Premature Twins - Causes, Diagnosis, and Management

Introduction:

Preterm or premature delivery means the baby is born when the pregnancy is significantly shorter, especially shorter than 37 weeks. It can be of various types, such as extremely preterm (less than 28 weeks), very premature, or preterm (28 to 32 weeks), and moderate to late preterm (32 to 37 weeks).

A twin pregnancy occurs when two eggs get fertilized simultaneously or if one egg gets split into two or more after fertilization. The average length of twin pregnancies is 36.4 weeks, and babies born between 32 and 37 weeks do well. Premature or preterm birth can occur in twin pregnancy also, and how a baby will do after a premature birth mainly depends upon two key factors: gestational (the period between conception and birth), age, and birth weight. Therefore, the article discusses premature twins, their causes, diagnosis, and management.

What Are the Causes of Premature or Preterm Birth?

The following are the reasons for preterm birth:

• Increase infection after rupture of membrane.

• Having a history of previous preterm birth.

• Pre-eclampsia (a dangerous pregnancy complication due to high blood pressure).

• Diabetes (high blood glucose levels) is either pre-existing or gestational (the period between conception and birth).

• Conceiving through IVF (in-vitro fertilization) or a procedure where the egg is fertilized in-vitro or out of the normal biological environment.

• Placenta bleeding due to complications, such as placenta abruption (detachment of placenta in the womb) or placenta previa (placenta covers the cervix opening).

• Genital or reproductive tract infection.

• IUGR (Intrauterine growth restriction) means the baby is not growing as expected.

• Monochorionic pregnancy (when both fetuses share one placenta).

• Reduced effectiveness of placenta.

• Twin-to-twin transfusion syndrome (TTTS) is a serious complication that occurs in identical twins as the blood flows from one baby to another through the placenta. One baby will get excess blood, thus putting extra pressure on the cardiovascular system, while the other will receive less blood.

• Fetal abnormalities (developmental issues in the baby during pregnancy).

• Other factors may include smoking, multiple miscarriages (sudden loss of pregnancy), abortions (termination of pregnancy due to various reasons), stress, the mother being overweight or underweight, and being younger than 17 years or older than 40 years.

What Are the Challenges With Preterm Twin Deliveries?

• Lack of knowledge about maternal-fetal conditions.

• Complications during delivery, such as hypoxia (lack of oxygen), cord prolapse (umbilical cord drops between the fetal presenting part and the cervix into the vagina), and premature placental separation.

• Low birth weight of the babies.

• Neurological and congenital disabilities in babies, including neural tube defects (a defect in the spinal cord, spine, and brain that occurs during the birth of a baby within a month).

• Cerebral palsy (a congenital disorder) that affects muscle tone, movement, and posture.

What Are the Risks Associated With Premature Twin Births?

Risks associated with premature twins are as follows:

• Long-term disability.

• Increase in morbidity (long-term illness).

• Increased mortality rate (death rate).

• Preterm babies are kept in the NICU (neonatal intensive care unit) and SCBU (special care baby unit) after delivery.

How Are Premature Twins Pregnancy Managed?

1. Before the Birth: Medications given to women with twins to prevent preterm delivery have not shown an improved outcome. Depending on the gestation age, the doctor usually tries to delay the deliveries so the babies get more time in the womb to develop their lungs and brain. For the lungs, a steroid injection is given (two or twelve hours apart), which increases the rate of surfactant formation required for the lungs to start functioning.

2. C-section Delivery: Studies have shown cesarean delivery can reduce the risk of morbidity.

3. After the Birth: Supportive care in the NICU includes:

• Incubator: The incubator is a closed plastic bassinet. It helps to maintain a normal body temperature, as it is warm.

• Kangaroo Care: In kangaroo care, the NICU nurse guides the parents in holding the babies so that they have skin-to-skin contact.

• Monitor The Vitals: Heart rate, blood pressure, temperature, and breathing rate are observed. A ventilator support is established to assist with breathing.

• Feeding Tube: It helps to provide nutrients and fluids. Also, breast milk is given later through the tube from the nose called the NG (nasogastric) tube.

• Replenishing the Fluids: Age-appropriate fluids are very important in the initial days. It is given by IV (intravenous). Also, breast milk can be given to babies under the doctor's advice.

• Keep the Babies Under Bilirubin Lights: This is done to avoid infant jaundice (excess bilirubin in the bloodstream). Excess bilirubin is broken down by these lights, which builds up because the liver can not process it all.

• Blood Transfusion: A blood transfusion is given in case the baby loses a lot of blood, especially if a lot of blood was drawn or any systemic illness.

What Are Tests Done After the Birth?

The following are the tests done after birth:

• Physical Examination: Breathing and heart rate monitoring are essential tools to monitor health.

• Water or Fluid Intake and Output: It is checked by counting the number of diapers used.

• Blood Test: To check for calcium, glucose, and bilirubin levels in the baby's blood. Sometimes a central umbilical intravenous (IV) line is inserted to avoid needles.

• Echocardiogram: Echocardiogram (ECG) is similar to fetal ultrasound. It helps to check the baby's heart rate.

• Eye Exam: To check any problems associated with the eyes as they are born prematurely.

Examining for contractions is a key way to detect early labor.

1. Place the fingers on the stomach (abdomen); if the uterus is tightening and softening, it is a contraction. Time the contractions. Write down the time when contractions begin and the start of the next contraction.

2. Please attempt to stop the contractions by walking, changing the position, relaxing, and not thinking about it. Drinking at least two or three glasses of water will be helpful.

3. If the contractions are every ten minutes apart or more often, call the doctor immediately. Also, if the symptoms get worse, or if the pain is very severe and does not go away, feel free to contact the doctor.

How Can Parents Help the Premature Babies?

Mothers can help by pumping breast milk. Fathers can help with diaper changing, giving skin-to-skin to babies, and helping to feed the babies if the hospital permits. Also, it is normal to feel helpless for parents as the doctors, nurses, and NICU staff will have control over the babies. The challenging situation will enable parents to bond with their babies. Nurturing premature babies will have a good impact on their health.

Conclusion:

No foolproof treatments are available to reduce risks for preterm labor for twin deliveries. About two to three percent of live deliveries are twin births. Advanced reproductive technologies are available all around the world. Lack of research will contribute to an increased rate of mortality and morbidity; hence, more research is the need of the hour. Premature twin babies need appropriate care right from birth. Research has predicted that the average age at first childbirth has been lowered in recent times. These two factors have boosted the incidence of twin pregnancies worldwide.