Pregnancy with twins: are there any risks?

Monochorionic or Bichorionic?

“From a medical point of view, the most important criterion for the course of pregnancy is whether the babies are supplied by a common placenta (monochorionic) or whether each baby has its own placenta (bichorionic),” explains Dr. König from the Professional Association of Gynecologists If the children are cared for by a common placenta, caution is advised. Since there are some risks for the development of the children due to the shared placenta, a pregnancy with monochorionic twins must be monitored more frequently and in more detail.

In order to find out whether the twins are monochorionic or bichorionic, the number of embryonic membranes (choria) is determined in an ultrasound examination. If your doctor can only find one embryonic membrane, both children are being cared for by a common placenta. Up to the 16th week of pregnancy, the gynecologist can still easily determine the number of embryonic membranes. After that, the envelope borders on the inner wall of the uterus and is difficult to see. Monochorionic twins are always identical twins.

• Growth retardation: In monochorionic twins, if the placenta divides unevenly, one child will be less nourished than the other. The growth and development of both children are then not at the same level, but a twin develops more slowly. Of course, fraternal twins can also differ in size and weight. Here, however, the causes often lie in the different genetic make-up, because dizygotic twins do not share the same DNA. They resemble each other like normal siblings, only they are born on the same day.
• Twin transfusion syndrome: About 15 to 20 percent of all monochorionic twins suffer from twin transfusion syndrome or fetofetal transfusion syndrome. The blood vessels of both children combine via the placenta to form a common bloodstream. If the blood exchange is not even, but one baby is primarily the donor and the other is the recipient, both develop developmental disorders, which in an emergency have to be corrected by an operation in the uterus.

Increased risks of pregnancy with twins

Regardless of monochorionic or bichorionic, there are certain risks to be aware of in all pregnancies involving twins.

• Premature detachment of the placenta: “ The risk of premature detachment of the placenta is also greater, especially if the mother is malnourished or smokes cigarettes at the same time , ” warns Dr. King. Premature detachment of the placenta can have serious consequences for both mother and child. If the placenta ruptures and there is a large loss of blood, both mother and child can bleed to death.
• Prematurity: The most common complication of twin pregnancies is preterm birth . This means birth before the 37th week of pregnancy. About half of all twin births occur before this week. The cause is usually the rapidly growing uterus, which has to offer space for both children and eventually has reached its maximum size. The babies’ weight then presses on the cervix, initiating labor. Preterm labor can be stopped with medication in the hospital. Attempts are made to delay the birth for as long as possible so that the babies’ lungs in particular can progress as far as possible.
• Hypertension: According to Dr. König von Berufsberand der Gynecologists, high blood pressure occurs twice as often in twin pregnant women as in “single” pregnancies. The reason for this lies in the physical strain of caring for two children in the womb instead of one. In addition, it can be that nervousness and fears are higher in expectant mothers of twins and that blood pressure suffers as a result.
• EPH gestosis (pre-eclampsia): Even if a slightly elevated blood pressure is normal in pregnancy with twins, your doctor will monitor your blood pressure closely. If it rises above 140/90 mm Hg and is associated with water retention and increased protein excretion, there is a suspicion of a so-called EPH gestosis , also known as preeclampsia. Unfortunately, the causes of a gestosis have not been fully clarified, but the statistical probability of an illness is unfortunately twice as high in twin pregnant women. The pregnancy can still proceed normally. However, you should prepare yourself for the fact that a caesarean section may be necessary. After birth, the gestosis usually disappears on its own.

Close controls in a pregnancy with twins

Most twin pregnancies are completely uncomplicated, also thanks to close checks by the gynaecologist. Depending on the course of the pregnancy, check-ups take place every two to three weeks in the first and second trimester. From the third trimester, according to Dr. König from the professional association of gynecologists then mostly weekly visits to the doctor are necessary. It is important that you keep all preventive appointments. They give you security and trust and enable the timely detection of complications.

More information about pregnancy with twins

If you want to learn more about twin pregnancy and life with twins, take a look at the ” Twins and triplets ” section.