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Twins:
Some Things to Consider
Many
of the factors that place multiple pregnancies at risk may be virtually
eliminated when the mother is adequately nourished, and this means "eating
for three." The mother of twins is more at risk of developing preeclampsia
due to the added stress upon her body. Yet, based on many years of experience
with women of all risk categories, I am convinced this condition need
never develop when adequate amounts of protein are consumed. Other conditions
such as anemia, varicosities, placental insufficiency, prematurity, hemorrhage,
uterine dysfunction and uterine atony are all hallmarks of a multiple
gestation which are to be expected, according to obstetric literature.
I believe, however, that these conditions may be completely preventable
as well.
Why do so many multiple births happen prematurely? The medical theory
is that multiple pregnancy not only causes added stress on the maternal
system but that over-distention of the uterus causes premature contractions
and labor. If that is so, why do so many very large babies (over 9 pounds)
often go to term, or are even overdue? I sincerely believe most twins
are born prematurely because they are suffering from starvation in utero,
and come out early so that they can be fed!
Several important considerations should be noted when anticipating a twin
delivery. These include: the mother's commitment to her nutrition and
general health; the type of twins (fraternal, monozygotic, etc.); the
placental attachment site; the position of the babies and their growth
and development. It must be noted that monozygotic twins have a greater
likelihood of having fetal anomalies and are at risk for developing twin-to-twin
transfusion. For this reason, I strongly advise clients to have at least
three ultrasound exams during the course of the pregnancy.
The first should be done at the time the multiple gestation is suspected
or diagnosed. In my experience, this is usually between 16 and 20 weeks.
At this time, the gestational age and the type of twins expected are most
easily diagnosed. Hopefully, even if only one placenta is seen (it is
possible that two placentas have fused early in pregnancy), individual
amniotic sacs will be identified. If both babies are within one amniotic
sac, the delivery risk is very high, as the babies, and most important
their umbilical cords, may become entangled.
The second ultrasound should be done at about 30 weeks, so results can
be compared with the first scans. At this time, problems such as intrauterine
growth retardation (IUGR) may be diagnosed in one or both babies due to
placental insufficiency. Or, any life-threatening anomalies in one or
both babies can be identified so that preparations and plans can be made
as to mode and place of delivery. An ultrasound at this time may also
detect a discrepancy in size and estimated gestational age, which is possible
when there is a separate conception date (rare) for the babies.
Also at the 30-week mark, if twin-to-twin transfusion is taking place,
the babies will be remarkably dissimilar in size and weight, and the mother
should be referred for high risk care. In this case, the babies will be
monitored closely and delivered as soon as they have reached sufficient
maturity.
Interestingly, the baby most at risk is the larger one who has received
a surplus of blood. This baby must be handled very delicately as its internal
organs have been stressed. Often, the suffused baby will require one or
more exchange transfusions to first reduce and then to supplant red blood
cells. The smaller, anemic baby can simply be given extra blood.
It is wise to have at least one more ultrasound done as close to term
as possible in order to verify the baby's presentation and position. Even
with the most experienced hands, this information is often difficult to
assess as there are so many parts to feel!
Valerie El Halta, Twins: A Very Special Occurrence, Midwifery Today Issue 39
From MidwiferyToday
E-News, a free weekly e-mail newsletter produced by Midwifery Today,
Inc., P.O. Box 2672, Eugene, OR 97401 USA, http://www.midwiferytoday.com. To subscribe
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