MULTIPLES PREGNANCIES

In this page you will find information about twin pregnancies (dichorionic and monochorionic)

TWIN DICHORIONIC PREGNANCIES MANAGEMENT

Twin pregnancies are classified according to the number of the placentas in dichorionic (each baby has its own placenta) and monochorionic (there is only one, common for both babies placenta). According to the number of sacs, they are classified as diamniotic (each baby is in its own sac) and monoamniotic (both babies are in the same sac).

In the following table, you will see a concise calendar of the most important pregnancy follow- up apointments alongside the purpose of each visit. This calendar is about a twin, dichorionic- diamniotic (with two placentas and two sacs), In case of dichorionic- diamniotic twin pregnancies we recommend delivery by elective (scheduled) cesarean 39 weeks of pregnancy.

It goes without saying that this schedule will be adjusted and individualised to each woman and pregnancy needs.

WEEK APPOINTMENT PURPOSE
4th- 5th Pregnancy test positive Scheduling, medical history taking
5th- 7th Early pregnancy scan Confirm fetal viability, exclusion of ectopic pregnancy, chorionicity assessment
Booking tests Full blood count, BUN, Creatinine, Electrolytes, Liver and thyroid function tests, Urine test, ABO Blood Group type, Rhesus Blood Group type, Circulating Antibodies, Test for thalassemia and sickle cell anemia trait, HIV, Hep Β and C test, Syphilis test, Toxoplasmosis and Cytomegalovirus antibodies, Smear test (if not done recently), Blood pressure, Body weight
11th- 14th 1st trimester scan Nuchal translucency, Probability of chromosomal abnormalities calculation, Fetal anatomy check, Estimated due date calculation, gender prediction (if possible), Preeclampsia and preterm delivery calculation, chorionicity confirmation, cervical length measurement to predict preterm birth
20th- 22nd Anomaly scan Detailed assesment of the fetal anatomy, fetal heart anatomy assessment, gender determination, placenta site assessment, Uterine arteries Dopplers studies to predict preeclampsia, cervical length measurement to predict preterm birth
Pregnancy check Weight, Blood pressure, Fetal movements, Blood and urine tests
24th Growth scan Assessment of fetal growth centiles, Amniotic fluid volume, Fetal anatomy
Pregnancy check Weight, Blood pressure, Fetal movements, Blood and urine tests
28th Growth scan Assessment of fetal growth centiles, Amniotic fluid volume, Fetal anatomy
Pregnancy check Weight, Blood pressure, Fetal movements, Blood and urine tests
Glucose tolerance test Gestational diabetes check
32nd 3rd trimester scan Assessment of fetal growth centiles, Amniotic fluid volume, Fetal anatomy, Fetal Dopplers studies
Pregnancy check Weight, Blood pressure, Fetal movements, Blood and urine tests
36th Growth scan Assessment of fetal growth centiles, Amniotic fluid volume
  Pregnancy check Weight, Blood pressure, Fetal movements, Blood and urine tests
38th Pregnancy check NST, Weight, Blood pressure, Fetal movements, Blood and urine tests

 In twin pregnancies there is an increased risk of premature delivery (about 10% risk of delivery before 32 weeks) and poor fetal growth in at least one of the babies (about 10%).

TWIN MONOCHORIONIC PREGNANCIES MANAGEMENT

Twin pregnancies are classified according to the number of the placentas in dichorionic (each baby has its own placenta) and monochorionic (there is only one, common for both babies placenta). According to the number of sacs, they are classified as diamniotic (each baby is in its own sac) and monoamniotic (both babies are in the same sac).

In the following table, you will see a concise calendar of the most important pregnancy follow- up apointments alongside the purpose of each visit.This calendar is about a twin, monochorionic- diamniotic (with one placenta and two sacs), normally continuing pregnancy. In cases of twin monochorionic- diamniotic pregnancy we recommend delivery by cesarean section at 35- 36 weeks of pregnancy.

It goes without saying that this schedule will be adjusted and individualised to each woman and pregnancy needs.

WEEK APPOINTMENT PURPOSE
4th- 5th Pregnancy test positive Scheduling, medical history taking
5th- 7th Early pregnancy scan Confirm fetal viability, exclusion of ectopic pregnancy
Booking tests Full blood count, BUN, Creatinine, Electrolytes, Liver and thyroid function tests, Urine test, ABO Blood Group type, Rhesus Blood Group type, Circulating Antibodies, Test for thalassemia and sickle cell anemia trait, HIV, Hep Β and C test, Syphilis test, Toxoplasmosis and Cytomegalovirus antibodies, Smear test (if not done recently), Blood pressure, Body weight
11th- 14th 1st trimester scan Nuchal translucency, Probability of chromosomal abnormalities calculation, Fetal anatomy check, Estimated due date calculation, gender prediction (if possible), Preeclampsia and preterm delivery calculation,chorionicity confirmation
16th Growth scan Assessment of fetal growth centiles, Amniotic fluid volume, TTTS signs
18th Growth scan Assessment of fetal growth centiles, Amniotic fluid volume, TTTS signs
20th- 22nd Anomaly scan Detailed assesment of the fetal anatomy, fetal heart anatomy assessment, gender determination, placenta site assessment, Uterine arteries Dopplers studies to predict preeclampsia, cervical length measurement to predict preterm birth, TTTS signs
Pregnancy check Weight, Blood pressure, Fetal movements, Blood and urine tests
24th Growth scan Assessment of fetal growth centiles, Amniotic fluid volume, TTTS signs
Pregnancy check Weight, Blood pressure, Fetal movements, Blood and urine tests
26th Growth scan Assessment of fetal growth centiles, Amniotic fluid volume, TTTS signs
28th Growth scan Assessment of fetal growth centiles, Amniotic fluid volume, Fetal anatomy, TTTS signs
Glucose tolerance test Gestational diabetes check
30th Growth scan Assessment of fetal growth centiles, Amniotic fluid volume, TTTS signs
32nd 3rd trimester scan Assessment of fetal growth centiles, Amniotic fluid volume, Fetal anatomy, Fetal Dopplers studies, TTTS signs
Pregnancy check Weight, Blood pressure, Fetal movements, Blood and urine tests
34th Growth scan Assessment of fetal growth centiles, Amniotic fluid volume, TTTS signs

In monochorionic twins there is a high risk (about 15%, or 1 in 6) of development of severe twin to twin transfusion syndrome (TTTS) or selective fetal growth restriction (sFGR). We will monitor with regular scans at 16, 18, 20, 22, 26, 30 and 34 weeks and aim for delivery at 35-36 weeks. If there is evidence of severe TTTS or sFGR we will have to discuss the need for specialised treatment and plan ahead. The pregnancy is also at increased risk of premature delivery (about 10% risk of delivery before 32 weeks) and we will monitor for this by measuring cervical length at 22 weeks.