08-05-2025
Understanding the rise in twin pregnancies and managing associated risks
Twin births account for about 2% to 4% of all births worldwide. Over the last few decades, the number of twin and higher-order pregnancies has significantly increased, largely due to advancements in fertility treatments and their high success OF TWIN PREGNANCIES: MONOZYGOTIC VS. DIZYGOTICMultiple pregnancies are categorised as either monozygotic or dizygotic based on the number of gametes involved. Monozygotic, or identical twins, result from the fertilisation of a single egg by a single sperm. If the embryo divides between the third and eighth days of fertilisation, the twins share a single placenta but have separate amniotic sacs. These are called Monochorionic Diamniotic (MCDA) OF SHARING A PLACENTA: TTTS IN MCDA TWINSMCDA twins are at risk of developing Twin-to-Twin Transfusion Syndrome (TTTS), a condition caused by abnormal blood flow between the twins through vascular connections in the shared placenta. One twin (the Donor Twin) transfers blood to the other (the Recipient Twin), which can lead to complications such as Single Intrauterine Fetal Demise (SIUFD). TTTS affects approximately 8% to 10% of MCDA twin pregnancies.
Although TTTS may develop without symptoms, some expectant mothers experience rapid abdominal growth, pain, swelling, or contractions. Prenatal screening plays a key role in early detection. Ultrasound imaging can reveal differences in fetal size and amniotic fluid levels, while a Doppler scan can detect abnormal blood flow. In the first trimester, a Nuchal Translucency (NT) scan may help predict the risk of OPTIONS AND MANAGEMENT STRATEGIESIf TTTS is diagnosed, timely intervention is critical. Patients are typically referred to fetal medicine specialists who tailor a treatment plan. Options include expectant management, amnioreduction, selective reduction, voluntary termination, or fetoscopic laser photocoagulation—a procedure that seals off abnormal blood vessels in the placenta. Before 28 weeks of gestation, laser surgery is preferred. After 28 weeks, early delivery may be necessary to protect both by Dr. Laxmi Narayan Sahoo, Consultant - Fetal Medicine and Clinical Genetics, Manipal Hospital, Bhubaneswaradvertisement
