Twin enclosure: what kind of pregnancy monitoring?: Twin ring, you wonder what medical follow-up requires a twin pregnancy, what tests are needed and how the childbirth will take place. We take stock with two specialists.
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Twin pregnancy: a pregnancy at risk
The first thing to know when talking about twin pregnancy is that it is, unfortunately, pregnancy, particularly at risk. The risks of prematurity, pregnancy toxemia (pregnancy hypertension), fetal growth retardation and infant mortality are greater than for a single pregnancy. According to Professor Yves Ville, a gynecologist-obstetrician specializing in twinning and head of department at the Necker Hospital in Paris, 20% of all neonatal resuscitation admissions are related to a twin pregnancy. Pregnant twins, therefore, require close follow-up to avoid the complications and prematurity of babies.
Twin pregnancy: the first ultrasound, a critical moment
It is during the first ultrasound that the follow-up of the twin pregnancy is played. Indeed, there are different types of twin pregnancy, which do not require the same follow-up month by month and week by week.
The ultrasound of the first trimester, performed during the 11th or 12th week of amenorrhoea (SA), will thus determine the chronicity, that is to say, the placental type of the twin pregnancy. This first step is essential and should be performed as early as possible, according to the French College of Gynecologists and Obstetricians (CNGOF), because of the earlier the diagnosis, the more reliable it is.
The ultrasound will then determine whether it is a pictorial twin pregnancy, that is to say with two placentas or a monochorionic twin pregnancy, with one and the same placenta for both twins.
From then on all the management and follow-up of the twin pregnancy will follow.
Bichorial twin pregnancy: follow-up every month
As part of a bichorial twin pregnancy, the twins are connected to the mother by two different placentas. They may be true or false twins, that is, monozygotic or dizygotic twins.
Because they do not share the same placenta, the twins of a bichorial pregnancy are not subject to blood exchange problems. However, their growth and evolution must be carefully monitored. A monthly ultrasound monitoring by an obstetric gynecologist in a suitable structure (hospital or clinic) is therefore recommended. This ultrasound will make it possible, in addition to the usual examinations, to ascertain the real evolution of the two fetuses. They will estimate their size and weight. Moreover, if there is a discordance of more than 20-25% between the two babies, an even closer ultrasound surveillance is advised by the National College of Gynecologists-Obstetricians.
Also, it is recommended to schedule birch twin pregnancy delivery from 38 weeks of amenorrhea (SA) and before 40 weeks.
Monochorionic twin pregnancy: ultrasounds every two weeks
When the two twins share the same placenta, in the case of a monochorionic pregnancy, specialists recommend Doppler ultrasound every two weeks rather than quarterly or monthly. Because in this configuration, the complications are more severe. An intrauterine growth retardation of one of the two fetuses, a transfuse-transfused syndrome when there is an inequality in blood exchange or an anemia polycythemia syndrome (TAPS) There is a blood transfusion from one fetus to the other are all complications of a monoclonal twin pregnancy.
Moreover, in the rare case where this monochorial pregnancy is also monoamniotic (a single amniotic sac), it must also be ensured that the cords of the two babies do not get tangled. An entanglement of wires is indeed at high risk of fetal mortality.
In the case of a monochorial and biamniotic pregnancy, it is recommended to start the delivery from 36 SA, or in any case not to exceed 38 SA and six days with very close supervision.
For monoamniotic mono chlorous pregnancy, intensification of surveillance is required from 27 to 30 SA. It can be carried out in a type III maternity unit (that is, with a neonatal resuscitation unit) or externally but in connection with a maternity unit of this kind. Delivery from 32 SA and before 36 SA is recommended by gynecologists.
An earlier work stoppage to avoid prematurity
Whatever the type of twin pregnancy, it is customary to put the patient to rest sooner than for an uncomplicated pregnancy. The aim is to prevent as much as possible premature delivery (before 33 weeks) and which could affect the health of babies. If it is not a question of suppressing any activity, it is preferable to reduce its activity at certain times of the day and to rest more and more as the term approaches. The minimum work stoppage is 12 weeks before the term and 22 weeks after delivery for a twin pregnancy. For a triple pregnancy, prenatal rest is 24 weeks and postnatal rest 22 weeks.
Twin pregnancy: how is childbirth?
Childbirth is often triggered in a twin pregnancy. The goal is to avoid arriving when the placenta (s) no longer work. Because the placenta ages faster in the context of a twin pregnancy, whether it is monochorial or bichoriale. The choice of maternity is important here because it is about being able to face all situations. It is recommended to choose a maternity ward that includes a neonatal service in case of prematurity, as well as an anesthetist and a gynecologist-obstetrician permanently present.
Twin births are not routinely performed by caesarean section, although this is often recommended by the medical team for more safety.
The choice of whether or not to opt for a Caesarean section rests with the patient once the team has informed her of the risks of low birth.
According to Professor Yves Ville, it is especially the configuration in which the twins will be found on D-Day, which will determine the procedure to be followed. “If the first baby is presented upside down and there is not a significant gap in growth between the two, a low birth delivery is possible,” he explains. For the delivery of the second baby, the obstetrician will perform intra-uterine maneuvers so that it presents itself in a suitable configuration. On the other hand, if the first baby is in the seat, the Caesarean is more than advised.
Professor Ville estimates the risk of giving birth by a Caesarean section of 25% per child. In the case of a twin pregnancy, there is, therefore, a 50% risk of having to give birth by caesarean section. It is not uncommon for the patient to attempt a low birth but a caesarean is finally put in place at the last moment.
Note that given the risk of complications, the delivery of twins is more medical than a simple delivery. Expect to be well surrounded on D-Day.
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