Abnormal Development - Twinning
Introduction
While singleton human births are the most common, there are also several different forms of twinning that may arise in the early weeks (first two weeks) of development. The two major twinning forms are monozygotic (from one fertilised egg and a single spermatazoa) or dizygotic (from two eggs fertilised by two different spermatazoa).
In addition to the zygosity, the additional twinning classifying terms refer to the type of placenta and fetal membranes, either separate or shared by the twins. Twinning has both a higher incidence of mortality in twins, due mainly to preterm delivery, and of incidence of birth defects.
Some Recent Findings
- Maternal immunologic rejection: lessons from discordant dizygotic twin placentas.[1] "We describe a series of dizygotic twin placentas where the more severe the chronic villitis, the more affected the placenta and fetus. Since the maternal environment was constant for each of these twins, differences in villitis severity appears to be attributable to differences in the ability of each placenta to induce a maternal immune response."
Twinning Prevalence
The prevalence of spontaneous livebirth monozygotic twinning is relatively constant, with variability in dizygotic twinning around the world.[2]
- Asia 6 in 1000
- Europe/USA 10-20 in 1000
- African-Americans 26 in 1000
- Africa 40 in 1000
- Japan 1 in 250
- Nigeria 1 in 11
Monozygotic conjoined twins - 1 in 100,000 births (more female)
United States of America - 2.7% of all confinements resulted in a multiple birth in 1996 (U.S. Census Bureau, 1999, p.80)
New Zealand - 1.6% in 1998 (Statistics New Zealand, 2000, p.70)
Australia - 1.5% in 1998 (ABS, see below)
Australian Twinning Prevalence
Data from the Year Book Australia (2002) looking at pregnancies (confinements) shows the number resulting in a singleton live birth has been declining while the number resulting in multiple births has been increasing. This has been attributed to increased number of births to older women and the increasing use of assisted conception technologies.
"While the number of confinements resulting in multiple births remains relatively low, there has been a steady increase since the 1970s."
Multiple Births
- 1980 - 1.0% (2,249 of 223,318; 2,219 twins, 30 triplets or higher)
- 1990 - 1.2% (3,168 of 259,435; 3,074 twins, 94 triplets or higher)
- 2000 - 1.6% (3,900 of 245,700; 3,800 twins, 100 triplets or higher)
"Among older women this trend is more pronounced. In 1980, there were 730 confinements resulting in multiple births to women aged 30 years and over, constituting 1% of all confinements among women over 30. By 2000, this number had increased to 2,300 (2%)." [3]
Dizygotic Twinning
Dizygotic twins (fraternal, non-identical) arise from separate fertilization events involving two separate oocyte (egg, ova) and spermatozoa (sperm).
Monoygotic Twinning
Monoygotic twins (identical) produced from a single fertilization event (one fertilised egg and a single spermatazoa, form a single zygote), these twins therefore share the same genetic makeup. Occurs in approximately 3-5 per 1000 pregnancies, more commonly with aged mothers. The later the twinning event, the less common are initially separate placental membranes and finally resulting in conjoined twins.
Week | Week 1 | Week 2 | |||||||||||||
Day | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 |
Cell Number | 1 | 1 | 2 | 16 | 32 | 128 | bilaminar | ||||||||
Event | Ovulation | fertilization | First cell division | Morula | Early blastocyst | Late blastocyst
Hatching |
Implantation starts | X inactivation | |||||||
Monoygotic
Twin Type |
Diamniotic
Dichorionic |
Diamniotic
Monochorionic |
Monoamniotic
Monochorionic |
Conjoined | |||||||||||
Table based upon recent Twinning Review.[2]
Twin-twin Transfusion Syndrome
Twin-twin transfusion syndrome (TTTS) can occur in both monochorionic and diamniotic twins that results from an unbalanced blood flow from one to the other in utero. Monozygotic twin pregnancies carry a 10-20% risk of twin-twin transfusion syndrome.
- Twin-to-twin transfusion syndrome, vein of galen malformation, and transposition of the great arteries in a pair of monochorionic twins: coincidence or related association? [4] "The development of TTTS, VGM, and TGA in a single monochorionic pregnancy could be pure coincidence, but there might also be a causative link. We discuss the possible contribution of genetic factors, fetal flow fluctuations, vascular endothelial growth factors, and the process of twinning itself to the development of these congenital anomalies."
Acardiac Twins
Historically called chorioangiopagus parasiticus. Acardia, also called twin reversed-arterial perfusion (TRAP) sequence, is an extreme form of twin-twin transfusion syndrome. In a twinned human fetal development where monozygotic twinning or higher multiple births have an artery-to-artery and a vein-to-vein anastomosis in the monochorial placenta.[5]
The incidence of this condition is 1% of monochorionic twin pregnancies (approx. 1 of 35,000 pregnancies).
References
Reviews
<pubmed>16283408</pubmed>
<pubmed>16045531</pubmed>
Articles
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Cite this page: Hill, M.A. (2024, April 26) Embryology Abnormal Development - Twinning. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Abnormal_Development_-_Twinning
- © Dr Mark Hill 2024, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G