Twin pregnancy

Finding out that you are expecting twins is always a huge surprise even if, knowing your family history or having undergone fertility treatments, you suspected that you could have a twin pregnancy: and in any case it may take some time for you to get used to the idea that you will have two -or more- twins.

It should be noted that the development of twins in the womb is very similar to the development of a single child. Since two or more fetuses are growing in the uterus during the same period, however, there are some differences, mainly during the last months of pregnancy.

With this article we want to give you an overview of what happens in your uterus during a twin pregnancy. Keep in mind that this is a general guide, so always refer to your midwife or gynecologist for any questions, symptoms, or concerns you may have.

Why you have twin pregnancy

Twin conception can be determined by one of the following reasons:

  • through ovulation you have produced two eggs that have been fertilized by two separate sperm;
  • you have undergone fertility treatments (in this case, surely you already knew you were running the “risk” of a multiple pregnancy);
  • You produced an egg, which was fertilized by a sperm that then spontaneously split into two. 

Monozygotic twins or dizygotic twins: the differences

Below we summarize the differences between monozygotic and dizygotic twins.

  • Dizygotic twins arise when two separate eggs are fertilized by two different sperm. Each twin has its own placenta and amniotic sac. Twins can be two girls, two boys, or a boy and a girl. Genetically, they don’t look more like each other than they would if they were “normal” siblings. This is the most common type.
  • Monozygotic twins originate when a single fertilized egg divides into two fetuses. Monozygotic twins might share the same placenta, but usually each has a separate amniotic sac. Genetically, the two children are “identical”. They will be of the same sex and will share traits and physical characteristics. Monozygotic twins very rarely fail to completely divide into two separate individuals: in this case, you will have the so-called Siamese twins.

Triple or multiple pregnancies can lead from having monozygotic, dizygotic twins, or a combination of both.

During the first few weeks of pregnancy, unless you have some hint of a twin pregnancy, you’ll probably be unaware that you have two babies growing inside you.

Your gynecologist may suspect a twin pregnancy if your uterus is larger than normal, or if it appears to have more than one fetal heartbeat. Most commonly, in most cases, a confirmation via an ultrasound provides the definitive answer.

Sometimes a seemingly normal twin pregnancy later reveals the presence of only one baby: this is known as the “missing twin syndrome”. Such an episode can be painful, frustrating and can be disorienting especially because, often, there is a clear explanation for this “loss”.

Twin pregnancy for mom

Even in the case of a twin pregnancy, taking care of yourself is the best way to take care of your babies too!. However, here’s what you might expect in a twin pregnancy:

  • More frequent checks. You may need more frequent ultrasounds or other tests, especially as your pregnancy progresses.
  • An increased need for certain nutrients. You’ll need more folic acid, iron, calcium, protein, and other essential nutrients.
  • A greater weight gain. Gaining weight – in the right way, in relation to a twin pregnancy – can promote the health of your babies.
  • Greater attention to post-term childbirth. Usually, until the 41st week, the length of pregnancy is not considered a cause for concern. Instead, in the case of twins, there are reasons in favor of these concerns must be taken into account first. Your doctor may recommend inducing labor, or performing a caesarean section as early as the 38th or 39th week of pregnancy.

Baby Bonus

Baby bonus in the case of twin pregnancies.

Also in 2017 it should be possible (as confirmed by the Budget Law for 2017, together with other measures to support families) to request the birth allowance, the so-called baby bonus provided for by Law no. 190 of 2014. The bonus consists of a monthly allowance of 80 euros, which can also become 160, for those with low income: it is paid for a three-year period. This applies to the single child. In the case of a double birth, the birth allowance doubles.

Twin pregnancy and possible complications

Every day, everywhere, healthy twins are born! However, it is important to be aware that there are also possible complications in the case of twin pregnancies. For example:

  • Hypertension. Moms of twins are more likely to develop hypertension during pregnancy. When hypertension combines with proteins in the urine, the condition is called preeclampsia or gestosis.
  • Premature. The more babies you carry in your womb, the less likely you are to carry your pregnancy to term.
  • Feto-fetal transfusion. In monozygotic twins, it is possible for a placental blood vessel to connect the circulatory systems of the two babies. This causes one child to receive too much blood, and the other too little. This is a serious complication for both babies, which may require invasive surgery during pregnancy. It may be necessary to induce premature childbirth.
  • Caesarean section. For twins, vaginal delivery is usually possible if the first baby is placed upside down. If this is not the case, a may be advisable. In some cases, complications that arise after vaginal delivery of the first baby may require a cesarean delivery for the second twin.

Some curiosities about twins

  • Did you know that twins form a bond with each other before they are born? Three-dimensional ultrasound images have shown that fetuses inside the uterus seem to intentionally seek each other’s presence, and squeeze together, as early as 18 weeks.
  • The twins understand each other. According to researchers, about 40% of twins develop their own language – and it is not just childish language -. Twins often see each other as points of reference for language, and assign meaning to their own babblings.
  • They could yawn and “infect” each other. “Contagious” yawning (like when you see someone yawn, and instinctively feel the need to do the same) may not seem like a major issue. Apart from the fact that most children usually do not exhibit this behavior until they reach about five years of age, the age at which the part of the brain that controls empathy begins to mature, however, it is also true that children yawn a lot in general: so it could be a coincidence. But there’s also a good chance that bonding in the womb will give rise to an empathic connection, which leads your twins to share their yawning “special sessions.”
  • They are different, even if they are identical. Can you recognize two monozygotic twins between them? Although they have a corresponding DNA, the profile of the furrows and ridges on their skins is not the same: it is thought that fingerprints are determined by the bone growth of each baby and contact with the amniotic fluid in the uterus and therefore, although they may also be very similar, their fingerprints will never be exactly the same (otherwise, for example, from their dimples).
  • Each influences the other’s sleep for years. When they’re babies, the cries caused by one’s hunger in the middle of the night will wake up the other (and even if they don’t, you’ll probably wake up the sleeping twin when the other wakes up to eat). When they are babies, they will giggle at each other through the bars of their cribs, shaking the railings and falling weight on their mattresses. When they are grown, even if one twin is very tired, he will not go to bed if the other is still awake, because he does not want to miss anything he could experience.

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform,

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