Chapter three: The death of a twin around birth

Chapter Three : the death of a twin around birth

This chapter was so sad to write. There are some very sad stories included, sent to me by womb twin survivors, but I can't publish them here because of copyright and privacy issues. They make poignant reading.

Multiple pregnancy is dangerous for both mother and babies. There is a higher incidence of neonatal death, SIDS and stillbirth in a twin pregnancy than in a singleton pregnancy.  If your twin died in the third trimester or around birth, then you can call yourself a womb twin survivor, because you only knew your living twin when you were together in the womb.

Here is a snippet for you:

Stillbirth of one twin
When labour begins, even after careful examination of the mother, it is not always obvious that there are twins.  These days, a twin birth is often induced early or at least monitored with extreme care.  However, before ultrasound scans - and even today in less well-equipped hospitals - it can happen that a second baby is delivered and takes everyone by surprise. Under those circumstances things can go very badly for the second twin, especially if he or she is in a breech presentation (head uppermost.)  With these unexpected twin deliveries, the second baby is often stillborn or lives only for a very short time.  Many do not survive the trauma of birth. The stillbirth rate in twins is double the rate for single births.

Accidental death of one twin
Even shortly before birth, a trauma to the womb or the mother may cause the death of one twin by precipitating a sudden labour when insufficient medical attention is available to prevent disaster.  Sometimes one baby is born dead as a direct result of the trauma.

Umbilical cord complications causing the death of one twin
The average umbilical cord is about 55cm long.  If the cord is much longer it can twist into a knot and the blood supply can no longer reach the baby, in which case the baby asphyxiates and dies.  If it is too short, then when labour begins, the placenta may be torn from the wall of the womb causing a fatal haemorrhage.  When MZ twins share an amniotic sac, the two cords may become entangled and the blood supply to one or both babies may be interrupted, with fatal consequences.  Also a longer cord can become wrapped around the neck of one of the babies, who is at risk of asphyxiation during delivery.  As prenatal ultrasound is becoming  increasingly sophisticated, many of these conditions are being diagnosed before birth.  However, some of these problems are not apparent before delivery, even with the idea of ultrasound.  Where the placentas of DZ twins overlap, this may badly affect the position of the cord of one twin.  Meanwhile, the other twin has a centrally-attached cord, and will thrive and grow rapidly, while the other, with little access to nourishment, will be much smaller and may not survive.

Infection causing the death of one twin
Bacteria entering the vagina can cause an infection and inflammation of the amnion and chorion (the membranes surrounding the baby.)  If an infection develops in the third trimester of an MZ twin pregnancy the inflammation of the shared membranes can trigger premature labour, as a result of which one or both twins may be born dead or die at birth.

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