilized by one sperm. Identical twins generally have the same placenta, but their amniotic sacs are separated in the uterus (in rare cases, identical twins have one amniotic sac). Identical twins will have the same gender, the same appearance, the same fingerprints and palms. However, this pregnancy is rare.
2. Non-identical twin pregnancy
   This is a twin pregnancy that originates from two eggs fertilized by different sperm. The tendency for this pregnancy is greater than that of identical twins, which is approximately 2/3 of the total number of twin pregnancies. The sex of the twins born can be the same or different. They also have different looks like the other children in the family.

Some facts and complications in multiple pregnancies

If you and your partner want or are expecting twins, it would be a good idea for you to know the following facts:

1. More calorie requirements.
   If pregnant with more than one fetus, pregnant women need a greater calorie intake, namely around 2,700 calories per day. Apart from that, women pregnant with twins also need more nutritional intake such as protein, carbohydrates, minerals and vitamins, including folic acid, to support fetal growth.
2. More common in women over 30 years of age.
   Women aged over 35–40 years have a higher chance of releasing 2 or more eggs during ovulation. Therefore, the chance of getting pregnant with twins is greater than for women of younger age.
3. Labor often occurs early/premature.
   The birth process in twin pregnancies usually occurs when the womb reaches 36 or 37 weeks, or even earlier than that. This condition can certainly affect the condition of twins. The more fetuses being carried, the higher the risk of the fetus being born prematurely. On average, twins will be born when the womb is 36 weeks old, triplets 32 weeks, quadruplets 30 weeks, and quintuplets 29 weeks. Thus, mothers are advised to check the condition of their womb more regularly if they are undergoing a twin pregnancy.

   One of the complications that often occurs from multiple pregnancies is prematurity. Therefore, prospective mothers carrying two or more fetuses must recognize the signs of early birth, such as:

   1. Lower abdominal cramps that can be accompanied by diarrhea.
   2. Contractions of the uterus that are continuous and do not go away, four or more times in 20 minutes, or eight or more times in 1 hour.
   3. Emphasis on the lower back.
   4. Increased vaginal spotting.

      If there are any of the signs above, immediately go to the nearest hospital to get treatment.

4. The risk of pregnancy complications is higher.
   Compared to mothers who are pregnant with one fetus, mothers who are pregnant with twins have a greater risk of experiencing pregnancy complications, such as high blood pressure, gestational diabetes, anemia, hypertension, hyperemesis gravidarum, placental abruption, bleeding and preeclampsia. Not only does it have an impact on pregnant women, multiple pregnancies can also have an impact on the fetus. Babies born with twins are known to be at greater risk of being born with a low birth weight.
5. Morning sickness symptoms feel more severe.
   Morning sickness which is often experienced by pregnant women is caused by increased pregnancy hormones. Twin fetuses in the womb can make these symptoms more severe than a single pregnancy, because the levels of pregnancy hormones are higher.
6. More weight gain.
   The weight gain of pregnant women in twin pregnancies is generally greater, because there is more than one fetus. Apart from that, there is also more placenta and amniotic fluid. The average weight gain in a single pregnancy is 11 kg, while mothers who are pregnant with twins can experience a weight gain of up to 15-16 kg.
7. Risk of twin-to-twin transfusion syndrome.
   Another complication that can occur in twin pregnancies is twin-to-twin transfusion syndrome (TTS). This condition occurs when there is an imbalance in blood flow from the placenta to the fetus, so that one fetus receives more blood and nutrients than the other fetus. Twin pregnancies are riskier than normal pregnancies with 1 fetus. However, this does not mean that mothers cannot have a healthy and safe pregnancy.
8. Congenital diseases for babies (congenital abnormalities).
   Congenital diseases often occur in babies born prematurely, including twins who are born earlier than their expected birth time. Several types of congenital diseases that twins often experience are congenital heart disease, eye disorders (ROP), hearing problems, respiratory problems and growth and development disorders.
9. Growth disorders in the uterus (IUGR).
   In the first few months of pregnancy, the growth rate of twin fetuses is almost the same as that of a single pregnancy. However, under certain conditions, the growth and development of twin fetuses can slow down. Slowed growth in the fetus can cause a condition called intrauterine growth restriction (IUGR). In twin fetuses, IUGR occurs when the womb is 30–32 weeks old. Meanwhile, in triplets, IUGR can begin to occur at 27-28 weeks of gestation. There are several factors that are thought to cause IUGR in the fetus, for example the placenta is unable to provide nutritional and oxygen intake to the twin fetuses, resulting in problems with their growth and development.
10. Miscarriage.
    Vanishing twin syndrome (VTS) is a condition when one or more fetuses in the womb disappear or miscarry. VTS often occurs when twins are in the first trimester and is sometimes accompanied by bleeding. The risk of miscarriage is also higher in the following trimester.
11. Amniotic fluid volume is abnormal.
    Disturbances in the volume or amount of amniotic fluid are a frequent complication of twin pregnancies, especially in twins who share a placenta.
12. The umbilical cord is entangled.
    In twin fetuses that share the same amniotic sac, the risk of umbilical cord entanglement may occur. If this condition occurs, the fetus may need to be monitored frequently when the womb is in the third trimester.

Apart from the facts above, some complications that may occur are as follows:

1. Stillbirth. The possibility of the baby being born dead.
2. Single or Multiple Fetal Demise. One or both babies suffer from a dangerous, fatal disease.
3. Single Fetal Demise and Co-twin Morbidity. One baby died and the twin became ill.
4. Single Fetal Demise and Maternal Morbidity. Death of one of the babies and health complications for the mother.
5. Disseminated Intravascular Coagulation. Heavy bleeding occurs due to blocked blood flow, so that blood clotting cells to control bleeding are reduced.
6. Low Birth Weight. Babies born prematurely and babies with very small body weight.

The thing that mothers really need to remember when they are pregnant with twins is to check their pregnancy condition regularly with a doctor. In this way, doctors can always monitor the condition of the fetus and detect early if there are problems in pregnancy, so that treatment can be carried out immediately.

Symptoms of twin pregnancy

The symptoms of twin pregnancy are the same as the symptoms of pregnancy in general. At first, expectant mothers may experience normal pregnancy symptoms such as late menstruation, nausea, enlargement of the uterus, etc. However, usually the symptoms of multiple pregnancies are seen from the development of a larger uterus. Apart from that, the mother-to-be’s weight also increases significantly, namely by 18-23 kg and is not caused by swelling or obesity.

Causes of multiple pregnancies

There are various factors that cause twin pregnancies, such as:

1. Race.
   It turns out that the African race has a higher frequency of multiple pregnancies than whites.
2. Age.
   The higher the age, namely above 35 years, the higher the frequency of multiple pregnancies. It is only after the age of 40 that the frequency of multiple pregnancies decreases again.
3. Frequency of maternal pregnancies.
   The frequency of multiple pregnancies increases with the mother’s number of pregnancies.
4. Time.
   The possibility of multiple pregnancies increases immediately after stopping the use of oral contraceptives.
5. Descendants.
   If there is a history of twins on the mother’s side, then the possibility of twin pregnancy increases.
6. Infertility therapy.
   Medicines during therapy can stimulate the ovaries to release more than one egg, so that they can be fertilized at the same time.

Diagnosis of twin pregnancy

In diagnosing twin pregnancies, the doctor will carry out a series of actions, starting from interviews, physical examinations, and supporting examinations. During the interview, the doctor will ask when your last menstruation was, history of contraception, history of previous pregnancies, history of IVF, family history of twins, and other important information. Meanwhile, during the physical examination, the doctor will check the mother’s vital signs and general condition, which will then be continued with a pregnancy examination.
During a pregnancy check-up, the doctor will suspect a twin pregnancy if the size of the pregnancy exceeds the gestational age, more than one fetus can be felt, and the fetal heartbeat can be heard in two locations. Supporting examinations that need to be carried out are ultrasound, hormone tests, and other routine examinations such as blood and urine tests.

Tips for Pregnancy with Twins

If the mother is experiencing a twin pregnancy, follow these tips so that the pregnancy continues smoothly until delivery:

1. Consume adequate nutrition. Don’t forget to pay attention to folic acid, iron and calcium.
2. Avoid smoking, drinking alcohol and excessive caffeine.
3. Reduce physical activity. Some doctors recommend stopping physical activity after 24 weeks of pregnancy.
4. Get enough rest, especially after the 24th week of pregnancy.
5. Regularly check your pregnancy with a doctor or midwife.

The nutritional needs of the expectant mother will increase during a twin pregnancy, so additional supplements such as iron need to be given. This substance is useful for preventing anemia during pregnancy. Apart from that, expectant mothers are advised to eat foods that contain lots of protein. You also need to pay attention to how you eat properly. It is better to consume small amounts of food but frequently, rather than eating large amounts of food at once.

For the benefit of the expectant mother and the twins she is carrying, pregnancy checks should be carried out more frequently. Get checked every week when your pregnancy reaches 36 weeks, so that signs of complications can be identified early and treated more quickly. Despite all the facts about conceiving twins, pregnant women do not need to worry too much, because twin pregnancies can be born normally. Usually a cesarean section will be chosen if necessary, for example if one of the fetuses is breech.