Twins: What You Need to Know

Having twins is a special and exciting experience, but it also comes with unique challenges. Twins are more likely to be born prematurely and face other complications compared to singleton pregnancies.

Why is the second twin harder to deliver?

• Poor fetal position: The second twin might be positioned with its feet or bottom first (breech presentation), making a vaginal delivery more difficult. The first twin is often in the optimal head-down position (cephalic presentation), which is ideal for a vaginal birth.
• Stronger uterine contractions after the first birth: After the delivery of the first twin, the uterus contracts strongly to push out the second twin. However, these strong contractions can lead to cervical tears and postpartum bleeding.
• The second twin “trailing” the first: The second twin might be positioned in a way that makes it difficult to maneuver for a vaginal birth.
• Weak labor: The larger uterus, coupled with the sudden emptiness after the first twin is delivered, can increase the risk of placental abruption, which can lead to weak labor and make it difficult to deliver the second twin.

Complications of Twin Pregnancy

• Premature birth: Twin pregnancies have a higher chance of premature birth due to the extra strain on the uterus.
• Placental abruption: This occurs when the placenta detaches from the uterine wall before birth, posing risks to both the mother and the babies.
• Uterine atony: Weak uterine contractions can lead to difficult delivery and postpartum bleeding.
• Prolonged labor: The second twin can be stuck, leading to prolonged labor, which can exhaust the mother and affect the babies’ health.
• Fetal growth restriction/Miscarriage: Twin pregnancies have a higher risk of fetal growth restriction and miscarriage due to competition for nutrients and oxygen within the uterus.
• Twin-to-twin transfusion syndrome:
  • Characteristics: Heartbeats of the twins differ by more than 10 beats per minute, and the babies are positioned more than 10 millimeters apart. Identical twins might share one placenta or have two placentas with connected blood vessels.
  • Symptoms: Ultrasound scans of the amniotic fluid and placenta show one twin with excessive amniotic fluid (polyhydramnios) and the other with too little (oligohydramnios). One twin has reduced resistance to blood flow, while the other has increased resistance.
  • Risks: If left untreated, the condition can be life-threatening for the babies.

When Cesarean Delivery is Recommended for Twins

• Breech presentation of the first twin, cephalic presentation of the second twin:
• Both twins in cephalic presentation: If both twins are head-down, but the babies are too large, the mother’s cervix is small, she has a history of cesarean delivery, or other complications exist, doctors might recommend a cesarean delivery.
• Monoamniotic twins: This type of pregnancy, where both twins share one amniotic sac, makes a vaginal delivery extremely difficult and dangerous, so a cesarean is usually recommended.

Delivering the second twin after the first

• Management: One person stabilizes the first twin while another ruptures the amniotic membrane to help position the second twin.
• Important Note: Do not attempt to deliver a transverse presentation (baby lying sideways).

Things to Remember:

• Twin pregnancies require extra care and monitoring due to the increased risk of complications.
• Women expecting twins should schedule regular prenatal appointments to monitor the babies’ growth and the mother’s health.
• Eating a healthy diet and maintaining a healthy lifestyle are crucial for mothers carrying twins.
• Don’t hesitate to discuss any concerns or questions about your twin pregnancy with your doctor.

Remember, knowledge is key to a healthy and safe pregnancy!