Antenatal care in twin pregnancy

  • Physical demands of multiple pregnancy can be very tiring for the woman. Common discomforts of pregnancy may be increased
  • Multiple pregnancies need close monitoring — refer to obstetrician as soon as multiple pregnancy identified and do obstetrician/doctor/midwife consult at every appointment. Consider telehealth
  • Birth of twins often complicated — always plan for hospital birth at major hospital with maternal and newborn services

Table 2.4   Increased risks of complications for mother and baby

Mother Baby
  • High BP, preeclampsia
  • Preterm birth
  • Anaemia
  • Gestational diabetes
  • Poor growth
  • Born preterm
  • Congenital anomalies

Talk with woman about

Antenatal care schedule

Explain schedule to woman so she can understand and be involved 

  • Extra visits will be needed as advised by obstetrician
  • See Antenatal care for what to do at visits

Obstetrician will help plan antenatal care and obstetric ultrasounds

  • Early first trimester ultrasound to confirm gestation, number of babies and placentas
  • Ultrasound at 16–18 weeks THEN
    • Every 4–5 weeks if 2 placentas (dichorionic diamniotic — DiDi twins) 
    • OR every 2 weeks if 1 placenta (monochorionic diamniotic) — MoDi OR (monochorionic monoamniotic) — MoMo twins — high risk of twin-to-twin transfusion syndrome with 1 shared placenta
  • Make plans for woman to birth in hospital — talk with woman about options for birthing. Woman will need to go to a major birth centre earlier than for a singleton pregnancy