How to Know if You’re Carrying Twins

Doppler Heartbeat Count

Fetal heart sounds may be detected by a Doppler late in the first trimester. Experienced doctors and midwives may be able to detect multiple heartbeats; however, this can be inaccurate because a single heartbeat can be detected in several areas of the mother’s abdomen.

Elevated hCG Levels

Women who are pregnant with twins may have increased levels of hCG, which is the hormone that is produced during pregnancy. However, increased levels of hCG do not automatically indicate multiples. Further investigation would be needed to verify the cause of a high hCG level.

Abnormal AFP Test Results

An alpha-fetoprotein (AFP) screening, also known as a maternal serum screening or the triple marker test, is performed during the second trimester. This screening is used to detect certain birth defects and measure the amount of a certain protein that is secreted by the fetal liver.
A positive or high test reading may indicate a multiple pregnancy.

Twin Pregnancies Measure Large for Gestational Age

Most doctors and midwives monitor a women’s fundal height (the distance between the top of the pubic bone to the top of the uterus) during pregnancy. This measurement can help indicate the gestational age.
Women who are carrying multiples often experience increased uterine stretching, and the fundal height may be greater than the actual gestational age. While this may be indicative of a multiple pregnancy, other factors can cause this as well.

Weight Gain

There are numerous factors that can cause excessive weight gain, most of which are attributed to poor eating habits. The amount of weight a woman should gain depends on her height, body type, and pre-pregnancy weight.
On average, women who are carrying multiples only gain about 10 more pounds than those carrying a single baby.

Excessive Morning Sickness

About half of all pregnant women experience some form of morning sickness during pregnancy. While some mothers of multiples report an increase in the severity of morning sickness, many do not.
Just because a woman is pregnant with multiples does not mean that she will experience a double or triple dose of morning sickness.

Early or Frequent Fetal Movement

Although controversial within the medical community, some women carrying multiples report feeling fetal movement earlier than expected. This being said, it is important to note that most women experience earlier movement in subsequent pregnancies.

Twins Pregnancy = Extreme Fatigue

While this can also be caused by stress, work, and responsibilities, it is also commonly reported by women who are pregnant with multiples. This may be associated with the mother’s body attempting to provide nutrients to more than one baby.

History or Intuition

A multiples pregnancy can run in certain families. Also, some mothers may have an intuitive feeling that they are pregnant with multiples. Remember that many of these signs can have other causes, and the only way to be 100% positive that you are carrying multiples is through ultrasound confirmation.

Want to Know More?

• How a Multiples Pregnancy Occurs
• Prenatal Care in a Multiples Pregnancy
• Safe Exercise During a Multiples Pregnancy

The post Twins Pregnancy Symptoms appeared first on American Pregnancy Association.

Vanishing twin syndrome was first recognized in 1945. This occurs when a twin or multiple disappears in the uterus during pregnancy as a result of a miscarriage of one twin or multiple. The fetal tissue is absorbed by the other twin, multiple, placenta or the mother. This gives the appearance of a “vanishing twin.”

How is Vanishing Twin Syndrome identified?

Before the use of ultrasound, the diagnosis of the death of a twin or multiple was made through an examination of the placenta after delivery. Today, with the availability of early ultrasounds, the presence of twins or multiple fetuses can be detected during the first trimester. A follow-up ultrasound may reveal the “disappearance” of a twin.

For example, a woman may have an ultrasound at 6 or 7 weeks gestation. The doctor identifies two fetuses, and the woman is told she is having twins. When the woman returns for her next visit, only one heartbeat can be heard with a Doppler.

A second ultrasound is conducted, and only one fetus is observed. Additionally, some women may have symptoms that would indicate a miscarriage, although an ultrasound reveals a single baby in the uterus.
Vanishing twin syndrome has been diagnosed more frequently since the use of ultrasonography in early pregnancy. Estimates indicate that vanishing twin syndrome occurs in 21-30% of multifetal pregnancies.

What causes Vanishing Twin Syndrome?

In most cases, the cause of vanishing twin syndrome is unknown. Abnormalities that result in the vanishing twin appear to be present from early in development rather than from a sudden occurrence.
Analysis of the placenta and/or fetal tissue frequently reveal chromosomal abnormalities in the vanishing twin, while the surviving twin is usually healthy. Improper cord implantation may also be a cause.

What are the effects on the mother and surviving twin?

If the loss occurs within the first trimester, neither the remaining fetus nor the mother generally has clinical signs or symptoms. The prognosis of the surviving twin is usually excellent, but this depends on the factors that contributed to the death of the other twin.

If the twin dies in the second or third trimester, there are increased risks to the surviving fetus, including a higher rate of cerebral palsy.

When a twin dies after the embryonic period of gestation, the water within the twin’s tissues, the amniotic fluid, and the placental tissue may be reabsorbed. This results in the flattening of the deceased twin from the pressure of the surviving twin.

At delivery, the deceased fetus may be identified as fetus compressus (compressed enough to be noticed) or as fetus papyraceous (flattened remarkably through the loss of fluid and most of the soft tissue).

What are the signs of a possible Vanishing Twin Syndrome?

Research indicates more cases in women over the age of 30. Symptoms usually begin early in the first trimester and include bleeding, uterine cramps, and pelvic pain.

What medical care is recommended?

No special medical care is necessary with an uncomplicated vanishing twin in the first trimester. Neither the surviving twin nor the mother would require medical treatment. If fetal death is in the second or third trimester, the pregnancy may be treated as high-risk.

Pregnant women should seek medical care if they are experiencing bleeding, cramping, and pelvic pain. Ultrasound should be used to determine that no viable fetus remains before deciding if a D&C might be indicated.
The woman can choose to wait for a natural miscarriage in many cases.

Want to Know More?

• Miscarriage
• After a Miscarriage: Surviving Emotionally
• After a Miscarriage: Getting Pregnant Again
• D&C Procedure After a Miscarriage

Compiled using information from the following sources:

1. Danforth’s Obstetrics and Gynecology Ninth Ed., Scott, James R., et al, Ch. 14

2. Emedicine from WebMD

https://www.emedicine.com

3. MedicineNet.com

https://www.medterms.com

4. The Fetus Net

5. Williams Obstetrics Twenty-third Ed., Cunningham, F. Gary, et al, Ch 39

The post Vanishing Twin Syndrome appeared first on American Pregnancy Association.

Identical or Fraternal? Twin Zygosity

DNA Diagnostics Center offers a twin zygosity DNA test that definitively determines whether twins are identical or fraternal. A twin zygosity DNA test is a simple procedure performed sometime after the babies are born. Some parents choose to start testing right away, while others prefer to wait to initiate testing until the twins’ features emerge later in life.
When twins are born, the physician is usually able to identify whether twins are identical or fraternal by examining the placenta; identical twins generally share a placenta, while fraternal twins are usually in two separate placentas.
However, for confirmation, a twin zygosity DNA test compares the twins’ DNA profiles to confirm whether they match. An exact match proves that the twins are identical.
The test consists of a painless buccal (cheek) swab collected from each twin. The swabs are shipped to DNA Diagnostics Center’s fully accredited laboratory where the DNA from the samples is extracted, analyzed, and compared.
Like all DNA tests performed by DNA Diagnostics Center, each sample is analyzed twice to ensure 100 percent accuracy.

Reasons To Consider a Twin Zygosity DNA Test Include:

• Records from birth may be lost or inaccurate.
• The twins’ placentas may have been discarded or damaged before twin zygosity was determined, especially in the event of an emergency or health-threatening birth experience.
• Different physical traits may emerge as the twins grow, casting doubt on the twins’ original zygosity.
• Personal curiosity may lead you to pursue confirmation of twin zygosity.

Identical vs. Fraternal Twins

Identical twins come from one fertilized egg called a zygote. The zygote, which usually develops into one child, instead grows and splits early in development to form two embryos. Because the twins come from one egg and one sperm, they have exactly the same DNA and are, therefore, identical twins.
Fraternal twins, on the other hand, develop when there are two different eggs in the mother’s womb that are fertilized by two different sperm. Fraternal twins will not have the exact same DNA, although, like other siblings, they can be expected to share some of the DNA they inherit from both parents.

Need More Information?

For more information about twin zygosity testing, please call DNA Diagnostics Center at 1-800-798-0580. You can speak with a case manager who can guide you through the testing process.

Want to Know More?

• Multiple Pregnancies: Twins, Triplets and More
• Complications in a Multiples Pregnancy
• Weight Gain with Multiples

The post Are My Twins Identical or Fraternal? appeared first on American Pregnancy Association.

Why is weight gain with twins important?

Eating right and gaining the recommended amount of weight is necessary for any pregnancy, but this is particularly important when carrying more than one baby due to the increased risk of preterm labor and low birth weight in a multiples pregnancy.

Weight gain is especially important between weeks 20 to 24 of pregnancy. If a mother of twins gains 24 pounds by the 24th week of pregnancy, she reduces her chance of preterm labor. Early weight gain is also vital for the development of the placenta, which aids in the passing of nutrients to the babies.

How much should I gain?

Weight gain depends on a number of factors including height, body type, and pre-pregnancy weight. However, most women who are carrying twins are encouraged to gain 35 to 45 pounds. Women carrying triplets are advised to gain 50 to 60 pounds.

At this time there is not enough information on quadruplets and quintuplets to suggest any guidelines. Because opinions vary, discuss your specific weight gain with your healthcare provider who will be most familiar with your specific healthcare needs.

How quickly should I gain weight?

Women carrying twins will only gain 4 to 6 pounds during the first trimester and 1 ½ pound per week during the second and third trimesters. If you are carrying triplets, you should expect to gain 1 ½ pound per week throughout the entire pregnancy.

Once again, because opinions vary, consult with your healthcare provider and keep them informed on your weight gain.

Want to Know More?

• Are My Twins Identical or Fraternal?
• Complications in a Multiples Pregnancy

The post Weight Gain With Twins appeared first on American Pregnancy Association.

Many more women in America are having multiple pregnancies than ever before. According to the National Center for Health Statistics, the number of twin births increased 74%, and the number of higher-order multiples (twins, triplets, quadruplets, etc.) increased fivefold from 1980 to 2000. Most of this increase is due to women waiting to have children until their 30’s as well as the rise in the use of fertility treatments.

Multiples Pregnancy Multiply… Everything

Moms with a multiples pregnancy may experience more morning sickness. But using the degree of morning sickness as an estimate that you are carrying twins isn’t necessarily very helpful.

Overall, 70% to 80% of women can experience some amount of nausea and vomiting with pregnancies, and up to 2% reportedly experience hyperemesis gravidarum, a form of severe morning sickness. At the same time, some moms of twins and triplets say they have no morning sickness.

• Rapid weight gain in the first trimester
• The uterus is larger than expected because a twin or multiples pregnancy may cause the mother’s uterus to expand beyond the range of a single pregnancy.
• Severe nausea, vomiting, breast tenderness, or other pregnancy symptoms
• Higher hCG levels.   hCG is a hormone detectable in pregnant women’s blood or urine about 10 days post-conception. It usually doubles every two to three days, peaking at about eight to 11 weeks into the pregnancy.

Possible Complications:

• Preterm delivery
• Low birth weight
• Preeclampsia (high blood pressure)

Imperative aspects of prenatal care:

• Early prenatal care
• Early increased nutritional intake
• More frequent trips to your health care provider

You may also need additional ultrasounds and have an increased potential for bed rest.

Want to Know More?

• Safe Exercise During a Multiples Pregnancy
• Weight Gain with Multiples
• Are My Twins Identical or Fraternal?

The following links may also be helpful as you begin your journey of carrying multiples:

• www.twinsmagazine.com
• www.multiplebirthsfamilies.com
• www.womenshealthchannel.com/multiplepregnancies/index.shtml
• www.asrm.org/Patients/FactSheets/complications-multi.pdf
• www.nomotc.org

The post Multiples Pregnancy: Twins, Triplets and More appeared first on American Pregnancy Association.

Is exercise safe during a multiples pregnancy?

The answer to this question can be extremely confusing. The recommendation for a single pregnancy is 30 minutes or more of moderate exercise a day. However, the American College of Obstetricians and Gynecologists (ACOG) suggest that women carrying multiples refrain from aerobic exercise because of high risks for potential problems.

It is best to discuss your desire to stay physically active with your health care provider. If you were physically active before you were pregnant, you will most likely be encouraged to remain active for as long as your health care provider feels it is safe.

What exercises can I do?

Once you have received permission from your health care provider, you may begin an exercise routine. If you walked daily before your pregnancy, there is a good chance that you will be able to continue this for the first half of your pregnancy.

Non-weight bearing exercises are often encouraged because they are tolerated better. Other exercises that are considered safe include stationary bike, arm exercises, and swimming. Many women find the buoyancy of the swimming pool comforting and enjoyable. Pregnancy yoga and Kegel exercises are also recommended.

What exercises should I avoid?

You should refrain from doing any exercises that require you to lie flat on your back. Weight training and resistance exercises should also be avoided. You should also refrain from doing any type of exercise if you are running a fever or if it is hot and humid outside. Hot tubs and saunas should be avoided as well.

What are the warning signs that I need to stop exercising?

• You feel like are having contractions
• You feel pelvic pressure
• You experience vaginal bleeding or discharge
• You feel lightheaded
• You experience swelling, especially in your feet

Make sure that you are communicating with your health care provider about your exercise routine throughout your pregnancy.

When should I cut back on exercise?

As long as you are feeling healthy and not experiencing any complications, most women who have exercised regularly throughout pregnancy can continue to as long as they feel comfortable.
Some healthcare providers encourage women to cut back on exercise at 20 weeks (singleton pregnancies cut back at 28 weeks).

Obviously, if you are experiencing complications that require partial or total bed rest, this cut back would occur even sooner. Make sure to discuss your exercise options and desires with your prenatal care provider.

Want to Know More?

• Exercise and Pregnancy
• Multiple Pregnancies: Twins, Triplets and More
• Complications in a Multiples Pregnancy
• Weight Gain with Multiples

The post Safe Exercise During a Multiples Pregnancy appeared first on American Pregnancy Association.

What can I do to make sure my twins do not develop Twin to Twin Transfusion Syndrome?

TTTS is a random event that cannot be prevented by doing or not doing anything specific. It is not a hereditary condition.

How is Twin to Twin Transfusion Syndrome diagnosed?

Your healthcare provider may suspect this disorder if any of the following is seen during an ultrasound:

• A marked difference in the size of fetuses of the same gender
• The difference in size between the two amniotic sacs
• The difference in the size of the umbilical cords
• A single placenta
• Evidence of fluid build up in the skin of either fetus
• Findings of congestive heart failure in the recipient twin
• Polyhydramnios (excess amniotic fluid) in the recipient twin
• Oligohydramnios (decreased or too little amniotic fluid) in the donor twin

A mother whose twins have TTTS may experience:

• A sensation of the rapid growth of the womb
• A uterus that measures large for dates
• Abdominal pain, tightness, or contractions
• A sudden increase in body weight
• Swelling in the hands and legs in early pregnancy

What treatment options are available for Twin to Twin Transfusion Syndrome?

Up until recently, twin to twin transfusion syndrome has claimed the lives of both babies, but technology has brought about two new treatment options for this condition.
The use of amniocentesis to drain off excess fluid appears to improve the blood flow in the placenta and reduce the risk of preterm labor.
Amniocentesis can save approximately 60% of affected babies. Laser surgery can also be used to seal off the connection between the blood vessels and appears to save 60% of affected babies.
Delivery is also an option if your healthcare provider determines the twins’ lungs have reached maturity.

What are the advantages of having laser surgery instead of an amniocentesis?

Amniocentesis may need to be done repeatedly throughout the pregnancy to maintain proper blood flow in the placenta, while laser surgery usually only requires one treatment.

What are the potential complications?

• Premature labor either due to ruptured membranes or induction
• Respiratory, digestive, heart, or brain defects in the recipient twin because of excess fluids
• Donor twin developing anemia
• Fetal demise/death

Is there anything else that I need to about this diagnosis?

The Twin to Twin Transfusion Syndrome Foundation recommends that weekly ultrasounds be performed after 16 weeks through the end of the pregnancy to monitor TTTS. They recommend that this be done even if the warning signs of TTTS have decreased.
The TTTS Foundation can be contacted at https://www.tttsfoundation.org or at 1-800-815-9211.

Want to Know More?

• Multiple Pregnancies: Twins, Triplets and More
• Complications in a Multiples Pregnancy
• Weight Gain with Multiples
• Exercise and Pregnancy

The post Twin to Twin Transfusion Syndrome (TTTS) appeared first on American Pregnancy Association.

Prenatal care schedule for a multiples pregnancy

Your first trimester prenatal schedule may not differ from that of a single pregnancy; however, you may discover that your healthcare provider wants to see you every two to three weeks. Once you enter into your second trimester, you should expect to have two prenatal visits per month.

During the third trimester, you should anticipate weekly prenatal appointments. Your healthcare provider may change the number of appointments based on the health of you and your babies.

Why do I need to make more frequent visits?

Women who are having multiples are at a greater risk of experiencing complications during their pregnancy. Frequent prenatal visits allow your healthcare provider to monitor both your health and the health of your babies.

This allows for proper prevention, detection, and treatment of any complications that could occur. If complications occur, your visits will become even more frequent. Your healthcare provider will determine the exact prenatal schedule that will benefit both you and your babies.

What kind of complications will I be monitored for?

The most common complications include:

• Preterm labor
• Preeclampsia or pregnancy-induced hypertension (PIH)
• Intrauterine Growth Restriction (IUGR)
• Fetal well-being
• Gestational diabetes
• Fetal demise or loss

You Might Need Bed Rest

If you do have complications associated with a multiples pregnancy, your doctor may recommend some level of bed rest to minimize potential risks to the mother (such as preeclampsia) or for the babies (such as preterm labor). Some doctors routinely prescribe rest after 24 weeks, while others take a “wait and see” approach.

More Helpful Articles:

• Multiple Pregnancies: Twins, Triplets and More
• Complications in a Multiples Pregnancy
• Weight Gain with Multiples
• Exercise and Pregnancy

The post Prenatal Care Schedule in a Multiples Pregnancy appeared first on American Pregnancy Association.

What are identical/monozygotic multiples?

Identical/Monozygotic multiples come from a single fertilized egg and are genetically identical. Monozygotic multiples are often referred to as identical twins/multiples. These multiples would all be the same gender and look alike.

How do identical/monozygotic multiples occur?

The occurrence of identical multiples is considered a random event and is not influenced by age, race, or heredity. Identical multiples occur in 3 to 4 of every 1,000 live births.

What are fraternal/dizygotic multiples?

Dizygotic multiples or fraternal multiples, result from multiple eggs that are fertilized by different sperm. These multiples may be different genders. This form of multiples would be no more genetically identical than normal siblings.

How do fraternal/dizygotic multiples occur?

The most common type of multiples is fraternal/dizygotic multiples. Dizygotic multiples occur commonly with infertility treatments. The increase of fraternal multiples is also due to the fact that older women are more likely to have multiples, and many women today are conceiving at a later age.
Other women who have an increased chance of fraternal multiples include those who have a higher body mass index (BMI), have recently discontinued hormonal birth control, and those who have had more babies.

Which category do higher-order multiples (triplets, quadruplets, etc.) fall into?

Higher-order multiples (triplets, quadruplets, etc.) are all a variation of identical or fraternal multiples. For example, triplets can result from one zygote (an egg fertilized by one sperm) dividing into three. This means that the triplets would be genetically identical.
Triplets could also occur if one of two zygotes divide in half. This would mean that two of the triplets would be genetically identical while the third child is considered a fraternal multiple. Similar scenarios occur in quadruplets and other forms of multiples.

More Helpful Articles:

• Multiple Pregnancies: Twins, Triplets and More
• Complications in a Multiples Pregnancy
• Weight Gain with Multiples
• Exercise and Pregnancy

The post How Do Multiple Births Occur? appeared first on American Pregnancy Association.

What are the most common complications associated with multiples?

• Preterm Labor/Delivery
• Low birth weight
• Intrauterine Growth Restriction (IUGR)
• Preeclampsia
• Gestational Diabetes
• Placental Abruption
• Fetal Demise/Loss
• Cesarean

Preterm Labor/Delivery

Preterm labor/delivery is defined as delivery before 37 completed weeks of pregnancy. The length of gestation typically decreases with each additional baby. On average most single pregnancies last 39 weeks, twin pregnancies 36 weeks, triplets 32 weeks, quadruplets 30 weeks, and quintuplets 29 weeks.
Almost 60% of twins are delivered preterm, while 90% of triplets are preterm.
Higher order pregnancies are almost always preterm. Many times premature labor is a result of preterm premature rupture of the membranes (PPROM). PPROM is a rupture of the membranes prior to the onset of labor in a patient who is less than 37 weeks of gestation.

Low Birth Weight

Low birth weight is almost always related to preterm delivery. Low birth weight is less than 5.5 pounds (2,500 grams). Babies born before 32 weeks and weighing less than 3.3 pounds (1,500 grams) have an increased risk of developing complications as newborns.
They are at increased risk of having long-term problems such as mental retardation, cerebral palsy, vision loss, and hearing loss.

Intrauterine Growth Restriction (IUGR)

Multiple pregnancies grow at approximately the same rate as single pregnancies up to a certain point. The growth rate of twin pregnancies begins to slow at 30 to 32 weeks.
Triplet pregnancies begin slowing at 27 to 28 weeks, and quadruplet pregnancies begin slowing at 25 to 26 weeks.
IUGR seems to occur because the placenta cannot handle any more growth and because the babies are competing for nutrients. Your doctor will monitor the growth of your babies by ultrasound and by measuring your abdomen.

Preeclampsia

Preeclampsia, Pregnancy Induced Hypertension (PIH), Toxemia, and high blood pressure are all synonymous terms. Twin pregnancies are twice as likely to develop preeclampsia as single pregnancies. Half of the triplet pregnancies develop preeclampsia.
Frequent prenatal care increases the chance of detecting and treating preeclampsia. Adequate prenatal care also decreases the risk of developing a serious problem from preeclampsia for both the babies and the mother.

Gestational Diabetes

The increased risk for gestational diabetes in a multiples pregnancy appears to be a result of the two placentas increasing the resistance to insulin, increased placental size, and an elevation in placental hormones.
The risk of occurrence of gestational diabetes in a multiples pregnancy is still being researched at this time. In one study, an increased risk of gestational diabetes did seem to be apparent, but the doctors involved recommended that further testing be conducted.

Placental Abruption

Placental abruption is three times more likely to occur in a multiples pregnancy. This may be linked to the fact that there is an increased risk of developing preeclampsia. It most often occurs in the third trimester, but the risk significantly increases once the first baby has been delivered vaginally.

Fetal Demise or Loss

Intrauterine fetal demise is extremely uncommon. Your healthcare provider will determine whether it is best to expose the other baby or babies to the fetus that has died or to proceed with delivery.
If the pregnancy is dichorionic (two chorions present), then intervention may not be necessary. (The chorion is a membrane that forms the fetal portion of the placenta. Fraternal twins always have two chorions while identical twins can have one or two chorions.)
If the pregnancy has a single chorion, fetal maturity will be assessed to see if immediate delivery is recommended. In this situation, it would be necessary to weigh the risks between having a premature baby and the risks of remaining in utero.

Cesarean

If you are pregnant with multiples it does not necessarily mean that you will have a cesarean birth. The typical recommendation for the delivery of triplets and higher-order multiples is a cesarean, but twins are often delivered vaginally.
The vaginal delivery of twins depends on the presentation of the babies.
Twins can be delivered vaginally when:

• The gestation is greater than 32 weeks
• Twin A (the baby closest to the cervix) is the largest
• Twin A is head down
• Twin B is head down, Breech, or sideways
• Twin B is smaller than twin A
• There is no evidence of fetal distress
• There is no cephalopelvic disproportion (CPD)

Want to Know More?

• Pregnancy Nutrition
• Multiples Pregnancy: Twins, Triplets and More
• Safe Exercise During a Multiples Pregnancy

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