Pregnancy Bliss | Reproductive Health Answers
If I develop pre-eclampsia while carrying twins, what should I expect?
Expect early delivery. Attempts will be made to keep the condition under control for as long as it is safe to do so. Valuable time may be bought to give your babies a better chance of survival.
Remember, pre-eclampsia is only treated by delivery and whatever measures are instituted while you are pregnant, they are meant just to keep the lid on. If the condition gets worse, in spite of everything thrown at it, delivery becomes inevitable.
Most obstetricians would prefer to get to thirty weeks of gestation or beyond. However, nobody tries to achieve this at any price. Delivery will be carried out when it becomes necessary. In such a situation, a balancing act is essential but maternal wellbeing remains paramount.
What is the likely method of delivery in such a situation?
It depends on a number of factors. If there is no contraindication to vaginal delivery, this will be aimed for. Labour will be induced. If, however, you are too remote from term - let's say below thirty weeks of gestation - induction of labour may be considered not feasible as it is unlikely to succeed in reasonable time. In such a situation, a caesarean delivery is the logical option.
Twin to Twin Transfusion
What if I am developing twin-to-twin transfusion (TTTS)?
Twin to twin transfusion syndrome (TTTS) is a serious problem and you will need to be admitted in hospital.
If this happens early in pregnancy (before 20 weeks), the chances of saving either baby are very small indeed. Difficult as this may be, you may be advised to terminate the pregnancy.
If it develops later, ideally after 24 weeks, endeavours are made to prolong the pregnancy to achieve viability.
The main plank of the management is likely to be frequent draining of fluid from the womb. This is because there is a tendency in this condition for the recipient twin to accumulate excessive amounts of fluid. This is actually the earliest sign of the complication. If left unchecked, it almost inevitably leads to premature labour, as well as being extremely uncomfortable, even painful, for the expectant mother.
Is there anything else that can be done to contain the situation?
Some people advocate use of a medicine called indomethacin. This is meant to reduce the production of excess fluid and also prevent premature labour by inhibiting uterine contractions. Not everybody agrees. The argument against it is that it hardly works, has the potential to cause heart complications in the fetus and may well cause kidney damage to the donor twin as it works by reducing urine output.
Laser Therapy in TTTS
Specialist centres now offer surgical treatment in the form of laser coagulation
of the rogue inter-communicating blood vessels in the placenta. It is, in a way,
the last desperate throw of the dice. The procedure is difficult to perform and there
is a fairly high rate of loss of one or both babies as a result. However, in severe
cases, it is the on
ly hope of salvaging at least one of the babies.
Not always so obvious. Non-identical twins Lauren and Kayleigh whose younger siblings have also followed suit with one being white and the other black. Their mother is white and their father black. This kind of distinction is exceedingly rare.