Twin

"Twins" redirects here. For the baseball team, see Minnesota Twins. For other uses, see  Twins (disambiguation).

Identical (monozygotic) twins

A twin is one of two offspring produced in the same pregnancy.[1] Twins can either be identical (in scientific usage,

"monozygotic"), meaning that they develop from one zygote that splits and forms two embryos,

or fraternal ("dizygotic") because they develop from two separate eggs that are fertilized by two separate sperm.

In contrast, a fetus which develops alone in the womb is called a singleton, and the general term for one offspring of

a multiple birth is multiple. It is theoretically possible for two singletons to be identical if all 23 chromosomes in

both gametes from the mother and father were to be exact matches from one birth to the next. While this is

statistically improbable (less than one in one billion-billion-billion chance) under natural conditions, a controlled

pairing may someday be possible. A less complex way to engineer genetically identical offspring is through the

process ofcloning, a procedure that has successfully been accomplished with several species of mammals.

Contents
 [hide]

1 Statistics

2 Zygosity

o 2.1 Fraternal (dizygotic) twins

o 2.2 Identical (monozygotic) twins

 2.2.1 Mechanism

 2.2.2 Incidence

 2.2.3 Genetic and epigenetic

similarity
  2.2.4 Phenotype similarity

o 2.3 Half-identical twins

 2.3.1 Types

 2.3.2 Incidence

3 Degree of separation

4 Demographics

o 4.1 Ethnicity

o 4.2 Predisposing factors

5 Delivery interval

6 Complications of twin pregnancy

o 6.1 Vanishing twins

o 6.2 Conjoined twins

o 6.3 Chimerism

o 6.4 Parasitic twins

o 6.5 Partial molar twins

o 6.6 Miscarried twin

o 6.7 Low birth weight

o 6.8 Twin-to-twin transfusion syndrome

7 Human twin studies

o 7.1 Unusual twinnings

o 7.2 Semi-identical twins

8 Animal twins

9 See also

10 References

11 Further reading

Statistics

Twins are estimated to be approximately 1.9% of the world population, with monozygotic twins making up 0.2% of the

total - and 8% of all twins.[

citation needed]

The twin birth rate in the United States is slightly above 32 twin live births per 1,000 live births while the Yoruba have

the highest rate of twinning in the world, at 45 twins per 1,000 live births,possibly because of high consumption of a
specific type of yam containing a natural phytoestrogen which may stimulate the ovaries to release an egg from each

side.

Due to the limited size of the mother's womb, multiple pregnancies are much less likely to carry to full term than

single births, with twin pregnancies lasting only 37 weeks (3 weeks less than full term) on average.

Zygosity

Zygosity is the degree of identity in the genome of twins. There are five common variations of twinning. The three

most common variations are all fraternal (dizygotic):

 Male–female twins are the most common result, 50 percent of fraternal twins and the most common

grouping of twins.

 Female–female fraternal twins (sometimes called "sororal twins")

 Male–male fraternal twins

The other two variations are identical (monozygotic) twins:

 Female–female identical twins

 Male–male identical twins (least common)

Among non-twin births, male singletons are slightly (about five percent) more common than female singletons. The

rates for singletons vary slightly by country. For example, the sex ratio of birth in the US is 1.05 males/female, while it

is 1.07 males/female in Italy. However, males are also more susceptible than females to death in utero, and since the

death rate in utero is higher for twins, it leads to female twins being more common than male twins.

Eight month old fraternal twin girls napping

Fraternal (dizygotic) twins

Fraternal or dizygotic (DZ) twins (also referred to as "non-identical twins", "dissimilar twins", "biovular twins", and, in

cases of females, occasionally sororal twins) usually occur when twofertilized eggs are implanted in the uterus wall

at the same time. When two eggs are independently fertilized by two different sperm cells, fraternal twins result. The

two eggs, or ova, form two zygotes, hence the terms dizygotic and biovular.

Fraternal twins, like any other siblings, have an extremely small chance of having the same chromosome profile. Like

any other siblings, fraternal twins may look similar, particularly given that they are the same age. However, fraternal

twins may also look very different from each other. They may be of different sexes or the same sex. The same holds

true for brothers and sisters from the same parents, meaning that fraternal twins are simply brothers and/or sisters

who happen to be the same age.

Studies show that there is a genetic basis for fraternal twinning. However, it is only their mother that has any effect on

the chances of having fraternal twins; there is no known mechanism for a father to cause the release of more than

one ovum. Dizygotic twinning ranges from six per thousand births in Japan (similar to the rate of monozygotic twins)

to 14 and more per thousand in some African countries.[6]

Fraternal twins are also more common for older mothers, with twinning rates doubling in mothers over the age of 35.
[11]
 With the advent of technologies and techniques to assist women in getting pregnant, the rate of fraternals has

increased markedly. For example, in New York City's Upper East Side there were 3,707 twin births in 1995; there

were 4,153 in 2003; and there were 4,655 in 2004[citation needed]. Triplet births have also risen, from 60 in 1995 to 299 in

2004.

[edit]Identical (monozygotic) twins

Comparison of zygote development in identical and fraternal twins. In the uterus, a majority of identical twins (60–
70%) share the same placenta but have separateamniotic sacs. In 18–30% of identical twins each fetus has a
separate placenta and a separate amniotic sac. A small number (1–2%) of identical twins share the same placenta
and amniotic sac. Fraternal twins each have their own placenta and own amniotic sac.

Identical or monozygotic (MZ) twins occur when a single egg is fertilized to form one zygote (hence,

"monozygotic") which then divides into two separate embryos.

There are an estimated 11 million sets of identical twins and triplets in the world today.

[edit]Mechanism
Regarding spontaneous or natural monozygotic twinning, a recent theory posits that identical twins are formed after

a blastocyst essentially collapses, splitting the progenitor cells (those that contain the body's fundamental genetic

material) in half, leaving the same genetic material divided in two on opposite sides of the embryo. Eventually, two

separate fetuses develop.[12] Spontaneous division of the zygote into two embryos is not considered to be a hereditary

trait, but rather a spontaneous or random event.[11][13]

Identical twins may also be created artificially by embryo splitting. It can be used as an expansion of IVF to increase

the number of available embryos for embryo transfer.[14]

[edit]Incidence

Monozygotic twinning occurs in birthing at a rate of about three in every 1000 deliveries worldwide.[13]

The likelihood of a single fertilization resulting in identical twins is uniformly distributed in all populations around the

world.[11] This is in marked contrast to fraternal twinning, which ranges from about six per thousand births in Japan

(almost similar to the rate of identical twins, which is around 4–5) to 15 and more per thousand in some parts of

India[15] and up to 24 in the US,[citation needed] which might mainly be due to IVF (in vitro fertilization). The exact cause for

the splitting of a zygote or embryo is unknown.

In-vitro fertilization techniques are more likely to create twins. Only about three pairs of twins per 1,000 deliveries

occur as a result of natural conception, while for IVF deliveries, there are nearly 21 pairs of twins for every 1,000.[16]

Genetic and epigenetic similarity

Identical twins are genetically identical (unless there has been a mutation during development) and they are always

the same sex. On rare occasions, identical twins may express different phenotypes (normally due to an

environmental factor or the deactivation of different X chromosomes in female identical twins), and in some extremely

rare cases, due to aneuploidy, twins may express different sexualphenotypes, normally due to an XXY Klinefelter's

syndrome zygote splitting unevenly.[17][18]

Identical twins actually have only nearly identical DNA, and differing environmental influences throughout their lives

affect which genes are switched on or off. This is called epigenetic modification. A study of 80 pairs of human twins

ranging in age from three to 74 showed that the youngest twins have relatively few epigenetic differences. The

number of epigenetic differences between identical twins increases with age. Fifty-year-old twins had over three times

the epigenetic difference of three-year-old twins. Twins who had spent their lives apart (such as those adopted by two

different sets of parents at birth) had the greatest difference.[19] However, certain characteristics become more alike

as twins age, such as IQ and personality.[20][21] This phenomenon illustrates the influence of genetics in many aspects

of human characteristics and behavior.[citation needed]

Phenotype similarity
Contrary to common opinion, identical twins are not always of the same phenotypical sex. There have been

described cases where monozygocity resulted in 46,XO (i.e. female with Turner syndrome) and 46,XY (i.e. male).

This is thought to be due to unequal distribution of zygotic protoplasm. However, as a rule, traits and physical

appearances of DZ twins are very similar.

Identical twins look alike, although they do not have the same fingerprints (which are environmental as well as

genetic). As they mature, identical twins often become less alike because of lifestyle choices or external influences.

The children of identical twins would test genetically as half-siblings rather than first cousins.

Half-identical twins

Half-identical or semi-identical twins (also referred to as "half twins") are the result of a very rare form of twinning

in which the twins inherit exactly the same genes from their mother but different genes from their father. Although

examples of half-identical twins have been found, the exact mechanism of their conception is not well-understood, but

could theoretically occur in polar body twinning where sperm cells fertilize both the ovum and the second polar body.

This situation is not the same as the common form of fraternal twinning, in which two genetically different ova are

fertilized by two genetically different sperm. In this case, the ova are genetically identical.

Types

There are two mechanisms by which this might happen:

 Polar twins (or "polar body twins"), where two sperm fertilize an ovum, one of the two fertilizing a polar

body;[22] or where an ovum splits into identical copies, one containing a polar body, prior to fertilization, allowing it

to be fertilized by two different sperm.[23][24]

 Sesquizygotic twins, where two sperm fertilize the one ovum, forming a triploid, and then splitting.[25]

Incidence

A 1981 study of a dead triploid XXX twin fetus without a heart showed that although its fetal development suggested

that it was an identical twin, as it shared a placenta with its healthy twin, tests revealed that it was likely a polar body

twin. The authors were unable to predict whether a healthy fetus could result from a polar body twinning.[26] In 2003 a

study argued that many cases of triploidity arise from semi-identical twinning.[27] In 2007, a study reported a case of a

pair of living twins, one a hermaphrodite and one a phenotypical male. The twins were both found to be chimeras and

to share all of their maternal DNA but only half of their father's DNA. The exact mechanism of fertilization could not be

determined but the study stated that it was unlikely to be a case of polar body twinning.[28]

Degree of separation
Various types of chorionicity and amniosity (how the baby's sac looks) in monozygotic (one egg/identical) twins as a
result of when the fertilized egg divides

The degree of separation of the twins in utero depends on if and when they split into two zygotes. Dizygotic twins

were always two zygotes. Monozygotic twins split into two zygotes at some time very early in the pregnancy. The

timing of this separation determines the chorionicity and amniocity (the number of sacs) of the pregnancy. Dichorionic

twins either never divided (i.e.: were dizygotic) or they divided within the first 4 days. Monoamnionic twins divide after

the first week.

In very rare cases, twins become conjoined twins. Furthermore, there can be various degrees of shared environment
of twins in the womb, potentially leading to pregnancy complications.

It is a common misconception that two placentas means twins are dizygotic (non-identical). But if monozygotic twins

separate early enough, the arrangement of sacs and placentas in utero is indistinguishable from dizygotic twins.

Type Description Day

Dichorionic-Diamniotic twins
Dichorionic- Normally, twins have two separate (di- being a numerical prefix for form when splitting takes
Diamniotic two) chorions and amniotic sacs, termed Dichorionic-Diamniotic or "DiDi". It place by the third day
occurs in almost all cases of dizygotic twins (except in very rare cases of afterfertilization.[29]
[29] [30]
fusion between their blastocysts  ), in 99.7% of all pregnancies,  and in 18–
36%[31] (or around 25%[29]) of monozygotic (identical) twins.
 DiDi twins have the lowest mortality risk at about 9 percent, although that is

still significantly higher than that ofsingletons.[32]

Monochorionic twins share the same placenta.

Monochorionic twins generally have two amniotic sacs (called

Monochorionic- Monochorionic-Diamniotic "MoDi"), which occurs in 60–70% of the

Days 4-8
Diamniotic pregnancies with monozygotic twins.[31] Monochorionic-Diamniotic twins

are almost always monozygotic, with a few exceptions where

the blastocysts have fused.[29]

Sometimes, monochorionic twins also share the sameamnion. This situation

occurs in 1–2% of monozygotic twin pregnancies.[31]

Monoamniotic twins are always monozygotic (identical twins).[33]

The survival rate for monoamniotic twins is somewhere between 50%[33] to

60%.[34] Monoamniotic twins occur

Monochorionic- when the split takes place
Monoamniotic after the ninth day after
Consequently, if twins are monoamniotic that means that the two babies will
fertilization.[29]
be sharing a placenta and as a result, due to the small capacity of sharing a sac,

the umbilical cord has an increased chance of being tangled around the babies.

Because of this, there is an increased chance that the newborns may be

miscarried or suffer from cerebral palsy due to the lack of oxygen.

When the division of the developing zygote into 2 embryos occurs, 99% of the

If the division of the zygote
time it is within 8 days of fertilization. occurs later than the 12 days
Conjoined twins
thenconjoined twinsare
Mortality is highest for conjoined twins due to the many complications usually the result.
resulting from shared organs.

Demographics

A recent study has found that Insulin-like growth factor present in dairy products may increase the chance of dizygotic

twinning. Specifically, the study found that vegan mothers (who exclude dairy from their diets) are one-fifth as likely to

have twins as vegetarian or omnivore mothers, and concluded that "Genotypes favoring elevated IGF and diets

including dairy products, especially in areas where growth hormoneis given to cattle, appear to enhance the chances

of multiple pregnancies due to ovarian stimulation."[35]

From 1980–97, the number of twin births in the United States rose 52%.[36] This rise can at least partly be attributed to

the increasing popularity of fertility drugs like Clomid and procedures such as in vitro fertilization, which result in
multiple births more frequently than unassisted fertilizations do. It may also be linked to the increase of growth

hormones in food.[35]

Ethnicity

About 1 in 90 human births (1.1%) results from a twin pregnancy.[37] The rate of dizygotic twinning varies greatly

among ethnic groups, ranging as high as about 45 per 1000 births for the Yoruba to 10% for Linha São Pedro, a tiny

Brazilian settlement which belongs to the city of Cândido Godói.[38] In Cândido Godói, one in five pregnancies have

resulted in twins.[39] The Argentine historian Jorge Camarasa has put forward a theory that experiments of

the Nazi doctor Josef Mengele could be responsible for the high ratio of twins in the area.[40] His theory was rejected

by Brazilian scientists who had studied twins living in Linha São Pedro; they suggested genetic factors within that

community as a more likely explanation.[41] A high twinning rate has also been observed in other places of the world,

including Igbo-Ora in Nigeria[42] andKodinji in India.[43]

The widespread use of fertility drugs causing hyperovulation (stimulated release of multiple eggs by the mother) has

caused what some call an "epidemic of multiple births". In 2001, for the first time ever in the US, the twinning rate

exceeded 3% of all births. Nevertheless, the rate ofmonozygotic twins remains at about 1 in 333 across the globe.

In a study on the maternity records of 5750 Hausa women living in the Savannah zone of Nigeria, there were 40 twins

and 2 triplets per 1000 births. Twenty-six per cent of twins were monozygous. The incidence of multiple births, which

was about five times higher than that observed in any western population, was significantly lower than that of other

ethnic groups, who live in the hot and humid climate of the southern part of the country. The incidence of multiple

births was related to maternal age but did not bear any association to the climate or prevalence ofmalaria.[44]

Predisposing factors

The predisposing factors of monozygotic twinning are unknown.

Dizygotic twin pregnancies are slightly more likely when the following factors are present in the woman:

 She is of West African descent (especially Yoruba)

 She is between the age of 30 and 40 years

 She is greater than average height and weight

 She has had several previous pregnancies.

Women undergoing certain fertility treatments may have a greater chance of dizygotic multiple births. This can vary

depending on what types of fertility treatments are used. With in vitro fertilization (IVF), this is primarily due to the

insertion of multiple embryos into the uterus. Some other treatments such as the drug Clomid can stimulate a woman

to release multiple eggs, increasing the likelihood of multiples.

Delivery interval
A 15-year German study[45] of 8,220 vaginally delivered twins (that is, 4,110 pregnancies) in Hesse yielded a mean

delivery time interval of 13.5 minutes.[46] The delivery interval between the twins was measured as follows:

 Within 15 minutes: 75.8%

 16-30 minutes: 16.4%

 31-45 minutes: 4.3%

 46-60 minutes: 1.7%

 Over 60 minutes: 1.8% (72 instances)

The study stated that the occurrence of complications "was found to be more likely with increasing twin-to-twin

delivery time interval" and suggested that the interval be kept short, though it noted that the study did not

examine causes of complications and did not control for factors such as the level of experience of the
obstetrician, the wish of the women giving birth, or the "management strategies" of the procedure of delivering

the second twin.

Complications of twin pregnancy

Vanishing twins

Researchers suspect that as many as 1 in 8 pregnancies start out as multiples, but only a single fetus is

brought to full term, because the other has died very early in the pregnancy and has not been detected or

recorded.[47] Early obstetric ultrasonography exams sometimes reveal an "extra" fetus, which fails to develop

and instead disintegrates and vanishes. This is known as vanishing twin syndrome.

Chang and Eng Bunker, born in Siam (now Thailand) in 1811, were the origin of the term "Siamese twins".

Conjoined twins
Conjoined twins (or the deprecated term "Siamese twins") are monozygotic twins whose bodies are joined

together during pregnancy. This occurs where the single zygote of MZ twins fails to separate completely, and

the zygote starts to split after day 12[29] following fertilization. This condition occurs in about 1 in 50,000 human

pregnancies. Most conjoined twins are now evaluated for surgery to attempt to separate them into separate

functional bodies. The degree of difficulty rises if a vital organ or structure is shared between twins, such as

the brain, heart or liver.

Chimerism

A chimera is an ordinary person or animal except that some of their parts actually came from their twin or from

the mother. A chimera may arise either from monozygotic twin fetuses (where it would be impossible to detect),

or from dizygotic fetuses, which can be identified by chromosomal comparisons from various parts of the body.

The number of cells derived from each fetus can vary from one part of the body to another, and often leads to

characteristic mosaicism skin coloration in human chimeras. A chimera may be intersex, composed of cells

from a male twin and a female twin. In addition, in certain cases the person or chimera may have two sets of

DNA.

Parasitic twins

Sometimes one twin fetus will fail to develop completely and continue to cause problems for its surviving twin.

One fetus acts as a parasitetowards the other. Sometimes the parasitic twin becomes an almost

indistinguishable part of the other, and sometimes this needs to be medically dealt with.

Partial molar twins

A very rare type of parasitic twinning is one where a single viable twin is endangered when the other zygote

becomes cancerous, or molar. This means that the molar zygote's cellular division continues unchecked,

resulting in a cancerous growth that overtakes the viable fetus. Typically, this results when one twin has

either triploidy or complete paternal uniparental disomy, resulting in little or no fetus and a cancerous,

overgrown placenta, resembling a bunch of grapes.

Miscarried twin

Occasionally, a woman will suffer a miscarriage early in pregnancy, yet the pregnancy will continue; one twin

was miscarried but the other was able to be carried to term. This occurrence is similar to the vanishing

twin syndrome, but typically occurs later than the vanishing twin syndrome.

Low birth weight

Twins typically suffer from the lower birth weights and greater likelihood of prematurity that is more commonly

associated with the higher multiple pregnancies.

Twin-to-twin transfusion syndrome

Monozygotic twins who share a placenta can develop twin-to-twin transfusion syndrome. This condition means

that blood from one twin is being diverted into the other twin. One twin, the 'donor' twin, is small and anemic,

the other, the 'recipient' twin, is large and polycythemic. The lives of both twins are endangered by this

condition.

Human twin studies

Main article: Twin study

Twin studies are utilized in an attempt to determine how much of a particular trait is attributable to either

genetics or environmental influence. These studies compare monozygotic and dizygotic twins

for medical, genetic, or psychological characteristics to try to isolate genetic influence from epigenetic

and environmental influence. Twins that have been separated early in life and raised in separate households

are especially sought-after for these studies, which have been used widely in the exploration of human nature.

However, the utility and accuracy of these twin studies has been called into question and remains controversial.

Classical twin studies have are now being supplemented with molecular genetic studies which identify

individual genes.

Unusual twinnings

Among dizygotic twins, in rare cases, the eggs are fertilized at different times with two or more acts of sexual

intercourse, either within one menstrual cycle (superfecundation) or, even more rarely, later on in the

pregnancy (superfetation). This can lead to the possibility of a woman carrying fraternal twins with different

fathers (that is, half-siblings). This phenomenon is known as heteropaternal superfecundation. One 1992 study

estimates that the frequency of heteropaternal superfecundation among dizygotic twins whose parents were

involved in paternity suits was approximately 2.4%; see the references section, below, for more details.

Dizygotic twins from biracial couples can sometimes be mixed twins, which exhibit differing ethnic and racial

features. One such pairing was born in Germany in 2008 to a white father from Germany and a black mother

from Ghana.[48]

Heterotopic pregnancy is an exceedingly rare type of dizygotic twinning in which one twin implants in the uterus

as normal and the other remains in the fallopian tube as an ectopic pregnancy. Ectopic pregnancies must be

resolved because they can be life-threatening to the mother. However, in most cases, the intrauterine

pregnancy can be salvaged.

Among monozygotic twins, in extremely rare cases, twins have been born with opposite sexes (one male, one

female). The probability of this is so vanishingly small (only 3 documented cases[49]) that multiples having

different sexes is universally accepted as a sound basis for a clinical determination that in utero multiples are

not monozygotic. When monozygotic twins are born with different sexes it is because of chromosomal birth
 defects. In this case, although the twins did come from the same egg, it is incorrect to refer to them as

genetically identical, since they have different karyotypes.

Semi-identical twins

Monozygotic twins can develop differently, due to different genes being activated.[50] More unusual are "semi-

identical twins". These "half-identical twins" are hypothesized to occur when an unfertilized egg cleaves into two

identical attached ova and which are viable for fertilization. Both cloned ova are then fertilized by different

sperm and the coalesced eggs undergo further cell duplications developing as a chimeric blastomere. If this

blastomere then undergoes a twinning event, two embryos will be formed, each of which have different paternal

genes and identical maternal genes.

This results in a set of twins with identical genes from the mother's side, but different genes from the father's

side. Cells in each fetus carry genes from either sperm, resulting in chimeras. This form had been speculated

until only recently being recorded in western medicine.

Twin calves of the Hereford breed

Animal twins

Twins are common in many animal species, such as cats, sheep, ferrets and deer. The incidence of twinning

among cattle is about 1–4%, and research is under way to improve the odds of twinning, which can be more

profitable for the breeder if complications can be sidestepped or managed. The nine-banded armadillo

(Dasypus novemcinctus) has identical twins (usually four babies) as its regular reproduction and not as

exceptional cases.

Identical twins are actually not that identical at all

Washington, Feb16: Identical twins are believed to be exactly alike, but a new study
contradicts the stereotype and suggests that they are genetically different.

The finding may be great importance for research in hereditary diseases and for the
development of new diagnostic methods.
 “Even though the genome is virtually identical in identical twins, our results show that there in fact are tiny differences
and that they are relatively common. This could have a major impact on our understanding of genetically determined
disorders,” said Jan Dumanksi, who co-directed the international study with his colleague Carl Bruder.

“By uncovering these small genetic differences in identical twins where one of them is sick, we have a way of tying
specific genetic changes to the genesis of common diseases,” said Bruder.

In the study, the research team studied 19 pairs of identical twins and found that they indeed had the same DNA but
nevertheless evinced differences in the number of copies of individual DNA segments.

A segment might be missing, or more copies might exist in one twin. This could explain how one identical twin can be
afflicted with a disorder while the other twin remains fully healthy, according to the scientists.

The study is published in the journal American Journal of Human Genetics. (ANI)

The Basics of Twins

By Robin Elise Weiss, LCCE, About.com Guide
See More About:
 vanishing twin syndrome
 multiple birth
 twin pregnancy calendar
 twins
 multiples

LifeART (and/or) MediClip image copyright 2008

Wolters Kluwer Health, Inc.- Lippincott Williams & Wilkins. All rights reserved.

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People are very fascinated with twins and other multiples. It seems mysterious how one pregnancy can result in more than one
baby.

Multiple pregnancies are on the rise in recent years with more and more twins and other types of multiples being born. The
majority of the reason for this rise is the increased use of fertility drugs.

How Twins Are Made

There are a couple of ways that multiples are conceived:

 Multiple eggs are released or there is more than one ovulation. Both (or more) eggs are fertilized and you have fraternal
twins. This can happen with or without fertility drugs.
 One egg is release but splits in two. Identical twins are made. This can happen with or without fertility drugs.
 In cases of IVF, there are usually 3 or more fertilized eggs put back into the uterus. The rationale is that not all of these
will implant, though sometimes they do.
Once conceived you have a lot of possibilities on placentas, implantation locations, number of amniotic sacs. For example, you
can have two babies, two placentas, and two sacs. You can have two babies one placenta, two sacs. It will be important to know
exactly what you are dealing with, particularly when it comes to amniotic sacs.

How Multiples Are Discovered

Many people learn about their multiples at an early ultrasound. Although some critics say that before twelve weeks gestation
there is still a high risk of Vanishing Twin Syndrome (VTS), where one baby stops growing and is either absorbed back into the
mother's body or is still born when the other twin is born.

Some people find a rapid rate of grow in their uterus which leads some to suspect twins. I will say, for all of you second timers
out there, that your bellies will grow faster than with your first pregnancy, so don't automatically assume twins.

Sometimes multiple heart beats are heard, leading your practitioner to believe that there is more than one bundle of joy in your
uterus.

Some women find out when they have abnormally high levels on the AFP test that multiples are on the way, since multiple
babies would increase the levels of these hormones. It's also sometimes possible to detect multiples with serial hCG levels in
early pregnancy. The more babies the faster the rate of rise in the hCG which should nearly double every 48 hours with a
singleton.

About 3% of all twin pregnancies are undetected until birth. It is possible to have an ultrasound and not see the other baby,
though rare.

Multiple Pregnancy

Being pregnant with multiples is not necessarily a high risk situation, except when dealing with higher order multiples or specific
problems. Someone on the bulletin board phrased it as being "high need." I really think that this is a positive shift away from the
technical side. Find a practitioner who is experienced with multiples births, but one who will not panic at every corner.
In general you need to increase the amount of protein that you eat. Protein is the building block of every cell in your body and
your babies' bodies. It will help you build a good placenta and a strong amniotic sac. A healthful diet will also help fight against
infection.

You will probably see your practitioner more frequently towards the end of pregnancy. You may have more testing than most
women during pregnancy, but not always. Some of these might include: non-stress testing, more ultrasounds, etc.

Complications

There can be a higher risk for complications. You will be monitored for the normal complications of pregnancy like high blood
pressure, and fetal growth. However, twins and other multiples can have higher incidences of things such as Intrauterine Growth
Restriction (IUGR), Twin to Twin Transfusion (TTTS), and others. Remember to keep your appointments, watch your diet and
do your Fetal Kick Counts.

Multiple Birth

In years past cesarean became popular for multiple births. Now that rate is about 50% for twins, and declining. We've found that
vaginal birth is usually very safe for multiples, who frequently need the stimulation and rise in hormones levels associated with
labor.

Whether or not you will have a vaginal birth will depend on many factors, including the position of the babies, and how the
babies tolerate labor.

If your babies are in a position where neither can move, they are said to be locked. These babies will have to be born via
cesarean.

Breech babies really depend on the size of the baby and the skill of the practitioner. Usually if baby A (The first baby in the
pelvis.) is head down a vaginal birth will be attempted. If Baby B is breech or transverse an internal or external version may be
attempted to help facilitate the birth, or that baby may be allowed to be born breech.

Monoamniotic twins will also be born via cesarean, due to the added risk of cord entanglement.

No matter how your twins were conceived, or how they were born, babies are delightful. Parenting multiples has its special
challenges, but it also yields special rewards.

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