On Monday, ace footballer Cristiano Ronaldo announced the death of one of his newborns, a boy, with partner Georgina Rodríguez, who was pregnant with twins.

"Only the birth of our baby girl gives us the strength to live this moment with some hope and happiness," Ronaldo wrote on his social media post.

It is important to note that there can be a number of risk factors associated with twin pregnancy. According to UAE experts, twin pregnancy or a higher-order multiple gestation has its own set of risks.

Speaking in this regard, Dr Shamsa Al Awar, consultant obstetrics and gynaecology, chair of the ObGyn Department at College of Medicine and Health Sciences at UAE University, explained that one of the reasons behind higher risks in twin pregnancy is the biological norm for the human species which is a single pregnancy. Two or more growing embryos can cause significant stress on the body.

“Every species is different when it comes to the number of embryos it is able to grow safely, and with humans, the default is a singleton pregnancy — any more than that is considered exceptional,” the doctor said.

She underlined that there is an increased risk of prematurity as the pressure on the uterus increases along with other issues when the foetuses are sharing the same placenta. Identical twins sharing the same placenta carry an even bigger risk for the mother and the foetuses. Normally, a twin pregnancy is considered full term at 37 weeks, while a singleton is 40 weeks.

Dr Al Awar further affirmed that in twin pregnancies, the mother is also more prone to infections such as urinary tract infections (UTI) and chorioamnionitis (infection of the placenta and the amniotic fluid). Such concerns may increase the increase the risk of stillbirth.

“Stillbirth increases in multiple gestation. The risk in twins is 3-6 times compared to a singleton, and in triplets it's 10 times more," Dr Al Awar stated.

According to Dr Al Awar, some of the reasons behind stillbirth can be preexisting maternal diseases such as diabetes, hypertension and pre-eclampsia; umbilical cord problems, intrauterine infections, birth defect from congenital abnormalities (like heart defects and defects in the abdominal wall).

Significantly, Dr Al Awar called for planning to avoid complications in any type of pregnancy. From stating with preconception health counselling before conceiving to regularly visiting the doctor to minimise risk, people can take various measures to maximise the chances of a healthy pregnancy.

“Take folic acid at least three months before you plan to get pregnant. If you are obese, lose weight. Improve your lifestyle. Smokers should quit smoking and ensure to have good nutrition and good sleep. You should prepare for the best journey ever," she continued.

Dr Mandeep Singh, MD MRCOG, sub-specialist and consultant in foetal maternal medicine and CEO at Burjeel Farha (Women’s and Children) underlined the two most important decisions parents must make during pregnancy: Get access to healthcare as early as possible; Find the right doctor who specialises in multiple pregnancies. He pointed out that not every obstetrician can manage a twin pregnancy.

“Twin pregnancies need to be managed by centres that have experience in managing multiple pregnancies. Twin pregnancy is different from singleton pregnancy, and both the patients and doctors need to recognise that. Somehow, there has always been this culture in that every doctor can manage the pregnancy. I think we need to move away from that," Dr Singh explained.

Noting that there are certain complications associated with twin pregnancy, timely screening and management in an appropriate way is crucial for ensuring safe deliveries and safe outcomes.

Avoid complications that may lead to a stillbirth

One of the best ways to avoid complication is to educate yourself, Dr Singh noted. Furthermore, adopting a healthy lifestyle, access to the right doctors and proper planning are also helpful in ensuring safe pregnancy.

"When you get access to good medical facilities, they will put all the things that are needed to make sure that the pregnancy is going well. These include booking a screening for chromosomal abnormalities, a screening for infectious diseases, a screening for diabetes, and screening for pre-eclampsia," the doctor added.

Other things parents can do to prevent complications as the pregnancy advances is to ensure regular monitoring and managing labour appropriately.

"Labour cannot just be managed by one person. You need trained doctors, you need trained midwives, you need trained nurses looking after the patient," Dr Singh said.

A scan is conducted every four weeks after 20 weeks gestation for non-identical (dichorionic twins) and every two weeks for identical twins (mono-chorionic twins) to rule out any complications, the expert explained.

There are factors that can make a pregnancy high risk, including mother with heart disease, lung complications, issues with the placenta or high blood pressure in pregnancy. Other factors can include a previous loss of a child or premature delivery where the baby was below normal size and weight.

What is a stillbirth?

According to Cleveland Clinic, a stillbirth is the death of a baby in the womb after week 20 of the mother’s pregnancy. Furthermore, the reason behind stillbirth can go unexplained for 1/3 of cases, while the other 2/3 cases may include problems with the placenta or umbilical cord, high blood pressure, birth defects, or poor lifestyle choices. One in 160 pregnancies witnesses stillbirth every year in the US.

“We do not know all the reasons why these babies die but the most common reason is because of problems with growth," Dr Singh.

However, the doctor underlined some risk factors including gestational diabetes, high blood pressure in pregnancy or preeclampsia which can result in stillbirth.

“Then there are certain blood disorders that can cause stillbirth. So it's a very complex field. The risk of stillbirth in identical twin pregnancies is 9 times higher than singleton pregnancies, and 4 times for non-identical (fraternal) twins," the health specialist said.

Dr. Kalavathy Subramaniam, Consultant Obstetrician & Gynaecologist at Corniche Hospital, noted other complications in twin pregnancy such as breathing difficulty at later gestation as a result of overdistended uterus/abdomen.

"Twin pregnancy also carries higher chances of premature deliveries, twin-to-twin transfusion syndrome, selective intrauterine growth restriction of a twin, polyhydramnios and increased fetal anomalies. Twin pregnancy is associated with higher cesarean section rates, post-partum haemorrhage and anaemia in the mother," Dr Subramaniam added. 

SOURCE: Khaleej Times

LINK: https://www.khaleejtimes.com/emirati-wise/twin-pregnancy-is-twice-the-risk-uae-doctors-say