Twin pregnancy: Understanding the care you need

A twin pregnancy is a unique journey for expectant parents, that brings both excitement and, understandably, questions regarding prenatal care and delivery.

Professor Mina Savvidou, highly revered consultant obstetrician and specialist in fetal maternal medicine, provides clear answers to frequently-asked-questions about twin pregnancies, helping you prepare for a happier, healthier pregnancy.

What are the chances of having twins?

The chances of conceiving twins depend on many factors. On average, about 1 in every 250 natural pregnancies results in twins. However, the likelihood of twin pregnancies increases significantly for women undergoing fertility treatments, such as in vitro fertilisation (IVF) or ovulation-stimulating medications.

Maternal age also plays a role. Women over the age of 35 and those with a family history of non-identical twins may be more likely to conceive twins themselves.

There are two types of twins: non-identical (usually dichorionic with two separate placentas) and identical (usually monochorionic with one shared placenta). Non-identical twins result from two separate eggs fertilised by two different sperm and are the more common type of twin pregnancy. Identical twins, on the other hand, result from a single fertilised egg that splits into two embryos and are rarer, occurring in about 3 to 4 per 1,000 births worldwide.

Are twin pregnancies high-risk?

Twin pregnancies are generally considered high-risk due to the increased risk of complications for both the mother and babies, including preterm birth, pre-eclampsia, fetal growth restriction, and twin-to-twin transfusion syndrome (TTTS) which can occur only in identical, monochorionic twin pregnancies.

Expectant mothers of twins may also experience more intense symptoms. Many women experience greater fatigue, more severe morning sickness, and higher weight gain due to the added physical demands of carrying two babies. Common symptoms like back pain, pelvic pressure, heartburn, and shortness of breath may also occur earlier and be more severe. Additionally, swelling in the legs and ankles, as well as varicose veins, can occur as the body adjusts to the higher blood volume.

What prenatal care will I need if I’m pregnant with twins?

Prenatal care for twin pregnancies requires more frequent and careful monitoring than for a singleton pregnancy, with appointments typically scheduled every 2 to 4 weeks. These prenatal visits will begin in the second trimester and increase in frequency as the pregnancy advances.

If you are expecting twins, you can anticipate a personalised care plan that includes:

Additional ultrasound scans

Twin pregnancies are usually detected through ultrasound in the first trimester, typically between 6 to 8 weeks. Subsequent ultrasounds will then allow your obstetrician to monitor each baby’s growth, amniotic fluid levels, and placental function.

Monochorionic twins face specific risks, such as (TTTS), a rare condition that occurs when one twin receives more blood flow than the other; 1 in 3 monochorionic twin pregnancies will be complicated by TTTS. Early detection is crucial to manage and prevent complications that can affect both babies.

Specialised blood tests and screenings

Prenatal care for twin pregnancies also includes additional blood tests to check the mother’s iron levels for anaemia. Additionally, a twin pregnancy can increase the risk of developing pre-eclampsia and some women, based on their background risk, will be advised to take low dose aspirin to reduce this risk.

Will I have to deliver twins via C-section?

The delivery options for twins depend on several factors, such as the position of each baby, the mother’s health and age, and any complications that may have developed during pregnancy.

If both babies are in a head-down position, a vaginal delivery may be possible, provided there are no other complications. However, if the first/presenting twin is in a bottom-first or sideways position, a C-section is often recommended for a safer delivery.

Monochorionic twins sharing a placenta are at a higher risk for complications, and may need to be delivered earlier at around 36-37 weeks, usually by C-section. In contrast, dichorionic twins, who have separate placentas, generally have lower risks of complications and need to be delivered at 37-38 weeks, but delivery recommendations will still depend on the specific circumstances of the pregnancy.

In the UK, around 60% of twin deliveries are performed via C-section. Even if a vaginal delivery is initially planned, an epidural is often recommended for pain relief to enable a quick transition to a C-section, if complications arise during labour or if one twin encounters difficulties during delivery.

Ultimately, the decision regarding how to deliver twins - whether via C-section or vaginally - will be based on a comprehensive assessment of the mother and the babies’ health and position, as well as any complications that arise and the mother’s wishes. Your obstetrician will carefully discuss the safest delivery method for you and your babies.

If you would like to book an appointment with Professor Mina Savvidou, head on over to her Top Doctors profile today.