Talking about twins


Shieva Ghofrany: [00:00:00] Welcome. I got a lot of new followers. Thank you, Liz. Joy. I'm gonna talk today about twins because my twin nephews turn 20. Um, long story short about twins. Here's what I want you guys to know, cuz there's a lot of confusion among the little things like twins who share a placenta, twins who don't share a placenta. 

Fraternal twins. Identical twins. So let's say you walk into your doctor's office, you find out you're pregnant, you go in like six and a half to eight weeks pregnant. You have an ultrasound because that's what they do to make sure that there is a pregnancy in your uterus to make sure there's a heartbeat and, um, to look for twins. 

Believe it or not. They find the twins. They see the twins. We could talk a lot about like, what if they just see a sack? What if they see other. Out of the scope of this program, we're just gonna talk about twins, and I'm not gonna talk about the fact that twins are now much more likely because of things like in vitro fertilization or ovulation induction, just cuz again, outside of the scope of this, but you walk in ultrasound twins, [00:01:00] the ideal case scenario is, Two placenta, two sacks. 

Okay? That's what's called die chorionic Diamniotic. Corion is what gives rise to the placenta. Okay? So when your doctor sees two separate sacs with a thick membrane in between and what looks like it's gonna give rise to two placenta, that is die chorionic diamniotic. That is, um, technically. The, the twin delivery or the twin pregnancy, that is least likely to have things like the twins communicating with each other too much what's called twin, twin transfusion. 

So that and la, and less likely to have growth restriction between the two twins. So that would be the ideal. Second ideal is they share a placenta, but they each have their own sack. That's monochorionic diamniotic and unfortunately, most concerning. Sharing a placenta, sharing a sack, which is very rare, but that is where it's monochorionic mono amniotic. 

And the concern is that [00:02:00] the twins will actually entangle themselves in each other's cord cuz they're swimming in the same bubble. Okay, so that is rare. We're not gonna talk about that. We're gonna talk about the two most common ones, which is die, die or mono Die di chorionic di amniotic monochorionic mono amniotic meaning. 

Twins that have separate sex, but share a placenta is mono twins that have separate sex but have separate, um, placenta that's die. Does that tell us if it's fraternal or um, or identical? It doesn't. So when an embryo forms, which is the egg in the sperm get together, they form an embryo. If they split super early, then they're gonna create, you guessed it, their own sack, their own placenta, right? 

Because the egg in the. They split really quickly and then they gave rise to their little houses, right? If they split a little bit later, then they're gonna share the placenta, but have their own sack. And if they split even later, once the placenta and the sack has already formed, [00:03:00] then they're gonna share that space. 

Right? Now, let's say someone says, oh, I have one Placent. With two sacks and you say to them, oh, do you know, is it a boy and a girl or two boys or two girls? What's the answer? Can't be a boy and a girl cuz they're sharing a placenta, which means one embryo split, which means it has to be the same genetics, which is two boys or two girls. 

Okay. Let's say someone says to you, oh, I have twins, and they each have their own placenta and they each have their own sack. Can you say, oh, then it must be two separate babies who came from two separate eggs, which means a boy and a girl? No, it could be two boys, two girls. It could be two separate embryos that just happened to grow, or it could be one embryo that split super early, not as. 

But it can happen. So again, it's not so straightforward. It's not so easy to say. Um, the things you have to be a little bit concerned about with twins is that there is a slightly higher risk of pre-eclampsia or blood pressure issues, slightly higher risk of gestational [00:04:00] diabetes, slightly higher risk of preterm labor. 

because now your uterus is over distended, and it might decide it wants to go into labor early and slightly higher chance. Again, depending on if they're sharing the placenta or not, of one twin, almost donating too much blood to the other twin. That's a, um, easy way of saying it. That is not easy. It's something called twin, twin transfusion. 

And while it's not very common, it is a concern. Again, outside of the scope of what we're gonna talk about. Um, and then you have to think about the delivery. So the delivery can be vaginal if both babies are head down, or if at least baby A we call it is head down. If baby e b is flipped, breach or sideways, Some doctors will feel comfortable trying it vaginally where the first baby comes out and the second baby can be turned or will turn on its own once the first baby comes out. 

I would say the majority of our patients seem to do C-sections nowadays for twins. I could talk about C-sections till I'm blue in the face as to why there is good and bad to everything we do. But, um, many patients will say to me, I just don't wanna deliver the first baby [00:05:00] vaginally and then have to have a C-section, which I understand. 

And. It becomes more prudent for us to discuss scheduling the C-section. Okay. That is my quickest nugget Happy birthday to my amazing twin nephews. Fun fact, my sister did not know she was pregnant with them until she was 17 weeks, which is bizarre cuz it was only 21 years ago that she was pregnant with them. 

Um, but she was in another state I will not name, and they didn't do routine ultrasounds and they ended up being fine. So good lesson to me and to my patients, which is, I'm glad we watched twins very carefully. We do ultrasounds every four weeks to look at the growth and make sure they're, um, doing all the things they should be doing. 

But if we didn't do that, many patients would actually be okay. All right. Welcome to all my new people, and I'm gonna try to get through all your dms, but there's a lot of 'em, so give me time. Bye.