Ques. 1 What is twin pregnancy?
Ans. Definition : The simultaneous development of two embryos in the uterus is spoken of as twin pregnancy.
- Twins developed from two ova are known as Binovular twins. In biological sense, they are not really twins, but simply two individual fetuses which happen to have been conceived at or about same time. Therefore, they may be of same sex or of chorion, and amnion. Binovular twins are more common than single-ovum twins.
- Twins developed from a single ovum are known as Uniovular or “identical” twins and are only true twins in the biological sense. These are always of the same sex and are mirror image of each other. They represent complete cleavage of the blastodermic vesicle.
Causes – Exact cause is unknown (heredity is one cause).
Ques. 2 What are the clinical features signs and symptoms of twin pregnancy?
Ans. Clinical Feature – Symptoms – 1. Breathlessness. 2. Oedema of feet. 3. Insomnia etc. may be present. 4. Palpitation.
- Excess weight gain.
- Per Abdomen – (i) Palpation – fundus height unduly enlarged, two relatively heads; (ii) auscultation – two foetal heart sounds audible; (iii) measurement – abdominal girth at level of umbilicus shows an increase than that of corresponds to period of single foetus. (iv) inspection – abdomen is unduly enlarged;
- P/V – one head may be left deep in the pelvis, another at the brim of fundus.
- Oedema of feet, hypertension, & albuminuria – may be present.
Ques. 3 What are the complications of twin pregnancy?
Ans. Complications or Dangers – 1. Premature onset of labour. 2. Anaemia. 3. Placenta praevia. 4. Mal-presentations. 5. Malformation of foetus. 6. Intra-uterine foetal death. 7. Locked twin. 8. Post-partum haemorrhage. 9. Pre-eclampsia. 10. Hydramnios.
Differential Diagnosis –
- Abdominal tumors complicating pregnancy – Numerous fibroid tumors of the uterus are usually felt when present.
- Complicated twin pregnancy – If one double ovum twin dies and the other lives on.
- Hydatidiform degeneration of the placenta of one fetus of a double ovum pregnancy may occur.
- Single pregnancy- only one fetus can be palpated and only fetal heart sound.
- Polyhdramnios – Either single or multiple pregnancy may be associated with excessive fluid accumulation.
Ques. 4 How can we diagnose the twin case of pregnancy?
Ans. Radiography provides after the 4th month, the only certainty of diagnosis during pregnancy, and without that aid, it should not be said that twins are present. In later months strong evidence is provided by the palpation of two hearts which would have a difference of at least ten beats per minute.
Ques. 5 How can a case of twin pregnancy be managed?
Ans. MANAGEMENT –
- During the antenatal period – (a) repeated supervision, (b) detection and treatment of any complication, e.g., pre-eclampsia, anaemia etc.(c) improve health of mother,
- Hospitalization of patient at 32nd or 36th
- During Labour –
- First stage – (a) rest, sedation. (b) close observation
- Second Stage – (i) usually delivery of first baby spontaneous and requires no interference ; (ii) wait and watch – if delay or distress of maternal or foetal – delivery by forceps of breech extraction ; (iii) after delivery of first baby clamp the cord of first baby distally and proximally before division to prevent bleeding from second foetus; (iv) wait an watch for second baby till uterine contraction returns (half hour). (v) with rupture of membranes- vaginal examination to exclude prolapsed of cord or limb;
- Third stage – (i) controlled of complications. (ii) Prophylactic measures; After the birth of the second twin, be ready to deal with possible haemorrhage. Give ergot intravenous moment both placentae have been born. Examine the placentae with care, as abnormalities are not uncommon.
In longitudinal lie, spontaneous delivery is awaited. If there is transverse lie, attempt is made to correct it by external version either cephalic, if possible, or podalic. If external version is not successful, internal podalic version is done as soon as pains start of in case of delayed onset of pains, after rupturing membranes and thereby augmenting process of labour.
After delivery of first baby, one is to clamp the cord of the first baby distally and proximally before division to prevent bleeding from second foetus in uniovular twins. – Then wait and watch for half an hour after delivery of the first baby, as the uterus usually returns its contractions at a variable period within half an hour. After birth of the baby, the lie and presentation (and also F.H.S.) of the second baby are examined per abdomen and vagina.