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Twins – Types, Risks and Delivery

Twins are two children who develop simultaneously during a single pregnancy. They are classified as identical (monozygotic) or fraternal (dizygotic) twins.

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Things worth knowing about "Twins"

Twins are two children who develop simultaneously during a single pregnancy. They are classified as identical (monozygotic) or fraternal (dizygotic) twins.

What Are Twins?

Twins are two children who develop at the same time in the womb and are typically born during the same delivery. Twin pregnancies are the most common form of multiple pregnancy in humans. Globally, twins account for approximately 1–2% of all births, a rate that has increased in recent decades due to advances in reproductive medicine and assisted conception techniques.

Types of Twins

Identical Twins (Monozygotic)

Identical twins develop when a single fertilized egg (zygote) splits into two genetically identical embryos at an early stage of development. Because they share the same DNA, identical twins are always the same sex and closely resemble each other. Depending on when the split occurs, they may share a placenta (monochorionic twins) or have separate placentas (dichorionic twins). Identical twins account for approximately one-third of all twin births.

Fraternal Twins (Dizygotic)

Fraternal twins develop when two separate eggs are fertilized by two different sperm cells at the same time. They share on average 50% of their genetic material, similar to ordinary siblings, and can be of different sexes. Fraternal twins are the more common type, accounting for approximately two-thirds of all twins. They always have separate placentas and amniotic sacs.

Causes and Risk Factors

Several factors can influence the likelihood of a twin pregnancy:

Genetic predisposition: Fraternal twinning tends to run in families, particularly on the maternal side.
Maternal age: Women over 35 have a higher chance of releasing multiple eggs during ovulation, increasing the likelihood of fraternal twins.
In vitro fertilization (IVF): Multiple embryos are often transferred during IVF, raising the chance of a multiple pregnancy.
Ovulation stimulation: Hormonal treatments that stimulate egg production can result in the release of more than one egg.
Ethnicity: Twin births occur more frequently in certain populations, particularly in West Africa.

Twin Pregnancy

A twin pregnancy is considered a high-risk pregnancy because it is associated with a higher likelihood of certain complications. Women carrying twins require more frequent medical monitoring than those with a singleton pregnancy.

Common Risks and Considerations

Preterm birth: More than half of all twins are born before 37 weeks of gestation.
Low birth weight: Twins frequently have lower birth weights compared to singletons.
Gestational diabetes: The risk is elevated in twin pregnancies.
Preeclampsia: A dangerous form of high blood pressure during pregnancy occurs more frequently in twin pregnancies.
Twin-to-twin transfusion syndrome (TTTS): In identical twins sharing a placenta, blood may flow unevenly between the two babies, causing serious complications.
Neonatal complications: Premature twins frequently require intensive neonatal care after birth.

Diagnosis

A twin pregnancy is typically detected via ultrasound (sonography) during the first trimester. This examination also helps determine whether twins are identical or fraternal and how many placentas are present. Regular ultrasound monitoring throughout the pregnancy is essential to track the growth and wellbeing of both babies.

Birth Planning and Delivery

The mode of delivery for twins depends on several factors, including the position of the babies in the womb, the condition of the mother, and the type of placentation. A cesarean section is often recommended, particularly if the first twin is not in a head-down position. Vaginal delivery is possible in certain situations and can be performed safely in experienced obstetric units.

Postnatal Care

Newborn twins, especially those born prematurely, often require intensive medical care. Parents of twins typically receive support from midwives, neonatology departments, and specialized counseling services. Breastfeeding twins is possible and encouraged, though it requires additional support and practice.

References

World Health Organization (WHO): Trends in maternal mortality and multiple pregnancies. WHO Press, Geneva, 2023.
Benirschke K., Burton G.J., Baergen R.N.: Pathology of the Human Placenta. 6th edition. Springer, Berlin, 2012.
Glinianaia S.V. et al.: Perinatal mortality in twin pregnancies: a regional study. BMJ, 2003; 327(7411): 374. PubMed PMID: 12919985.

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