- defined as those born at the same time or of the same pregnancy.
- may be fraternal
identical or
conjoined
Source: http://www.lemenille.com/twins.jpg
IDENTICAL TWINSMONOZYGOTIC TWINS
Identical twins begin as a single fertilized egg (zygote),
THEN…
that creates
2 separate, but identical, individuals.
IDENTICAL because they have the same DNA
Therefore, they have the same
* gender
* blood type
* hair & eye color
* genetic disorders
Timing is Everything!
Source: http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/images-thefetus/gem-04.jpg
Dichorionic diamnioticIf the split occurs before cells begin to
differentiate at 4 days, the monozygotic twins will implant as 2 separate blastocysts. Each will have his/her own chorion and therefore his/her own amnion, as well.
These twins are then called dichorionic (2
separate chorions) diamniotic (2 amniotic sacs).
(NOTE that in this case, they are traveling through the oviduct when they separate.)
This occurs in 1 of every 4 twin sets.
Dichorionic diamnioticThese twins will develop in
their own amniotic sac, each with his/her own placenta. This separation decreases the risk of entanglement and twin-twin syndrome (described below) that occurs with greater frequency in monochorionic twinning.
Source:http://bidmc.harvard.edu/content/bidmc/departments/radiology/files/fetalatlas/gestations/dimono/xyz_b9737_19b.jpg
Monochorionic diamnioticIf, however, they separate between days 4-8, the
twins will share a chorion/placenta but have separate amniotic sacs.
Thus, they are referred to as monochorionic
diamniotic twins.
3 in 4 sets will develop in this way.
Source: http://bidmc.harvard.edu/content/bidmc/departments/radiology/files/fetalatlas/gestations/dimono/xyz_s9897
Summary of Two Types
Source: http://www.centrus.com.br/DiplomaFMF/SeriesFMF/11-14weeks/images-thefetus/gem-04.jpg
Late and Rare
If they split between the 8th and 13th day, then twins will share the same chorion AND amnion – monochorionic monoamniotic
(Mo-Mo’s)
(Keep in mind: they were implanted in the endometrium as one, THEN split.)
Only 1-2% of monozygotic twins occur this way.
Mo-Mo’sMo-Mo’s will share the placenta, as well as
the amniotic sac. That means there is a risk of being entangled/strangled by the umbilical cord/s.
The fetal heart rate is often tested daily to check for entanglement
This risk decreases as the twins mature, there is less room and less movement.
Mo-Mo’sMo-Mo’s share a placenta, therefore, blood
vessels often go between the two. This can lead to imbalance of blood flow, called twin-twin syndrome (TTS). That leaves one twin getting less blood and produces less urine. This twin is often much smaller than the other. Extra blood flow to the other, however, may result in heart failure.
Untreated, TTS may terminate the pregnancy
Disk and RiskOn day 13, the embryonic disk (bilayer of
epiblast and endoderm) begins to differentiate.
If the split occurs after day 13, the twins will share a chorion and amnion. They will also share body parts. They will be conjoined (Siamese) twins
Only monozygotic twins can be conjoined.
Source: http://home.att.net/~drdipstik/pow/pow041.jpg
Conjoined twinsConjoined, often referred to as “Siamese”
twins were once thought to be the stuff of myths and legends. With modern medicine and global communication, we are well aware that this incomplete division of identical twins really does occur. Television shows have documented the drama of having conjoined twins separated through very complex and surgeries.
“Siamese”
Conjoined, or “Siamese”, twins are so named due to the common recognition of the set of male conjoined twins of Siam. Born in 1811, they acquired ‘celebrity status’ through public exhibition in the U.S. and England.
Though remained attached by skin and liver and married (sisters) and conceived a combined total of 21 children.
Conjoined twins are 3 times more likely to be female than male
1 live set of conjoined twins is born in every 200,000 births
Country of origin influences frequency
Conjoined facts to ponder
Types of Conjoined Twins
Diagram sources: http://i.cnn.net/cnn/2003/WORLD/asiapcf/south/08/18/india.twins/vstory.india.twins.afp.jpg
Craniopagus:
Attached at back of the head
Separation is possible although brain damage is common
Diagram sources: http://www.conjoinedtwinsint.com/types.htm , http://www.hopkinschildrens.org/images/news/craniopagus_twins.jpg
A website dedicated to support, education and research regarding conjoined twins
Types of conjoined twins
Rachipagus:Very rare – union at
back of spine
Diagram source: http://www.conjoinedtwinsint.com/types.htm A website dedicated to support, education and research regarding conjoined twins
Diagram source: http://www.conjoinedtwinsint.com/types.htm , http://www.conjoined-twins.i-p.com/twins.jpghttp://www.conjoined-twins.i-p.com/bacjoin.jpg A website dedicated to support, education and research regarding conjoined twins
Parapagus:
Side union, limbs vary
Separation is possible, but is indicative of prosthetic limb/s
Pygopagus:
Union at back of pelvis
Low frequency of occurrence, but survival rate is high
Cephalopagus:
Union is in the front at the chest and head with 2 faces on opposite sides
These twins do not survive.
Ischiopagus:
Union is at the front of the pelvis - many shared internal organs.
Separation survival rate is good - excretion and sexual functions may be compromised.
Diagram source: http://www.conjoinedtwinsint.com/types.htm A website dedicated to support, education and research regarding conjoined twins
Omphalopagus:Union at front of abdomenal region – liver tissue may be
shared.
Separation of these twins has the highest rate of survival.
Thoracopagus:Union is at the front of the chest – the heart may be
shared.
These twins do not survive separation
Diagram source: http://www.conjoinedtwinsint.com/types.htm , http://cellar.org/pictures/moretwins.jpgA website dedicated to support, education and research regarding conjoined twins
Parasitic
Additional limbs, torsos or heads, believed to be caused by the death of one twin in utero.
Diagram source: http://www.conjoinedtwinsint.com/types.htm A website dedicated to support, education and research regarding conjoined twins
Why does twinning happen?
?
Don’t know
about 30% of twins are identical yet the causes
of monozygotic twinning are not known
monozygotic twinning is NOT genetic, BUT
the frequency of monozygotic twinning does increase with mother’s age, especially over 35
Twin birthsCommon complications with twin births exist for
mom and baby and include:
* higher risk of gestational diabetes * preeclampsia (high blood pressure, protein in urine,
swelling) * pre-term delivery (due to rupture of membranes) * undersized babies
* risk of breech delivery
sites to visit• http://zygote.swarthmore.edu/cleave4b.html• http://www.uhrad.com/pedsarc/peds034.htm
references• http://www.vh.org/adult/provider/obgyn/twinpregnancy/• http://www.dhmc.org/monochorionic_twins.cfm