Twin Deformities
Twin Deformities
Twin Deformities
Submitted to
2023-2024
By
SUSRUDHAN S
GRADE-XII
DEPARTMENT OF BIOLOGY,
CERTIFICATE
This is to certify that Master Susrudhan S , student of class XII, VelalarVidyalayaa Senior
Secondary School, Erode, has successfully completed the project titled “TWIN
DEFORMITIES” during the academic year 2023-2024 towards partial fulfillment of credit for
the Biology Practical evaluation of AISSCE-2023-2024 under my supervison.
Mr. A.VASUKUMAR,
Department of Biology,
VelalarVidyalayaa Sr. Sec. School,
School Seal Erode-638012.
ACKNOWLEDGEMENT
Gratitude is the deep perception which makes thread flow from one’s inner heart. I owe my
Principal VelalarVidyalayaa Senior Secondary School, Erode, for their kind patronage and
facilities offered.
I expressed my whole hearted thanks to the faculty guide of Mr.A.VASUKUMAR who gave his
My vocabulary falls short of right words to express my immense debts to my parents who were
Twin pregnancies in India complicates 1% of pregnancies and are the cause of 10%
perinatal mortality.
The rate of twinning continues to increase due to the combined effect of a rise in parental
age, urban residence and increased use of assisted reproductive technology. The risk of
congenital anomalies in twins is higher than in singletons, but it is less well reported in
relation to growth patterns. The auxological outcome of twin pregnancies when one or
both of twins are affected by one or more malformations.
Fraternal and identical twins can be affected by pregnancy complications, and subsequent
birth defects.One of the most common issues is that twins are very often delivered
preterm, often due to premature rupture of the membranes. While most mother give birth
to healthy babies, there may be problems that lead to improper development of one or
both the fetuses. This increases the chance of twins being born with birth defects.
TheART techniques including ovulation induction with or without IUI are associated
with a risk of multiple pregnancy of 8–10%. This increases up to 30% with IVF and two
blastocyst transfereffects by 50%.
Definition of Twins
Twins refer to the two offspring that are brought forth by the same pregnancy and birth. Twins
may be monozygotic (or identical) or dizygotic (fraternal).
Prevalence
The prevalence of multiple gestation globally at present is 32 per 1000 deliveries. Recent
studies from India report an incidence of 30.5 per 1000 deliveries.
Kodinhi- twin city in India,about 150km from Kochi, the village is home to 2,000 families.
And there are at least 400 pairs of twins or more among those families, as of 2017. But the
reason is still a mystery.
Classification of twins
Twins may be classified according to the degree of separation in utero: (1) dichorionic-
diamniotic twins, (2) monochrorionic-diamniotic twins, (3) monochorionic-monoamniotic twins,
and (4) conjoined twins.
1.Monozygotic twins
The National Library of Medicine says that monozygotic, or identical, twins are conceived from
one fertilized egg. This egg separates into two embryos after it has begun to divide. These two
embryos develop into two babies.
Genetic materials called chromosomes in both babies are completely identical. This is because
both babies come from the same egg and sperm. For this reason, both children are assigned the
same sex at birth and share the same genetic characteristics, such as eye and hair color.
Still, because of differences in the environment where they’re born (like the amount of space
each had in the uterus), identical twins may have slight differences in appearance.
In monochorionic-diamniotic twins, the twins share the same placenta and (mostly) are
diamniotic, i.e. having two amniotic sacs. This is common in monozygotic twins (i.e. 60-70%).
Not all twins are identical, of course. More often than not, twins are born with unique physical
characteristics. Nonidentical twins are generally known as fraternal twins.
The scientific term for fraternal twins — “dizygotic” — refers to two fertilized eggs. Dizygotic
twins happen when the birthing parent’s body releases two eggs at the same time. A different
sperm will fertilize each egg.
Since fraternal twins are the result of different eggs and different sperm, they share the same
percentage of chromosomes as any other siblings. The National Human Genome Research
InstituteTrusted Source says that this is about 50 percent. This is why they don’t look exactly
alike and can be assigned different sexes at birth.
In dichorionic-diamniotic twins, the twins have separate chorions and amniotic sacs (hence, the
name). This is very common among dizygotic twins. This type also has the lowest mortality risk.
3. In monochorionic-monoamniotic twins, the twins share the same chorion and amniotic sac in
utero.
4. In conjoined twins, the identical twins are joined in utero and share one common chorion,
placenta, and amniotic sac.
Twin deformity
A birth defect or deformity or anomaly is a medical term meaning irregular or different from
normal. Anomalies occur more frequently in identical twins than in other pregnancies.
Risk factors for twin deformities
Genetic cause.
Environmental causes.
The first order born twin has the higher risk of birth defects.
Monozygotic (MZ) twins are at an increased risk of birth defects compared to both
singletons and dizygotic (DZ) twins.
Fetal Factors
Maternal Factors
Twin deformity
It is common for twins to be a little underweight compared to babies from singleton pregnancies.
This is because they are born premature or before the entire pregnancy term is finished. Since a
fetus mainly gains weight in the last trimester of pregnancy, in the case of preterm twins the
babies do not get the opportunity to gain weight before birth.
Babies will increase in weight soon after birth, but those born before 32 weeks and weighing less
than 3.3 pounds are at increased risk for long term problems. Such problems include blindness,
hearing loss, mental retardation and cerebral palsy.
Figure 2. The one baby is normal and another baby is having microcephaly, Decreased
weight
2. Chromosomal anomalies
A study conducted by the University of Florida’s Maternal Child Health Education Research and
Data Center, found that boys were at a 29% higher risk of developing birth defects in pairs of
opposite sex twins.
The boys were two times more likely to be born with defects affecting their genitals and urinary
organs than the girls. Researchers believe this is because boys develop at a slower pace in the
womb as compared to girls. They believe that if the baby is further ahead in development it
would be protected against certain birth defects.
The same study by researchers at the University of Florida also found that boys were five times
more likely to be born with an obstruction between the stomach and the small intestine.
However, a common birth defect in twin is congenital hip dislocation. Researchers computed
that girl were ten times more likely to end up with congenital hip dislocation than boys.
This condition has an abnormal hip joint wherein the ball at the top of the thigh bone, is not
stable within the socket which is supposed to hold it. This often causes the ball and socket joint
to dislocate at the time of birth. The ligaments on the hip are stretched or loosened due to this
dysplasia.
b. Club foot
One hypoplastic ventral pair of legs without any spontaneous movements and one normally
developed dorsal pair of legs with spontaneous movements) as well as a pes equinovarus of the
right foot and an imperforate anus.
Identical twins who share a single placenta but have two separate amniotic sacs are called
monochorionic twins. The shared placenta connects the blood supply of the twins, allowing the
flow of blood between them.
In case there is unequal blood supply, the twins will develop at different rates. This can lead to a
condition where the smaller twin pumps blood to the larger twin. It is called twin to twin
transfusion syndrome (TTTS).
This uncommon condition, also termed Acardiac Twinning, affects less than 1% of
monochorionic twin pregnancies. In this condition, one twin develops with an abnormally
functioning heart. It may also be missing other organs such as the head or limbs. The acardiac
twin receives all its blood supply from the healthy twin as they are sharing umbilical artieres via
the placenta.
This places pressure on the healthy twin’s heart, putting it at risk of heart failure and even death.
The survival rate for the healthy twin is 25-50% if the TRAP sequence is not treated in time. The
condition can be identified by a simple ultrasound and will require prenatal care of the healthy
twin to reduce the risk of heart failure. Unfortunately, the acardiac twin will not survive.
Figure 8. Twin reversed arterial perfusion (TRAP) sequence
Twins are more likely to develop a congenital heart defect than babies from singleton
pregnancies. Congenital heart defects are the most common form of birth defect and there has
been a have reduced mortality due to them in recent years. The term actually refers to a number
of different defects that may affect the heart, which are classified as cyanotic and non-cyanotic.
1. Cyanotic defects are easily identifiable based on the blue skin colour of the baby caused
due to the lack of oxygen.
2. Non-cyanotic defects may be tougher to identify at birth as they may not have any
obvious physical symptoms.
Figure 9. Conjoined twin girls who shared part of their livers and heart
8. Conjoined twins
Preterm labor/birth
Low birth weight and infant mortality.
Single intra uterine fetal death
Investigation
Fetal monitoring was done by daily fetal movement count, biweekly nonstress test (if
more than 32 weeks).
Treatment
1. Although there is high prenatal and postnatal mortality, successful separation has
become more common due to advances and improvements in neuroimaging, neuro-
anesthesia, and neurosurgical techniques.
2. There is a higher risk of preterm birth in twin pregnancies with SIUFD (Single
intrauterine fetal demise), so steroids should be administered <34 weeks to induce lung
maturity. Most studies favor conservative management until 37 weeks’ gestation, if fetal
movements, cardiotocography, and USG show no abnormalities. If there are no other
obstetric causes, delivery of dichorionic twin pregnancies with single fetus demise is not
recommended before the 38th week.
3. All twin pregnancies with one dead fetus should be managed in tertiary referral centers
with sufficient neonatal support. Intensive fetal surveillance is required and the
determination of chorionicity should be done early in the pregnancy.
4. A detailed study of the anatomic features by clinical examination and with the use of
different imaging modalities is mandatory for the surgical planning and several surgical
reconstructive steps had to be performed by a multidisciplinary team over the first years
of life. Ultimately, however, there is an improvement in quality of life considerably and it
is likely that these children will be able to live an independent life in the future.
Prevention
Conclusion
Use of fertility treatments has been considered the primary reason for the observed
increase in twinning, few studies have examined the impact of use of fertility treatment
on twins’ risk of birth defects.
Twin pregnancies with congenital malformations in foetuses is associated with higher
morbidity and mortality both for the mother as well as the child Its incidence is 4 times
more common than single births.
The clinicians can assist in counselling women on the risk of birth defects associated with
a twin pregnancy.
Increased risk for a number of specific defects were observed in multiple, including
anencephaly,hydrocephalus, tetralogy of Fallot, pulmonary valve stenosis, coarctation of
the aorta,cleft lip with or without cleft palate,oesophageal atresia with or without
tracheoesophageal fistula,anorectal atresia, and hypospadias.
All twin pregnancies with one dead fetus should be managed in tertiary referral centers
with sufficient neonatal support. Intensive fetal surveillance is required and the
determination of chorionicity should be done early in the pregnancy.
Using valproic acid to treat epilepsy during pregnancy, obesity, zinc defciency,
hyperthermia, and folate defciency are all predisposing factors for neural tube defects.
References
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2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299593/
3. Twinning_rates_in_Chennai,_India___A.35 (1).pdf
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5. https://www.babymed.com/monozygotic-dizygotic-monochorionic-dichorionic-twins
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