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Twins pregnancies

Photo of twins

Twin pregnancies are exciting both for parents and doctors.  At the same time there is no doubt that these pregnancies carry more risks for both mother and babies.  For this reason twin (and triplet pregnancies) are managed by consultant led care in Leeds.  Three consultants are responsible for all the antenatal care within the city and patients are seen in both the LGI and St. James.

Topics covered on this page

 

Which Consultants in Leeds look after twin pregnancies?

In Leeds twin pregnancies are routinely looked after by Dr. Emma Ferriman (LGI), Dr. Tracey Glanville (St. James) and Mr. James Campbell (St. James).  Twin pregnancies are seen outside of normal antenatal clinic.

How do I get referred to these Consultants?

When you are diagnosed with a twin pregnancy you should be automatically referred by your midwife. If this does not happen please contact the secretaries of the consultants listed above (click here for link).

When will I be seen in hospital for the first time?

We aim to see all twin pregnancies between 11-13 weeks as after this time it can be difficult to determine whether twins are identical or non-identical.  Thereafter patients are seen every 2 weeks in identical twins and 18, 24, 28, 32, 36 weeks in non-identical twins

What is the difference between identical and non-identical twins?

~80% of twins are non-identical, that is they come from two eggs (released at the same time) and two sperm fertilizing them.  These twins are as similar as siblings, but importantly have their own pregnancy sacs (diamniotic) and individual placentas (medically this is called dichorionic). The majority of twin pregnancies resulting from IVF are from two implanted embryos and are therefore non-identical.  Identical twins come from one fertilised embryo and as such share the same placenta (monochorionic), usually they are in separate sacs, but very rarely they can be in the same sac (monoamniotic, monochorionic). As they come from the same original fertilised egg identical twins are genetically identical (and therefore have to be of the same sex).

I have been told my twins are identical, why is this important?(TTTS)

There are several additional problems affecting identical twins, but the biggests of these is Twin-Twin- Transfusion Syndrome (TTTS).

Twin-twin transfusion syndrome (TTTS) is a problem with the babies’ shared placenta that can arise at anytime in pregnancy but most commonly before 22 weeks.  It only affects identical twins and occurs in about 15% of such pregnancies.  Usually there are blood vessels that run backwards and forwards between the two halves of the twins’ shared placenta and each baby receives the same amount of blood from you. In TTTS there are abnormal connecting vessels in the placenta that shunt blood from one twin, the donor, to the other, the recipient.  As a result the donor twin receives too little blood from the shared placenta. They are usually smaller than the other twin and become anaemic. The donor twin does not produce as much urine as normal, so the amount of fluid in their gestational sac is low. This can be measured on ultrasound scan and is called oligohydramnios.  Conversely the recipient twin receives too much blood from the shared placenta. They are usually larger than the other twin and the extra blood puts a strain on their developing heart. The recipient twin produces more urine than normal, so the amount of fluid in their gestational sac is high. This is called polyhydramnios. You yourself may feel breathless and uncomfortable with a swollen tummy due to this extra fluid. More seriously, the extra fluid increases the pressure on the opening of the womb, the cervix. This extra pressure can cause early contractions and premature labour.

TTTS is detected by ultrasound scan. Assessment of the twins overall sizes, their bladder sizes, the volume of fluid around each one and signs of heart failure in the recipient twin is done in the twins clinic at 16, 19 and 22 weeks. A special scan, called a doppler, can be used to assess the flow of blood through the twins’ umbilical cords.  The severity of TTTS ranges from mild to severe. Mild TTTS does not necessarily require treatment and can be monitored by ultrasound scanning in Leeds. It may resolve spontaneously. More severe TTTS requires treatment. For this you would be referred to a specialist clinic outside of Leeds.

TTTS can be a serious condition and untreated will result in the loss of one or both babies.

If you would like more information about TTTS please visit the Twin-Twin Transfusion Syndrome Foundation website at http://www.tttsfoundation.org

Will I be treated differently if my twins come from IVF?

No, once we have determined the chorionicity of your twins we havve shown that IVF twins have the same (or slightly better!) outcomes are twins arising spontaneously, and you will therefore be treated with the same care.

What about antenatal screening for Downs Syndrome?

Currently the NHS in Yorkshire provides the serum screening based "Triple test" for the prenatal detection of Down's syndrome. This test is very poor in twin pregnancies and therefore Leeds is currently offering Nuchal fold screening (available for singletons in the private sector) on the NHS.  This ultrasound based test can only be performed before 14 weeks so if referral occurs after this it will not be possible.

(Please note that there are other additional tests available in the private sector that can enhance the nuchal fold measurement please contact the Leeds Screening Centre before your twins clinic appointment for information on these)

Will my twins be born early?

Full term for twins is considered to be 37-38 weeks and this is when you will ideally deliver your babies. Some twins will deliver before this and depending on when this occurs depends on how signficant it is. Reassuringly a recent audit of outcome showed that <2% of our twins deliver before 28 weeks (when problems from prematurity are at their highest)

If you go into premature labour attempts may be made to stop labour, but if this is not possible the babies will need extra care on the special care baby unit (SCBU). Unfortunately is not always possible for the SCBU to accommodate all preterm babies and there is a risk that you and the babies will need to be transferred to another unit elsewhere in the region or even in the country to ensure they get the best available care.

If you experience intermittent or constant abdominal pain, bleeding from your vagina, loss of fluid from your vagina or reduced movements of your babies, please ring either:

 Maternity Assessment Centre (MAC) at the LGI on 0113 3926731

or

Delivery Suite at the LGI on either 0113 392 3830 or 0113 3923831

How will my twins be born?

For women with a twin pregnancy, the way you give birth to your babies will depend on the position of the first baby closest to the cervix (or opening of the womb), if the babies are to be born prematurely, if the woman or her babies have any health complications, as well as your own preferences.
Essentially the process involved, whether a Caesarean or vaginal birth, will be very much the same as for women having single babies, but there are some aspects that can vary.

Vaginal birth or Caesarean Section?

The decision to plan a vaginal birth or have an elective Caesarean section is often based on the same reasons for women having a single baby. These can include health complications such as the woman having very high blood pressure, placenta praevia or placental abruption, fetal distress, problems with the labour not progressing, an unsuccessful induction or an increased risk of a cord prolapse. Twins that are very premature  are more likely to be delivered by Caesarean section.

Factors influencing the decision of how a woman with twins gives birth tend to centre around whether the first twin(the baby lying closest to the cervix) is in a head down position and what position the other baby is in.
Vaginal birth for twins is possible, but a less common occurrence when compared to women having only one baby. In the Multiple pregnancy clinic in Leeds the Caesarean rate for twins is ~50% (about twice the amount for single babies at 20%).

However, if there are no major complications, the first baby is lying in a head down position, you are keen to have a natural birth and your caregiver is supportive, it is good to know that it is achievable. Around 50% of twins are born at term (often around 37 to 39 weeks); the other 50% are born prematurely (before 37 weeks).
The first baby born vaginally is the one situated closest to your cervix and is referred to as Twin 1; the second baby born is called Twin 2. If you have a Caesarean the babies will be born in whatever order is most convenient for the doctor. So Twin 1 may not necessarily be the baby that was lying closest to your cervix and they may not be born in the order you labelled them with ultrasound before birth.
It is now recognised that a previous Caesarean birth should not exclusively rule out a woman planning a vaginal birth with twins.

Parentcraft classes for twin pregnancies

What are parent craft classes?

At the Leeds General Infirmary we offer all prospective parents the opportunity to attend parent craft classes. We have developed specific parent craft classes for women expecting a twin pregnancy. The rationale behind this is that parents expecting twins will have different issues to those expecting only one baby.

 

Parent craft classes are a series of information sessions co-ordinated by midwife Jackie Mullaney and supported by Dr Emma Ferriman. They are designed to support your antenatal care and give you some additional information and advice about your twin pregnancy and post-natal care. We strongly encourage partners to attend wherever possible, in particular the second session.

The sessions are an excellent opportunity to meet with other women expecting twins and their partners and most people find them both informative and enjoyable.

The sessions are organised as follows:

Session 1: This is run by the obstetric physiotherapist. Topics covered include advice about pain management, simple exercises and sleep during your twin pregnancy.

Session 2: This is run by midwife Jackie Mullaney. The session focuses on labour and delivery and includes a tour of the delivery suite and the special care baby unit. Partners are particularly encouraged to attend this session.

Session 3: This final session is again run by Jackie Mullaney and focuses on post-natal care. You will be given advice about early skin-to-skin contact, breast feeding and caring for your twins at home.

When and where do parent craft classes for twins take place?

A series of 3 classes are run every 2 months. Each class lasts 2hrs, from 10:30am – 12:30pm on Tuesdays.

Classes are held in the parent craft room on A Floor of the Clarendon Wing at the Leeds General Infirmary. This is opposite the antenatal reception, where you will attend for your antenatal appointments with Dr Ferriman.

How do I register?

A form is included in the information pack sent to you after your first antenatal appointment at the hospital. Dr Ferriman may also pass you details on to Jackie Mullaney. Once we have booked you into the classes we will send you an appointment letter in the post.

When during my pregnancy will I attend parent craft classes?

When you will attend the classes varies. We try to see you as early as possible because of the increased risk of early delivery with twin pregnancies. Please be patient, we will book you into the classes as soon as possible.

Contact details

If you are unable to attend or have any other queries, pleases contact the Antenatal Department on 0113 3923688.


 

 

 

 

 

 

 

 

 

 

 

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