Womb Twin Survivors (1) - Signs of a twin


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Part 1 of the introduction to the Womb Twin Survivors Research Project. Explaining what a womb twin survivor is. Womb twin survivors are the sole survivors of a twin or multiple pregnancy. Their twin died in the womb or around birth and this includes the "vanishing twin" pregnancies. Various signs are explained, first during the pregnancy, then at the birth and finally inside the body of the survivor, which includes a dermoid cyst and a teratoma.

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Womb Twin Survivors (1) - Signs of a twin

  1. 1. Womb Twin Survivors: <ul><li>A research project about the sole survivors of a twin or multiple pregnancy </li></ul><ul><li>Headed by Althea Hayton </li></ul>
  2. 2. What is a womb twin survivor? The sole survivor of a twin or multiple pregnancy An ultrasound image of a twin pregnancy. The fetus at the top has died. The fetus below will survive to be born alone.
  3. 3. What is a womb twin? In a twin or multiple pregnancy one or more of the embryos or fetuses may die during the pregnancy or around birth. A womb twin has a very brief life: sometimes lasting only a few days or weeks. Some womb twins manage to survive until birth, but are stillborn.
  4. 4. 1 in 10 people is a womb twin survivor <ul><li>How do we know? </li></ul><ul><ul><ul><li>1 in 100 births is a twin birth </li></ul></ul></ul><ul><ul><ul><li>For every twin birth there are 10 womb twin survivors </li></ul></ul></ul><ul><ul><ul><li>That is 10% of the population! </li></ul></ul></ul><ul><ul><li>Boklage, C. E. (1990). “Survival probability of human conceptions from fertilization to term.&quot; International Journal of Fertility 35(2): 75, 79-80, 81-94. </li></ul></ul>
  5. 5. Are YOU a womb twin survivor? <ul><li>The signs: </li></ul><ul><ul><li>In your mother’s pregnancy </li></ul></ul><ul><ul><li>At your birth </li></ul></ul><ul><ul><li>In your body </li></ul></ul>?
  6. 6. Your mother’s pregnancy Twinning - a brief introduction
  7. 7. Monozygotic twinning Identical (monozygotic)twins formed from one zygote Note: zygote = fertilised egg
  8. 8. Dizygotic twinning Fraternal (dizygotic) twins formed from two zygotes Note: zygote = fertilised egg
  9. 9. Multiples Triplets, quadruplets or more, from three or more zygotes
  10. 10. Womb twin survivors can be: <ul><ul><ul><ul><li>Monozygotic (MZ) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Dizygotic (DZ) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Multiple </li></ul></ul></ul></ul>
  11. 11. The death of a twin before birth More images like this: www.layyous.com
  12. 12. Uterus extra large in first trimester
  13. 13. One foetal heart stops beating
  14. 14. The “vanishing” twin on the ultrasound scan The sac on the left is all that remains of the second twin
  15. 15. Bleeding in the first trimester 1 in 5 pregnant women experience first trimester bleeding and the pregnancy proceeds normally. This can be a sign that one twin has died. Trimester = 12 weeks
  16. 16. Ovulation stimulating hormones Clomiphrene citrate is used to assist conception by stimulating the ovaries. This which causes hyperovulation, which often leads to twinning and the birth of twins. Hyper-ovulation = the production of more than one egg a month by the ovaries
  17. 17. More than one embryo implanted after IVF After in-vitro fertilization and the re-introduction of several embryos back into the womb, it is not unusual for more than one embryo to implant and begin to grow. In many cases, one or more of these will die after a few days or weeks. Embryo = an un-born child less than 12 weeks from conception
  18. 18. Miscarriage, but pregnancy continues normally When a mother miscarries her baby, and the fetus is completely expelled with a lot of bleeding, it looks as if the pregnancy is over - but sometimes she remains pregnant and a baby is born after all: in that case, she had been carrying twins.
  19. 19. Abortion, but pregnancy continues A miscarriage is induced but the pregnancy continues, leading to one live birth. This is not a “failed” abortion because the mother had been carrying twins: rather, it is a partial abortion.
  20. 20. Multi-fetal pregnancy reduction The number of fetuses in a multiple pregnancy is reduced by selective abortion of one or more of them. The survivor is born alone, along with the shrivelled remains of the others. Quads or more may be reduced to triplets; triplets to twins, or twins to one baby.
  21. 21. At birth
  22. 22. One twin stillborn One twin may die in the process of being born, or may have already died in the womb before the time of birth.
  23. 23. The birth of an acardiac twin One twin may not develop vital organs, such as a heart (acardiac) kidneys or a proper skeleton. The mis-shaped body of the twin will be delivered along with the sole survivor. The body may be attached to the survivor’s placenta or delivered separately. An ultrasound image of twins, one of them acardiac.
  24. 24. A fetus papyraceous The fetus papyraceous is the name given to the tiny body of a dead twin, whose body remains in the womb attached to the placenta of the sole survivor. It may be embedded in the placenta and scarcely visible. In this case it is clearly seen, but a fetus papyraceous can be missed if the placenta is not carefully examined after delivery. Body of the dead twin Placenta after delivery
  25. 25. Additional cords or sacs When the placenta is examined after delivery, an additional umbilical cord, with or without an empty sac, or may be seen. This cord or sac belonged to a twin, who died in the first 10 weeks of life. This was before the skeleton was formed so the body disintegrated and was soon resorbed. Resorb = to remove cells, a tissue or structure by gradual breakdown into the component materials and disperse into the circulation
  26. 26. In the body of the sole survivor
  27. 27. Parasitic twin Illustration of an adult man with a parasitic twin from “Monstrorum Historia Memorabilis” by Johann Schenk , 1609 A parasitic twin is formed when a zygote split into a monozygotic twin pair more than 14 days after conception. One twin remains attached to the other. If the parasitic twin is surgically removed, then the individual becomes a half-twin: a womb twin survivor.
  28. 28. The fetus in fetu If a parasitic twin develops within the body of the other, this is known as a fetus in fetu. At birth, or many years later, the parastic fetus may cause problems, and is surgically removed. After removal, the surviving twin is alone - a womb twin survivor . Fetus in fetu = a fetus inside a fetus
  29. 29. Teratoma A teratoma is formed when a parasitic twn begins to develop with the body of the other, but only some tissues form properly. In this example the outer membranes have been removed to reveal, a few teeth, some fatty tissue and a piece of bone.
  30. 30. Dermoid cyst <ul><li>Inside the cyst </li></ul>When a parasitic twin develops inside the other twin, the result is a dermoid cyst. Within it there are no recognisable tissues. In this example there is some hair to be seen. Dermoid cysts can be found anywhere in the body, often on one of the ovaries. In this example the cyst is visible just under the skin, on the jaw.
  31. 31. Signs of the opposite sex A man A woman When a dizygotic, opposite-sex twin dies before birth, an additional dose of hormones passes into the body of the DZ womb twin survivor.
  32. 32. Cerebral palsy Pharoah, P. O. and Y. Dundar (2009). &quot;Monozygotic twinning, cerebral palsy and congenital anomalies.&quot; Hum Reprod Update 15(6): 639-48. The incidence of cerebral palsy and some other congenital abnormalities has been strongly associated with the loss of a monozygotic twin in the first few weeks of life.
  33. 33. Left-handedness Left-handedness has been associated with the loss of a monozygotic “mirror” twin early in life. “ Mirror” twins are monozygotic twins who are like mirror images of each other, one left-handed, one right handed.
  34. 34. If you have none of these signs… But you feel sure you are a womb twin survivor, you still could be. The loss of a twin before birth often goes undetected by everyone involved. There is help available….
  35. 35. Womb Twin Survivors <ul><li>Find out more </li></ul><ul><li>http://www.wombtwinsurvivors.com </li></ul><ul><li>http://WombTwinSurvivors.blogspot.com </li></ul>