twins and multiple pregnancy buxton u3a 16 th may 2014 ann clark and marion overton
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TWINS AND MULTIPLE PREGNANCY
Buxton U3A 16th May 2014
Ann Clark and Marion Overton
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Frequency of Births in England and Wales 2011
• MATERNITIES 716,040
• TWINS 11,330 1/63
• TRIPLETS 1721/4163 Almost 1/63² (1/3969)
• QUADRUPLETS OR MORE 31/238,680Almost
1/63³ (1/250,047)
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Multiple Births statistics in the UK for 2012
• England and Wales
Scotland Northern Ireland
UK Total
Total
Maternities 729,674 (excluding stillbirths)
57,419 25,269 812,362
All multiples
1,441 (including stillbirths
8741 377 12,692
Twins 11,228 876 371 12,466 1/65
Triplets 208 7 6 1/3508
( 1/65²
1/4225)
Quads and above+
5 Not listed Not listed 5 1/145935
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Length of pregnancy Average birth weight
40 weeksSingletons 3.5kg
37 weeks Twins 2.5kg
34 weeks Triplets 1.8kg
32 weeks Quads 1.4kg
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Mortality Rates England and Wales 2007 (deaths per 1000 births)
Stillbirth Perinatal (first week)
Infant (1 week to 1 year old)
All 5.2 7.7 4.7
Twins 11.2 23.3 19.9
Triplets 19.7 49.3 50.3
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• Identical twins have a higher mortality rate because ⅔ share the same placenta and blood circulation
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Signs of Multiple Pregnancy
• Pregnancy test
• Morning sickness
• Uterine size
• Ultrasound scan
• Palpation of foetal parts
• Heartbeat
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Who has twins or more?
• Older Mums
• Fertility treatment –particularly In Vitro Fertilisation (IVF)
• Positive Family History (for Hyperovulation)
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Are they identical?
• Identical –from one egg (monozygous or uniovular)
• Fraternal –from 2 eggs fertilised at the same time (polyzygous or binovular)
• This is the zygosity of multiple births, and still holds true, but
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NICE Guidelines
• 2011 National Institute for Clinical Excellence published guidelines for Antenatal Care:
• Risks ..determined by chorionicity and not by zygosity
Chorion includes the placenta
Amnion is the gestational membrane (sac) round the baby
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Triplets
• Trichorionic, triamniotic
• Dichorionic, triamniotic
• Dichorionic, diamniotic
• Monochorionic, triamniotic
• Monochorionic, diamniotic
• Monochorionic monoamniotic
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Is sharing a placenta BAD news?
It may be:
1. Chromosomal/congenital abnormalities
2. Foetofoetal transfusions
3. Discordance in size
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NICE Guidelines
• Refer to a Regional centre:– Major foetal abnormality– Shared placenta (monochorionic)– Foetofoetal transfusion– Discordant foetal growth
Scan at 11-14 weeks, then fortnightly from 16-24 weeks
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1947
1947
1949
1950
2008
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1960
1960
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2008
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