Twin Pregnancy Check ups

The mother needs more prenatal checkups in case of twin pregnancy comparing with singleton pregnancy.

Generally, the visits will be every month for the first 24 weeks,
then every 2 weeks until 32 weeks,
then weekly till the end of pregnancy.

But, the total number of visits depends on whether the fetuses share a placenta or not.

Different types of twins:
1. dichorionic diamniotic twins
2. monochorionic diamniotic twins
3. monochorionic monoamniotic twins

Check-up list for all types of twins:
1. Determination of chorioamnionicity, number of fetuses and expected due date with ultrasound scan from week 11 – 13.
2. test for Down’s syndrome can be done in the first trimester.
3. In the middle of pregnancy, vaginal exam may be performed to check any signs for premature labor.
4. More frequent blood tests for anemia.
5. Test for gestational diabetes earlier, before week 24.
6. Check for any possibility of developing pre-eclampsia. Low dose of aspirin might be prescribed starting from week 12.
7. Screening for possible congenital anomalies at 18 – 22 weeks.
8. Screening for short cervical length during the second trimester.
9. Starting from 32 weeks, nonstress tests, amniotic fluid evaluation or biophysical profile every week.

Extra information for each type of twins:

1. dichorionic diamniotic twins:

– After the first trimester, if the sexes of the fetuses are different, this can confirm this type of twins.
– Best seen at 10 to 14 weeks.
– Risks are relatively lower.

2. monochorionic diamniotic twins:

– Are identical twins.
– At higher risk of twin-twin transfusion syndrome (TTTS), so more scans are expected.
– Antepartum monitoring from week 28 – 32 might be started.

3. monochorionic monoamniotic twins:

– Rare.
– Are identical twins.
– More frequent scans and check up as there is a risk of cord entanglement.
– Antepartum monitoring from week 28 – 32 might be started.
– At higher risk of early delivery around week 32-33.

Weight gain during twin pregnancy:
It is advised to gain weight by consuming extra 600 calories per day.

Allowed weight gain according to the mother’s weight:
1. Normal weight (BMI 18.5 to 24.9) : 17 to 24 kg gain.
2. overweight (BMI 25 to 29.9): 14 to 23 kg gain.
3. obese (BMI 30≥): 12 to 19 kg gain.

Twin pregnancy complications:
1. Premature labor.
2. Sometimes, steroid injection might be given to help in lung developments of the fetuses.
3. Gestational diabetes.
4. High blood pressure.
5. Twin-twin transfusion syndrome.