Twins

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Out lines

1. Introduction
2. Definition
3. Incidence
4. Risk factors
5. Types of twins
6. Complication (mother fetus)
7. Management (ante labour labour)
 Introduction
1. Twins are tow offspring produced by the same pregnancy.
Twins can be either monozygotic ("identical"), meaning
that they develop from one zygote, which splits, and
forms tow embryos, or dizygotic ("fraternal"), meaning
that they develop from two different eggs. In fraternal
twins. Each twin is fertilized by its own sperm cell.
2. In contrast. Afeitus that develops alone in the womb is
called a singleton and the general term for one spring of
multiple birth is multiple.
3. Non-related look alike whose resemblance parallels that
of twins are referred to as doppelgangers.

Definition
Twins: one of two children produced in the same pregnancy.
Twins can develop from one ovum (egg) or from tow ova (eggs).
Twins: who develop a single ovum are called monozygotic or
identical twins. They have identical genomes. Twins: who
develop from two ova are called dizygotic or fraternal twins.
They are nonidentical and have different genomes.
Types of twins:
1. Dizygotic ("fraternal")
2. Monozygotic ("identical")
3. Diamnionil ("mort chorionic")

Dizygotic (fraternal twins) (also referred to as "non-

identical twins" "dissimilar twins" "biovular twins" and
"informally in the case of females " "sororal twins")
o usually accrue when two fertilized eggs are implanted
in the uterus wall at the same time. When two eggs
are independently fertilized by two different sperm
cells, franatal twins result. The two eggs or ova, from
zygotic, hence the term dizygotic and biovular.
Fraternal twins are essentially, two ordinary siblimgs
who happen to be born at the same time since they
arise from two separate just like ordinary siblings,
this is the most common type of twins
o Dizygotic twins live any other siblings have an
extremely small chance of having the same
chromosome profile.
o Even if they happen to have the same chromosome
profile they will always have different genatic
maternal or each chromosome, due to chromosomal
cross over during meiosis. Like any other siblings,
dizygotic twins may look similar, particularly given
that they are the same age. However dizygotic twins
may also look very different from each other.
o Dizygotic twins also more common for elclerly
mother "over the age of 35"
 Monozygotic or "identical" twins
o Accur when a single egg is fertilized to from one
zygote (hence, "monozygotic") which then divides
into tub seprate embryos.
o Comparison of zygote development monozygotic and
dizygotic twins. In the uterus a majority of
monozygotic twins (60-70%) share the same placenta
but have seprate amniotic sacs.
o In 18-30% of monozygotic twins each fetus has a
seprate placenta and a separate amniotic sac. But
fraternal twins each have either own placenta and own
amniotic sac

Diamnionil, monozygotic: if division occur between the

fourth and eighth day following fertilization, the cho-rion
has already begun to develop, whereas the amnion has not.
Therefore, each fetus will later be surround bath fetuses.

Division thereafter is incomplete resulting in the devel

opment of conjoined twins. The fetuses may be fused in a
number of ways, with the most common involvery the clef
and for abdomen- this rare condition is seen in appropriately
in 70.000 diverse. This condition is associated with a
mortality rate of up to fluid.

notes
twins can be:
1. Female female twins sometimes celled sororal twins
2. Male female twins most common paining half of all
fraternal (dizygotic) twins are male female
3. Male male twins no special name
Risk factors of twins
1. Maternal age
Women over the age of 30 more likely to have twins
and the rate increase even more after. the age of 30
years old because a woman grows older she is likely
hyper volute
2. Genetics
It's thought that women just hyper volute regularly
and that is agent that cause them to do. So, a woman
with the gene who hyper volute may have fraternal
twins
3. Fertility treatment
Increase utilization of Fertility treatment have
definitely resulted in an increase a twin birth fertility
enhancing drugs and injection. Retribute to hyper
volition and can Cause dizygotic twins artificial
insemination (IUI treatment) doesnt necessary
increase the rate of twins but is usually (IUI
TRETMENT) in vitro feralization may cause twins.
This treatment involves transferring embryo or
fertilized egg to the mother's womb. Often two or
more embryos are transferred to increase the chmces
of a successful outcome.
4. Diet: high rates of twins have been found in culture
where the diet is rich in a type of yams that contain
phytoestrogen for example Nigeria which has the
highest rate of twins of any population in the world
5. Family history:
Its though that women who have had conceived and
borne serval children already more likely to have
twins. While the previous pregnancies dont cause
hyper volute.
 6. Race:
A women African descent produce a higher number
of twins than a women of Asia descent.
Risk of multi pregnancy:
Anaemin because of increase fetal demand for iron and
folic acid
Hyperemesis gravid rum
Pregnancy include hypertension
Pole hydra minors
Abortion and preterm labour
Placenta praevia due to presence of a placenta or large
placenta
Pressure syndrome (dyspnea palpitation oedema of
lower limbs)
congenital anomalies.

Common complications associated with twins

pregnancy fetus
1. Preterm labor delivery:
Delivery occurs before 37 completed weeks and the
length of gestation decreases
It results in premature refuter of the ovarian
membranes orgasms remains in developed and baby
require medical attention venerable to infection and
need NICU

2. Low - birth weight

Birth of babies is less than 5.5 pounds (2.500)
Babies are at rich for long term health complication

3. Intrauterine growth retraction (IUGR)

In this phase growth of twins slow at 30 to 32 weeks
and (IUGR) occur when the placenta can't hand
 growth for twins both babies completed obtain
sufficient amount of nutrients. Gynecologist detects
the once of IUGR 10:15 ultrasound.

4. Fetal Demise or less

Intrauterine fetal demise is rare to occur but
crynecologist examines determine mother medical or
interaction is required or not. If your pregnancy is
dichorionic and you have pregnancy has a single
chorine immediate delivery is recommended

5. Birth detects:
Twins pregnancy increase the risks of congenital in
newborn twins as heart abnormalities, neural tube
(like spinal bifida) and gastral intestinal disorders.

6. Twins to twins transfusion syndrome

It is the medical emdition usually develop only with
identical twins sharing the same placenta. The brood
vessels present with the placenta supply blood and
oxygen from one fetus the other in TTTs the blood
flow shunts from one fetus to the other through
common vessels connections, overfine the recipient
fetus receives an excess supply of blood them the
other or this overloads the cardiovascular system and
increase the level of amniotic fluid.
The loner fetus doesn't get enough quaintly of blood
and this has lesser amounts of amniotic fluid.
Gynecologist treats twins-to-twins transfusion
syndrome during gestation by withdrawing the excess
fluid using an hadal.

7. Card entanglement:
The card tangles within the amniotic sac shard by the
identical twins
 In such case the doctor monitors the growth rate of the
fetuses during the third trimester. If there soems any
complexity. The doctor recommends for preterm
delivery.
Complication (mother)
1- Preterm labor delivery: is defined as delivery before 37
completed weeks of pregnancy, the length of gestation
decreases with each additional baby.
2- Intrauterine growth resttaction:
Multiple pregnancies grow at approximately the same rate
as single pregnancies up to certain point the growth rate of
twins pregnancies beguines to slow at 30 to 32 week it
occurs because placenta cannot handle any more growth
and because babies are competing for nutrein.
3- Gestational diabetes
Is a common occurrence in twins pregnancy, the two
placentas increase the resistance towards insulin production
and body experiences a sudden increase in the blood sugar
level, some other factors to cause gestation diabetes in twin
pregnancy include greater placenta size and elevated levels
of the placenta hormones.
4- Post-partum hemarrge:
The large placenta area and the over-distended uterus
imposes your art higher risk of post-partum hyper tension,
you may experience saver bleeding during and after your
delivery.
5- Placenta abrution:
Mostly occurs during the third trimester of pregnancies.
6- Cesarean.
7- Preeclampsia, during a twins pregnancy, you are at higher
risk of developing preeclampsia and pregnancy include
hypertension (PIN)
Management of multiple pregnancy
1. Antepartum management
Become familiar with the warning signs of preterm
labor
Make sure you are well nourished well hydride.
Family, don't miss any personal appointment and
make sure to follow your providers instruction.

2. Intrapartum management
On admission in labor option interactors (IV)
access
Blood should be taken for group and save, as
signified blood loss is more likely in multiple
pregnancy.
Monitor fetal heart rates separately and
continuously.
Choice of made of delivery depends on a number
of factor including amniocity, experience of the
delivery team, wishes of the mother, presentation
and other risk factor, there are no clear universal
guidelines. Generally, a trial of vaginal delivery is
usually first choice, if the first twin has a cephalic
presentation. Caesarean section is usually
preferred if there is mono amniocity, a non-
cephalic presentation of the first twin or other risk
factors.