Public Education Pamphlets
The SOGC provides the following public education pamphlets designed for patients, clinics and health-care facilities. This material has been reviewed and endorsed by the SOGC’s subject matter experts.
Multiple BirthTwins and higher order multiples have unique: conception, gestation and birth processes; impact on the family system; developmental environments; and individuation processes. Therefore, in order to insure their optimal development, multiples and their families need access to health care, social services and education which respect and address their differences from single born children.
POMBA fact sheet). In 1997 an incredible 126.67 sets of triplets were born in Canada, compared to 49 sets in 1980. The number of higher-order multiple sets is increasing the most rapidly due to the increasing use of ART (especially the use of ovulation stimulants).
Implications1) The rise in preterm birth rates parallels the rise in the number of multiple births. Since the great majority of higher-order multiple births are premature, and smaller babies are being saved due to the advancements in neonatology over the last 30 years, the direct health care costs of multiple birth are rising rapidly. 2) Multiple birth children are more at risk for neonatal mortality, developmental disabilities, and severe and lifelong special needs. 3) Families of multiple birth children face increased physical, financial, and psycho-social stresses
Further information:Incidences of Multiple Birth (Canada) Twin Statistics (U.S.) Statistics on the Incidence of Multiple Births (U.S.)
ZygosityTwins (and higher order multiples) can be either monozygotic or dizygotic (or trizygotic etc. depending on the number of fetuses). Zygosity has implications for the twins after birth- whether they are "identical" (which no monozygotic twins truly are), or "fraternal". MZ twins are often treated differently and assumed to have a closer bond than DZ twins, and can always act as organ donors, blood donors etc. for each other. Monozygotic twins are also likely to develop the same genetic disorders- if a disorder is present in one twin than it is likely the other twin will develop it as well. The ONLY time that placentation can determine zygosity is if the twins are Monochorionic (therefore the twins must be MZ) . Two placentas or two chorions do not mean that the twins are dizygotic. Unless you have Monochorionic twins DNA testing must be performed to detect zygosity.
ChorionicityThe early detection of chorionicity is one of the most critical aspects of successfully managing a twin pregnancy. Monochorionic multiples are at high-risk for Twin to Twin Transfusion Syndrome, a life-threatening condition. Chorionicity in twins (and especially higher-order multiple pregnancies) can be very confusing. In Dizygotic (or Trizygotic etc.) twins, the number of placentas equals the number of embryos. (MZ twins may also be in separate chorions). Monozygotic twins may have separate chorions, in which case there is little implication for the success of the pregnancy. But if they share the same chorion there is potential for serious complications such as a higher rate of fetal malformations, TTTS, and the difficulties for survival of one fetus if the other one dies. If they share the same amnion as well then the risk of complications is much greater. Within one multiple pregnancy it is possible to have any number of combinations- all of the fetuses in separate chorions, some sharing chorions as well as amnions, others sharing chorions but not amnions. Therefore it is highly recommended that thorough ultrasound examinations take place as early in the pregnancy as possible, performed by technicians trained in detecting chorionicity.
Further information:The Alphabet Soup of Twin Biology Dr. Geoffrey A. Machin Dizygotic (dizygous) -- formed from two separate zygotes. Embryo reduction -- See fetal reduction. Fetal reduction -- The reduction in number of viable fetuses/embryos in a multiple (usually higher multiple) pregnancy by medical intervention. Fetofetal transfusion syndrome -- see Twin to Twin Transfusion Syndrome (TTTS) . Fetus papyraceous -- A fetus that dies in the second three months of pregnancy and becomes compressed and parchment-like. Fraternal Twins - Dizygotic. Higher order birth -- Triplets, quadruplets, quintuplets or more. Higher order pregnancy -- A pregnancy with three or more fetuses. Infant death -- Death in the first year of life. Monoamniotic twins -- Two babies who have developed in the same amniotic sac. Monozygotic (monozygous) -- Formed from one zygote. Multifetal reduction -- See Fetal reduction. Multiple pregnancy -- A pregnancy with more than one fetus. Neonatal death -- A death in the first four weeks after delivery. Perinatal mortality -- A stillbirth or death during the first week after delivery. Selective fetocide -- The medical destruction of an abnormal twin fetus in a continuing pregnancy. Selective reduction -- See Fetal Reduction. Siamese twins -- conjoined twins. Stillbirth -- A baby born with no sign of life from 24 weeks' gestation. Superfecundation -- Conception of twins as a result of two acts of sexual intercourse in the same menstrual cycle. Superfetation -- Conception of twins as a result of two acts of sexual intercourse in different menstrual cycles. Supertwins -- Triplets and higher order births. Trizygotic -- Formed from three separate zygotes. Twin to twin transfusion syndrome -- (TTTS) Condition in which blood from one monozygotic twin fetus transfuses into the other via blood vessels in the placenta. Uniovular -- Monozygotic. Vanishing twin syndrome -- The reabsorption of one twin fetus early in the pregnancy. Zygosity -- Describing the genetic make-up of children from a multiple birth. Zygote -- A fertilized ovum
- Preterm Labour
- Antenatal Care
Women who are expecting multiples have a need for:
education regarding the prevention and symptoms of pre-term labor
prenatal resources and care designed to avert the pre-term birth of multiples, including:
- diagnosis of a multiple pregnancy, ideally by the fifth month, which is communicated tactfully, with respect for the privacy of the parents;
- nutrition counselling and dietary resources to support a weight gain of 18-27 kilos (40-60 pounds)
- obstetrical care which follows protocols of best practice for multiple birth; and when the health of the mother or family circumstances warrant:
- extended work leave;
- bed rest support; and
- child care for siblings.
- Low Birth Weights and Pre-term Multiple Births: a Canadian Perspective (Best Start and Multiple Births Canada)