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Twin Pregnancy

Types of twins

There are 2 types: identical and non-identical twins.

Identical twins: when a fertilised ovum (egg) “splits” or divides producing 2 embryos.  The embryos further divides producing 2 genetically similar foetuses (babies).

Non-identical twins: when 2 ova (eggs) are fertilised by 2 sperms producing 2 embryos, each producing twins which are non-identical to each other.

Identical twins share the same genetic make-up and sex (both either boy-boy or girl-girl) but not non-identical twins. The sex of non-identical twins can be either similar or different.

What are the factors that lead to twin pregnancy?

Some women are more prone to develop twin pregnancy, especially if:

  1. She is in her thirties or older.
  2. On fertility medication for pregnancy (e.g. clomiphene or follicular stimulating hormone)
  3. Undergone an in-vitro fertilization (IVF)
  4. More common in black (African) women than Asians or European (Caucasian)
  5. History of twins in the family (mother, father, sister etc.)

The above factors increases the chance of the mother conceiving non-identical twins but not identical twins

How can my doctor suspect or know that I am having twins?

Your doctor may notice your uterus being larger than your dates. However, twins are usually diagnosed using an ultrasound scan. This is done routinely in early pregnancy and the doctor would be able to determine the number of foetuses, their position, liquor volume and the position of the placenta. If the ultrasound scan is performed early enough then, the trained doctor would also be able to determine if there are 1 or 2 placentas or if there are 1 or 2 amniotic sacs. This information will help the doctor manage and monitor the twin pregnancy better. DCDA twins (2 placentas and 2 amniotic sacs) are of lower risk than MCDA twins (1 placenta and 2 amniotic sacs). The twins may have the same sex but this does not confirm that it is an identical twins.

Do I need to go for early antenatal booking?

It is generally advisable for all pregnant women to go for early antenatal booking and to have an early ultrasound scan. Early ultrasound scan would be able to ascertain the gestational age of the pregnancy more accurately and in the event that is a twin pregnancy, then the number of placenta and amniotic fluid sac can be known. It may not be possible to ascertain this if the ultrasound scan is performed later in pregnancy.

Twin pregnancy carry a higher risk compared to normal pregnancy. Thus it requires closer monitoring during the antenatal follow-up. Twin pregnancies are at higher risk of premature labour (see premature labour), pregnancy induced hypertension (high blood pressure during pregnancy), diabetes during pregnancy, anaemia and others.

How and where should I deliver?

Twin pregnancies should be delivered in a hospital with specialist. There is a criteria, on which twins are allowed vaginal birth and those that requires an elective caesarean section. Your doctor or Obstetrician, would be able to advise you on the mode of delivery. Twin deliveries also carries higher risk of post-partum haemorrhage (profuse vaginal bleeding after delivery). Besides this there is a risk of premature babies, poor baby outcome and the need for emergency caesarean section for the delivery of the second twin baby despite successfully delivering the first twin normally.

Can I breast feed my twins?

Mothers are encourage to breast feed their twins as her breast milk is more than enough for both.  Premature babies who may be unable to suckle well initially can be given expressed breast milk. The lactation nurses or counsellors will advise and assist mother on breast feeding.

Taking care of twins can be tiring and stressful for the mother, therefore they would require the assistance and support from their husband and family members. This would go a long way in easing the physical and emotional burden endured by mothers of twins.

Last Reviewed : 23 August 2019
Writer / Translator : Dr. Hj. Mohamed Hatta b. Mohamed Tarmizi
Accreditor : Dr. Haris Njoo Suharjono
Reviewer : Dr. Rafaie bin Amin