Twins are a source of delight to parents, family and friends. Yet behind the awe of a twin pregnancy are challenges that expecting parents should be aware of so that they may partner with their obstetrician to achieve optimum outcomes.
In our practice we currently have quite a number of patients excitedly expecting twins. The rate of twin pregnancy in the United States is approximately 32 per 1000 births. An important aspect of our initial evaluation of a twin pregnancy is determining the chorionicity. When we determine chorionicity, we want to know whether the babies are sharing one placenta or if each baby has its own placenta. When the babies share one placenta there are different concerns for the infants than when there are two distinct placentas and two amniotic sacks. Another initial aspect of twin pregnancies is determining if chromosome abnormalities are present. Interestingly, the likelihood of an abnormality is higher in twin pregnancies. Fortunately, nuchal translucency, a non-invasive early ultrasound, is very sensitive for detecting trisomy 18 and 21. However, while we offer screening to all of our expectant mothers, this is a very individual decision that ultimately rests with the parents.
Undeniably, twin pregnancies are more likely to deliver preterm, and it is this risk that is often underappreciated. Sometimes preterm delivery is necessary because of medical concerns for the mommy or one or both babies. Often, preterm birth ensues after spontaneous onset of preterm labor or after premature rupture of the membranes. In our practice, we discuss openly these statistics so that our mommy’s and their families can make modifications in their daily lives to help support and nourish these special pregnancies. We will evaluate the cervical length via ultrasound between 22 and 32 weeks of gestation to look for any risks of preterm delivery. The use of oral medications to reduce preterm birth is not proven to work nor is prophylactic cerclage. However, the use of steroids has been shown to dramatically improve infant outcomes.
While twin pregnancies can be twice the fun, they can also be twice the ouch! Beyond 16-20 weeks into the pregnancy, growth of the abdomen will quickly outpace growth experienced in singleton pregnancies. This means that it becomes more difficult for mommy to reach down to tie her shoes (hint: a great gift is a pedicure) and it becomes more difficult to reach the steering wheel. Mommy may find that she tires easily, feels pelvic pressure and has lower back discomfort (another hint: a great gift is a pregnancy massage). We recommend at least 8 to 10 hours of sleep nightly, regular gentle exercise and increased intake of vitamins, vegetables and fruits.
Many of our mothers who are expecting with twins want to know if they can still have a natural, vaginal birth. Yes! That being said, we want to ensure a safe delivery for all three of the lives in our hands. A patient is a good candidate for a vaginal birth if the first baby is facing head down, the babies have achieved a safe minimum weight and the babies weights are within 10% of each other. We recommend that our patients have regular, interval ultrasounds of the babies to monitor these and other parameters of well-being. We have a lot of experience with breech and transverse presentations and when circumstances permit, we are pleased to offer these patients the opportunity for a vaginal delivery, too.
To schedule an appointment or consultation with Dr. Jennifer Mushtaler, please visit www.capobgyn.com or call 512-83.OBJEN. We look forward to seeing you at Capital Ob/Gyn Associates of Texas.
OB JEN is excited to be back as a sponsor of the 2011 Couple’s Triathlon! Jen and her husband, Trent, will be out on the course again this year so keep your eyes peeled for this couple!
