Twins and umbilical cord anomalies

I am 32 weeks pregnant with twins. I was told that one of the babies has only has two vessels in his cord. Should I be concerned?

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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

Umbilical-cord anomalies such as a two-vessel phenomenon have been implicated in an increased risk of having a baby small for its gestational age. In general, twins are at risk for this anyway.

But whether or not a smaller-than-average baby is also at an increased risk for birth hypoxia (low oxygen levels) is still debated.

Twins who share the same chorion (fetal membrane) are at higher-than-average risk for hypoxia and growth discrepancies. Usually, the smaller baby is at increased risk for lower hemoglobin and, therefore, for hypoxia.

Two-vessel cords sometimes alert care providers to look for kidney problems in the baby. But remember, this is an association, not an absolute. If the baby were having difficulty excreting urine, an ultrasound would reveal an enlarged bladder or an abnormal amount of amniotic fluid in the uterus. You may wish to ask about fetal kidney function.

Additional concerns to ask about include:

  • Appropriate size for dates;
  • Discrepant size between the babies;
  • When sharing the same membrane/placenta, do both babies have approximately the same placental mass?
  • Amount of amniotic fluid;
  • Fetal kidney appearance/function;
  • Ask your provider if there are any indications of a twin-to-twin transfusion. In this condition, one baby gets most of the blood at the expense of the other.

Be aware that some doctors get annoyed when clients ask well-studied questions. They prefer to have the clients feel that the doctor has everything under control and will let you know what you need to know. Some clients like this approach best as well.

Good luck with your babies. Having Twins: A parent's guide to pregnancy, birth, and early childhood" by Elizabeth Noble is a great resource.

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