Royce Gabrielle B.

Castronuevo
BSN II-D

Introduction

At least everybody knows some one or knows of someone who is a twin, but none of us really ever stop to think about
why there are twins and how are they formed What processes does it involve? how many types of twins can we have?
What are conjoined twins?etc.

Here is an attempt to explain what twinning is, and to explain the various questions related to it.

Basically there are two types of twins:

1. Identical twins: Monozgotic twins, having a very similar genetic make-up, are always the same sex, have the
same blood type, and usually look very similar. There are exceptions though. Some identical twins do not have
the exact same genetic composition. The rate of identical twinning shows little variation with the mother’s age
but identical twins occur approximately once out of 250 births.
2. Fraternal twins:. Dizgotic or fraternal twins are twice as more common than identical twins. These twins arise
from multiple ovulation. Normally, just a single ovum is released from an ovaryeach month. When more than a
single ovum is released it is called multiple ovulation. If all of the ova are fertilized, genetically dissimilar twins
or higher multiples may occur. Dizgotic twins usually do not share anymore similarities than would be
expected with any siblings. Fraternal twins often have a different gender, blood type and other characteristics.
Studies also show that the rate of fraternal twinning increases with the mother’s age.

Then there can be polar body twins also, which are very rare.

There is one special type of twins called conjoined twins. They have fascinated the people for centuries now. They are
also called as Siamese twins.

The rarest type of twinning would be the twins by two different fathers. This is called “Heteropaternal
Superfecundation. This occurs when an egg is released, even though another egg has already been fertilized. If the
second egg is fertilized by another man’s sperm, the fetuses would be no closer genetically than half siblings. There
are not very many cases depicting this type of birth.

Identical and fraternal twins

Identical - monozygotic (one zygote) -- twins formed when a single fertilized egg splits into two genetically identical
parts. The twins share the same DNA set, thus they may share many similar attributes. However, since physical
appearance is influenced by environmental factors and not just genetics, identical twins can actually look very
different. Identical twins are always same-sex sets.

There is also such a thing as “Half-Identical” twins which is not to be confused with “fraternal” twins. Half-Identical
twins occur when and unfertilized egg splits and then the two eggs are fertilized by two separate sperm. The fetuses
share about half of their genetic code, which they receive from their mother.

Fraternal - or dizygotic (two zygotes) -- twins develop when two separate eggs are fertilized and implant in the uterus.
The genetic connection is no more or less the same as siblings born at separate times. They may look alike, or they
may not.

Scientists have theorized a third, hybrid type called polar body twinning, that occurs when an unfertilized egg splits
into two parts and each part is fertilized by a different sperm. The twins would then share one-half of their gene set
(from their mother). Because it is the father's DNA that determines the sex, the twins can be either same-sex or
male/female.

Definition of monozygotic or identical twins: A type of twins derived from a single (mono) egg (zygote).
Monozygotic twins form when a single

Monozygotic Twins Dizygotic Twins Polar Body Twins

Occur when a single unfertilzed egg
Form when a single fertilized egg splits Form when two eggs are fertilized by
splits into two and is fertilized by
into two. two separate sperm.
separate sperm.
 Sometimes referred to as hybrid or half-
Also called identical. Also called fraternal.
identical twinning.
Only one-third of all twins are It is not known what percentage of twins
Two-thirds of twins are fraternal.
identical. falls in this third category.
Can be hereditary on the mother's
Don't "run in families" except by
side. The tendency to hyper ovulate
coincidence. No hereditary influence
(release more than one egg in a cycle) Not known.
for identical twinning has been
is a genetic trait that can be passed
identified.
from mother to daughter.
May have one shared placenta, two
May have two separate placentas or May have two separate placentas or two
separate placentas, or two placentas
two placentas fused into one. placentas fused into one
fused into one.
Share about 75% of their genetic
Share about 50% of their genetic
Share 100% of their genetic markers. markers, more than fraternals but less
markers, same as singleton siblings.
than identicals.
Are always same sex. May be same sex or male/female. May be same sex or male/female.
May have the same blood type or May have the same blood type or
Have the same blood type.
different. different.
Not caused by fertility treatments, Can be attributed to fertility
birth control pills or maternal age. No treatments, advanced maternal age, No one knows what causes this type of
one knows what causes identical birth control pills or other factors that twinning to occur.
twinning. influence twinning.
May be contained in one sac in utero. Develop separate sacs in utero. Develop separate sacs in utero.
Can result in conjoined twins or mirror
Not conjoined. Not conjoined.
image twins.
May be at risk for Twin-to-Twin
Rarely at risk for TTTS. Rarely at risk for TTTS.
Transfusion Syndrome (TTTS)

The following pictures and text explain the difference between identical and non-identical twins.

Identical Twins (also known as Uniovular or Monozygotic twins).

During the fertilization process, only one ovum is impregnated by only one
spermatozoid, but the egg divides in 2 embryos afterwards. They have
exactly the same chromosomes, they have a perfect resemblance and they
have the same sex.

There are 3 different ways that identical twins can develop and be carried:

• With the first case there is only one placenta that feeds the babies,
but there can be two amniotic sacs (as in the diagram at the side).
When there is 1 placenta and 2 amniotic sacs then the pregnancy is
referred to as having a "mono-chorial" placenta and is "bi-amniotic".
• In the second scenario, there is only one amniotic sac. In the case
of 1 placenta and 1 amniotic sac then the pregnancy is referred to
as having a "mono-chorial" placenta and is "mono-amniotic".

• The third scenario is where there are two placentae and each
embryo has its own amniotic pocket. When there are two placentas
and two amniotic pockets like this, then one speaks of a "bi-chorial"
pregnancy that is "bi-amniotic". (This last case is an identical
situation to fraternal twins as shown below).
 Non-Identical Twins (also known as Fraternal, Binovular or Dyzygotic
twins).

When twins are non-identical, then two seperate eggs have been
impregnated by 2 separate spermatozoa.

They each have a different chromosome make-up, they don't look alike and
they can be either the same or different sex. In fact, this is simply two
separate pregnancies that just happened to occur at the same time.

Each embryo is in its own amniotic sac and has its own placenta. This type
of pregnancy is referred to as "bi-chorial" and "bi-amniotic".

The following pictures and text explain the different ways that cellular division can occur in twins.

What's happening in each scenario?

The Monozygotic twins are derived from only one egg and only one fertilization.

Conjoined twins
History of conjoined twins
One of the earliest documented cases of conjoined twins are Mary and Eliza Chulkhurst, also known as the Biddenden
Maids. Born in 1100, the sisters lived for 34 years in Biddenden, County of Kent, and England. Mary and Eliza, though
often depicted as joined at the hip and shoulders, were likely pygopagus twins who were joined at the buttocks and
lower backs.
Then there were the famous Siamese twins with whose name are the conjoined twins called these days. Chang and
Eng Bunker, the famous conjoined twins from Siam who earned their living in the U.S. as a circus attraction in the
Barnum and Baily Circus.

What are conjoined twins?

The phrase 'Conjoined Twins' is the appropriate given name for twins that are physically conjoined.

How are they formed?

Siamese or conjoined twins are the result of a rare embryological accident. The developing embryo begins to split into
identical twins but then stops part way leaving the partially separated egg to mature into a fetus. Most conjoined twins
are stillborn, and those that survive often die within a few hours. The frequency of the birth of conjoined twins is
difficult to estimate, but perhaps 5% of monozygotic (identical twin) twinning fail to separate completely and are
conjoined. "According to Dr. Alan Guttmacher, noted physician and monozygotic twin, conjoined pairs are rarities
which occur only once in 50,000 to 80,000 births." There is a great range in the degree of fusion, and depending upon
which organs are shared, some twins have undergone separation surgery where both have survived. Points of juncture
can be entire torsos, the top or side of the cranium, hips, rear ends, and chests.

Conjoined twins are usually classified by the point at which they are joined (the Greek word pagos , means "that which
is fixed.") Hence, the suffix-pagus is used meaning fastened.There have been as many as three dozen separate types
identified in the last century. The following basic classifications can be combined to more closely define individual
cases.

Types:
1. cephalopagus
2. craniopagus
3. craniothoracopagus
4. dicephalus
5. ischopagus
6. omphalopagus
7. parapagus
8. pygopagus
9. thoracopagus

1. Conjoined Twins
Conjoined twins are monozygotic multiples that do not fully separate from each other due to the incomplete division of
the fertilized ovum. The individuals will be connected at certain points of the body, and may share tissue, organs or
limbs.njoined twins are monozygotic multiples that do not fully separate from each other due to the incomplete
division of the fertilized ovum. The individuals will be connected at certain points of the body, and may share tissue,
organs or limbs.

2. Twins Conceived Separately: Superfetation

Normally when an egg is fertilized, a woman's cycle is interrupted and ovulation ceases. Rarely, however, an egg can
be released while a woman is already pregnant, resulting in twins that are conceived at different times.

3. Twins with Different Fathers: Heteropaternal Superfecundation

Fraternal (dizygotic) twins are the result of hyperovulation, the release of multiple eggs in a single cycle.
Superfecundation describes a situation where the eggs are fertilized by sperm from separate incidences of sexual
intercourse. In a case where a woman has sex with different partners, the twins could have different fathers and the
apporpriate term is heteropaternal superfecundation

4. "Half Identical" Twins: Polar Body Twins

There are two types of twins, right? Dizygotic (fraternal) twins result when two eggs are fertilied. Monozygotic
(identical) twins come from a single fertilized egg that splits. But what if the egg splits and then each half meets a
sperm? That's the proposed theory for polar body or "half-identical" twins, twins who are very much alike but aren't a
100% DNA match. Although it seems to be a reasonable theory, there is no definitive test to confirm polar body
twinning.

5. Boy/Girl Identical (Monozygotic) Twins

Identical (monozygotic) twins are always same gender because they form from a single zygote that contains either
male (XY) or female (XX) sex chromosome. However, there have been a few reported cases of a genetic mutation in
male twins where one twin loses an Y chromosome and develops as a female. The female twin would be afflicted
with Turner's Syndrome, characterized by short stature and lack of ovarian development. Of course, another
explanation for gender differences in identical twins is an identical twin who undergoes a sex change operation.

6. Mirror Image Twins

Mirror image twins are monozygotic, twint that form from a single fertilized egg. When the split occurs late - more than
a week after conception - the twins can develop reverse asymmetric features. This term is not really a type of twin,
just an way to describe their physical features. For exmample, they may be right- and left-handed, have birthmarks on
opposite sides of their body, or have hair whorls that swirl in opposite directions. In theory, if the twins faced each
other, they would appear to be exact reflections of each other. About 25% of identical twins are mirror image twins.

7. Parasitic Twins
A type of conjoined tiwns that develops asymmetrically, with a smaller, less formed twin dependent on the stronger,
larger twin. Manar Maged gained notoriety after being featured on Oprah. A variation of parasitic twinning is fetus in
fetu, where an abnormally formed mass of cells grows inside the body of its monozygotic twin. It survives during
pregnancy, and even occasionally after birth, by tapping directly into the blood supply of the host twin.
This report describes an Indian man whose fetus in fetu was discovered as an adult.

8. Semi-Identical Twins
A type of twinning identified in a pair of three-year-old twins in 2007. Described as identical on the mother's side but
sharing only half their father's genes, the rare twins developed when two sperm fertilized a single egg, which then
split. One twin is a hermaphrodite being raised as a female, with both testicular and ovarian structures, while the other
is anatomically male.