Pregnant with Twins information

I am eight weeks pregnant with twins. I saw both heartbeats a week ago. Could you tell me what my odds are for successfully carrying both babies from this point?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

The happy diagnosis of twins also carries the realistic prognosis that this pregnancy may be at greater risk for problems. Miscarriage, fetal loss, intrauterine fetal death, placental problems, pregnancy induced hypertension, unequal (discordant) fetal growth, genetic as well as biochemical and "positional" fetal defects, and especially preterm labor all occur with more frequency in a multi-fetal pregnancy.

Miscarriage occurs at approximately a three times greater rate with multiple fetuses. If the babies are "monozygotic" or identical (from the same egg), the risk goes higher as it does with other problems as well.

The reassurance that we can sometimes provide to women after seeing the fetal heart on ultrasound does not necessarily extend to a twin pregnancy. Because twins are more likely to suffer other problems, visualization of the fetal heart, while somewhat reassuring, is not as reassuring.

One of the best indications of potential miscarriage in twin pregnancy is a disparity of 3 mm or more between the twin gestational sac diameter (if less than 49 days gestation) or between the twin crown-rump length in later gestations. When such discrepancy exists, the rate of miscarriage is 50 percent or higher.

Miscarriage may impact only one baby. The existence of a "vanishing twin" syndrome has been shown with a prevalence rate at about 21 percent. In this case, one twin is reabsorbed leaving the other twin to develop normally. This situation is seen more frequently in scans performed before 12 weeks.

A large percentage of mothers carrying twins in this decade have undergone some type of fertility treatment. Such women tend to be older and the literature is showing that infertile women have a profound increase in spontaneous pregnancy loss even after the early documentation of fetal cardiac activity. In addition, an abrupt increase in spontaneous abortion rates was seen in women over the age of 35 years.

A recent study from a perviously infertile population reported a seven percent incidence of spontaneous abortion after the early detection of fetal cardiac activity by transvaginal ultrasonography. Additionally, another study evaluating pregnancy outcomes in 293 pregnancies in previously infertile women with early documentation of fetal cardiac activity reported an incidence of spontaneous pregnancy loss of 11 percent.

Miscarriage also occurs more frequently with increased maternal age in fertile women. A large study in a fertile population reviewed the transabdominal sonograms of women presenting before 10 weeks of gestation for prenatal care. The overall loss rate after seeing the fetal heart was 2.1 percent. In this study of fertile women, the miscarriage rates ranged from 1.6 percent to 2.6 percent for patients less than 39 years of age. A miscarriage rate of 13.6 percent was noted in patients more than 40 years of age.

Ultrasound detection of fetal cardiac activity has been shown to have a higher positive predictive value for viability than the presence of either a gestational sac alone or the use of biochemical markers. The presence of fetal cardiac motion by transvaginal ultrasound in previously infertile women aged less than 30 years is highly reassuring. In one study, no pregnancy loss occurred in these women after documentation of fetal cardiac activity within 35 to 42 days after ovulation.

Thus, patients more than 35-years-old should be counseled that their risk of spontaneous abortion is significant even after early detection of fetal heart motion by transvaginal ultrasound. Furthermore, previously infertile women more than 40-years-old should be informed that their risk of pregnancy loss is increased fivefold over women 31 to 35 years of age. Despite the optimism engendered by the early confirmation of fetal cardiac activity by transvaginal ultrasound, the prognosis is guarded in these patients until a minimum of 10.4 weeks, when subsequent miscarriage rates should decline.

Although I don't know the precise statistics for twins as we've found for older infertile mothers, the risk of miscarriage is significant even after visualization of the fetal heart.

Despite all of this, a twin pregnancy has a good chance of being a healthy pregnancy. With proper care, nutrition and support, there is a high likelihood that the pregnancy will go to term or near term and you will have two healthy babies.

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