5: The death of a twin in the first trimester

I had dozens of appropriate references for this chapter because I have spent years unearthing research studies about the death of a twin  in the first three months of pregnancy.  The most controversial idea in this book is that, even when your twin died in the first trimester, (the first 12 weeks) this can still leave some vague psychological impression, somewhere in the back of your mind.  So I made sure I got my facts right.  If I am to be taken to task on this, and if I can demonstrate a solid foundation for the physical aspects of this, then  it will be a good start.

So. Here is your snippet for today, about bleeding, which is one of the most widely recognised signs of a twin lost in the first trimester.

Chapter 5: the death of a twin in the first trimester

Vaginal bleeding
Various studies suggest that vaginal bleeding complicates a quarter of all pregnancies.  The nature of that bleeding has been subjected to careful analysis.  The term “light spotting” is used to describe the situation when a woman discovers bleeding by wiping but does not require use of sanitary protection.  “Heavy bleeding” soaks underwear or requires a pad.  In one study, three quarters of women who experienced bleeding reported “a single episode of light spotting” in the first trimester. 
Spotting or slight vaginal bleeding, at a stage when one is still unsure of a pregnancy, is a private matter.  For most women it is too embarrassing to discuss at all.  Furthermore, according to several studies, most women with vaginal bleeding in the early weeks of pregnancy go on to achieve a live birth, so an episode of light spotting could easily be overlooked or ignored.    Until the advent of ultrasound and its use in early pregnancy, vaginal bleeding was an unexplored area.  It is now generally assumed that significant vaginal bleeding in early pregnancy probably signals the foetal death of one twin. One study of first trimester bleeding revealed a “blighted” ovum in every case.     

When one MZ twin dies in a mono-chorionic twin pair (ie. sharing a chorion) the placental blood supply shifts and changes as a result of the changed demands made upon it.  There may be some leakage of blood from around the placenta.  Mother may notice this as a show of blood.
In a dichorionic twin pregnancy (i.e. with separate chorions) the twins may be DZ or MZ and the two placentas are implanted separately.  If the two separate placentas are fused together, then the placenta of the dead twin remains in the womb, attached to the surviving twin’s placenta.  Even so, the changes in the placenta when one twin dies may cause some bleeding.

Vaginal bleeding misinterpreted
When a mother notices some vaginal bleeding, depending on the stage of pregnancy that has been reached, she may assume that this is her menstrual flow back again and she is not pregnant after all.  If she knows she certainly is pregnant; if she has no idea she is carrying twins and no ultrasound scan is made to check, she may assume that the bleeding signals the end of her pregnancy and that her baby is lost.  Later on, experiencing all the symptoms of pregnancy, she may take a test and be surprised to find she is still pregnant.  After an “incomplete miscarriage” – i.e. where there has been bleeding but no sign of a foetus or placenta, a doctor may recommend a dilatation and curettage procedure (D&C) to clear all remaining detritus of the pregnancy out of the womb.  This is to prevent a major bleeding episode or an infection, which can happen if parts of the placenta are left behind. For many years it has been common practice to carry out a D&C after a miscarriage and it is probable that many sole surviving twins have been “surgically removed” in this way after the miscarriage of their co-twin.

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