Twin pregnancies have always kept me in wonder and awe, especially at the time of a delivery. At present, they represent 33% of all live births and their numbers are rising thanks to the increase in older women who are successfully conceiving through In Vitro Fertilization (IVF). Fertility drugs account for a 70% increase in multiple births. Are you at risk for having a twin pregnancy? You are if you have:

• Advanced maternal age
• Are African or African American
• 3 or more children
• A tall height or are obese

Unfortunately twin pregnancies can be complicated and everyone must be appropriately prepared.
Twins can be divided into 3 categories: monozygotic (identical); dizygotic (fraternal) and conjoined. In a monozygotic (MZ) pregnancy, only one egg was fertilized but “split” and then divided. MZ pregnancies represent the greatest risk for complications because the babies share the same placenta and circulatory system. One baby can have too much fluid and the other baby not enough. This is called a twin-twin transfusion or TTS. Dizygotic twins involve the fertilization of two eggs and have two separate placentas. It is more common, representing 69% of all pregnancies. Conjoined twins result when a single, fertilized egg only partially splits and the babies share a delay or a partial split from when there is a delay in the division of the fertilized egg and the babies share are physically connected. This is sometimes referred to as Siamese twins and represents a very poor prognosis in terms of survival. ALL twin pregnancies are at risk for preterm contractions and delivery and therefore are high risk. I am therefore perplexed when patients with twin pregnancies are not referred to a high risk specialist for a consultation.
At minimum, patients with twin pregnancies should have

• Monthly ultrasounds to document appropriate fetal growth. The number of ultrasounds might increase as you get closer to the due date
• Nonstress tests beginning at 32 weeks to document fetal well being
• A well thought out delivery plan in a level 3 hospital with a pediatrician waiting in the delivery room

Twins are a joy but remember their pregnancies are high risk. If you are pregnant with twins and no one has recommended you to see a high-risk specialist, make some noise . . . loudly. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

Check out my very informational pregnancy video!