Most of us recall the longtime Doublemint gum ads — a set of twins telling us: “Double your pleasure, double your fun.”
Well, the fact is, says an obstetrician specializing in high-risk births, when it’s double the babies, it’s also double the danger.
Nevertheless, Dr. Kevin Sumsion, an obstetrician and gynecologist at Tanner Clinic Layton, enjoys giving the twin prognosis to parents, who are almost universally delighted with the announcement. “When they hear the news,” he said, “they’re taken back at first; they don’t know if I’m kidding or not. Then, they’re excited.”
Twins put mom at risk
Multiple fetuses will always place the pregnancy in the high-risk category. Such pregnancies, said Dr. Sumsion, present a higher risk than single births in a number of areas.
For example, preterm delivery. “All multiple gestations have a higher risk of being born early,” he said, “which puts them in the neonatal intensive care unit.”
Mothers of twins are also at higher risk for:
▸ High blood pressure
▸ Toxemia and preeclampsia syndrome, when a pregnant woman develops high blood pressure and possible damage to other organs, usually late in the pregnancy
▸ HELLP syndrome: A life-threatening liver disorder, thought to be related to preeclampsia
▸ C-section: Twins present a greater risk of “malpresentation”, a situation when the baby is in the wrong position for birth, Dr. Sumsion said. “You can’t turn them like you can turn a single fetus.” This situation requires a c-section.
▸ Increased risk of bleeding following delivery “because of the higher volume of babies inside,” he said.
▸ For the newborn twins, higher risk of learning disabilities, developmental abnormalities and structural abnormalities.
Where the twins develop is vital to risk factor
A fetus develops within a warm, cozy encasement that’s actually two sacs — the inner amniotic sac and the outer chorionic sac. The big factor in whether a multiple gestation will go smoothly is where the fetuses develop in relation to the two sacs.
The highest risk is with twins sharing the same amniotic sac and chorionic sac. These twins are in danger of getting tangled up together and are usually delivered at around 32 weeks, said Dr. Sumsion.
Also at higher risk of complications are twins in separate amniotic sacs but the same chorionic sac. These twins are usually delivered at around 34 weeks.
The best situation is when each fetus has it own amniotic and chorionic sac, said Dr. Sumsion.
“Identical twins are the product of an egg that has divided,” he explained. “The earlier the egg splits, the more likely you’ll have two sacs around each baby.” Eggs that divide later are at risk for not developing separate sacs.
Conjoined twins result if the egg begins to split soon after conception but stops before the process is complete.
The ‘vanishing twin’ syndrome
Another phenomenon is that of the “vanishing twin” syndrome. The vanishing twin is a fetus that dies during pregnancy.
If this miscarriage occurs early in the pregnancy, the first trimester for example, the fetus will likely be reabsorbed into the placenta or mother’s body. The later in the pregnancy that one of the twin fetuses dies, said Dr. Sumsion, the more likely it will be visible on the placenta when the mother delivers. Such late-term miscarriages are uncommon.
Dr. Sumsion will always tell the mother if she has a “vanishing twin.”
“We just delivered an early vanishing twin the other day,” said Dr. Sumsion. He add, “There a tenderness a mom feels. So even as she rejoices, there’ll be a lot of tears for the baby that didn’t quite make it all the way.”