1. TWINS AND MULTIPLE PREGNANCY Buxton U3A 16 th May 2014 Ann Clark and Marion Overton

2. Frequency of Births in England and Wales 2011 MATERNITIES 716,040 TWINS 11,3301/63 TRIPLETS 1721/4163 Almost 1/63² (1/3969) QUADRUPLETS OR MORE 31/238,680 Almost 1/63³ (1/250,047)

3. Multiple Births statistics in the UK for 2012 England and Wales ScotlandNorthern Ireland UK Total Total Maternities 729,674 (excluding stillbirths) 57,41925,269812,362 All multiples 1,441 (including stillbirths 874137712,692 Twins11,22887637112,4661/65 Triplets208761/3508 ( 1/65² 1/4225) Quads and above+ 5Not listed 51/145935

4. Length of pregnancy Average birth weight 40 weeks Singletons3.5kg 37 weeksTwins2.5kg 34 weeksTriplets1.8kg 32 weeksQuads1.4kg

5. Mortality Rates England and Wales 2007 (deaths per 1000 births) StillbirthPerinatal (first week) Infant (1 week to 1 year old) All5.27.74.7 Twins11.223.319.9 Triplets19.749.350.3

6. Identical twins have a higher mortality rate because ⅔ share the same placenta and blood circulation

7. Signs of Multiple Pregnancy Pregnancy test Morning sickness Uterine size Ultrasound scan Palpation of foetal parts Heartbeat

8. Who has twins or more? Older Mums Fertility treatment –particularly In Vitro Fertilisation (IVF) Positive Family History (for Hyperovulation)

9. Are they identical? Identical –from one egg (monozygous or uniovular) Fraternal –from 2 eggs fertilised at the same time (polyzygous or binovular) This is the zygosity of multiple births, and still holds true, but

10. NICE Guidelines 2011 National Institute for Clinical Excellence published guidelines for Antenatal Care: Risks..determined by chorionicity and not by zygosity Chorion includes the placenta Amnion is the gestational membrane (sac) round the baby

13. Triplets Trichorionic, triamniotic Dichorionic, triamniotic Dichorionic, diamniotic Monochorionic, triamniotic Monochorionic, diamniotic Monochorionic monoamniotic

14. Is sharing a placenta BAD news? It may be: 1.Chromosomal/congenital abnormalities 2.Foetofoetal transfusions 3.Discordance in size

16. NICE Guidelines Refer to a Regional centre: –Major foetal abnormality –Shared placenta (monochorionic) –Foetofoetal transfusion –Discordant foetal growth Scan at 11-14 weeks, then fortnightly from 16- 24 weeks

19. 1947 1949 1950 2008

20. 1960

21. 2008