Dr. Shobha Venkat

"Let’s try to understand how the multiple pregnancy or how the twin pregnancy is formed. We all know that the sperm unites with the egg and forms the zygote and the zygote keeps on multiplying and undergoes series or stages of the development and forms the embryo. So in twin pregnancy what happens is when there is two types of the twin pregnancy, one is the dizygotic twins and one is the monozygotic twin. Zygocity is refers to the number of eggs from which the baby is formed. So as the name itself indicates that if it is a dizygotic twins, there are two separate eggs that are fertilised by two separate sperms and each one developing into a separate embryo. So that is called as the dizygotic twins and which is common like they are more or less siblings and they may not be of the same sex and there will be having different blood groups and they will be having a different architecture of growth pattern and that is called as non identical twins or fraternal twins or the dizygotic twins and this is very common and this type of twins shows a varied pattern and the incidence of dizygotic twins is increasing because of the increase in pregnancy is happening because of the IVF treatment and also these type of twins show variation in terms of the maternal age and also the parity and also the geographic distribution and also the ethnicity . So these dizygotic twins are more common in women who are of the higher age group and in those women whom we call it as multiparous, those who have had many children and who have had a family history of twins, especially on the maternal side"

Discovering a twin pregnancy is an exciting experience that brings double the happiness! However, the body goes through many transformations during this type of pregnancy. Dr. Shobha Venkat, a Senior Consultant Obstetrician and Gynaecologist at Cloudnine Hospital on Old Airport Road, provides answers about the length of a twin pregnancy.

"Fetal growth restriction could be seen in multiple pregnancy because of pre-eclampsia problem there is a placental problem, there is a placental pathology and growth restriction is also more common in monochorioinic twins because of the vascular communication between the placenta and sharing of the blood supply by the two babies"

"Monochorioninc and diamniotic twin pregnancy may be associated with the complications and which includes something called as TTTS or Twin-to-twin transfusion syndrome, which is because there are vascular communications between the two placenta. So normally there is no gradient between the two. So it is balanced. So let us say, there is a gradient, So the blood flows, more so from one baby to the other baby, so that one baby acts like the donor and the other baby acts like the recipient. So the recipient baby will have lot of blood and because of the extra blood, the recipient baby’s heart is put into more action. So there is a cardiac strain on the recipient baby and such babies can have excess water around the baby what we call it as a polyhydramnios and such babies will be little bigger. They will go into what is called as a non-immune hydrops and whereas the donor baby will have less water around the baby, goes for what is called as oligamnios and hydramnios and such babies will be very smaller and this is one of the noted and also dreadful complication, which will be identified in the early stage of pregnancy"

"In monozygotic twins what happens is when the zygote keeps on dividing, at one particular stage, the single zygote divides completely into two and each one develops into a separate embryo. That is why it is called as a monozygotic twins. Monozygotic twins genetically they are similar and they share the same blood group and they will be of the same sex. In monozygotic twins what happens is the zygote divides completely into two and each one develops into separate baby. So what happens is in monozygotic twins, they will be of the same sex and they will be of the same blood group and they will be of the same genetic composition. Depending on the stage at which this complete division happens. We call it as diamniotic, dichorionic, monozygotic twins or monoamniotic, monochorionic and monozygotic twins and especially if the division is incomplete, bit the babies may be fused at different levels of the body and that is what we call it as conjoined twins"

"Multiple pregnancy is highly fascinating. However it carries high risk both for the baby and the mother, It is a real challenge, both for the obstetrician and for the patient and of course to our sonologist also. There are some complications because of the multiple pregnancy. So let us consider in the first trimester that is in the first three months of the pregnancy there could be excess vomiting because of the extra production of the hormones, which can lead on to some nutritional deficiency and also dehydration and also there is risk of abortion in the multiple pregnancy Because of the increased chromosomal and also the congenital anomalies in the babies. In second trimester, there is increased risk of pregnancy induced hypertension and also excess water around the baby, call it as hydramnios and also there is increased risk of Iung and also there is abruption placenta, where there is a premature separation of the placenta and also because of the large size of the placenta, the placenta can also extend into the lower segment. The condition called as placenta previa is also more common in the multiple pregnancy and also multiple pregnancy is in the increased risk for diabetes and preterm delivery is one of the dreadful and one of the very common complication associated with the multiple pregnancy and following the delivery, there is increased risk for the bleeding, what we call it as a post-partum haemorrhage and they might have challenges with respect to the lactation and because of difficulties in handling two babies, there could be increased incidence of post-partum blues or the depression in Multiple pregnancy. In general there is increased incidence of caesarean in the case of multiple pregnancies. Under normal circumstances, each baby is surrounded by a membrane called as amnion and one more membrane called a chorion. So in twin pregnancies, what happens is there are two babies. If each baby is surrounded by its amnion and chorion, it is called as dichorioninc and diamnionotic. The beauty of that is that each baby has its own independent circulation and has its own placenta and because of which the complications are much lesser whereas if you consider the other types where the two embryos, each one has the amnion around it, but both together have a single chorion, what we call it as a monochorionic and diamniontic twin pregnancy. What happens here is that they may have two different placentas. But however there could be a vascular communication between the two placenta which can lead to special complications in these type of pregnancies or they may have a single placenta which might do a little bit of partiality for the blood supply for these two babies which in turn can lead to some special complications. That is why it is very important to identify, whether it is a monochorionic or a dichorionic, monoamniotic or a diamniotic in the initial stage of pregnancy so that we can lay down a specialised antenatal plan and also an antenatal scan modalities for the pregnancies and handle them accordingly"