Twin Pregnancy — A Comprehensive Care Guide

Twin pregnancy carries higher risk than singleton pregnancy and requires specialised antenatal care. This page covers what to expect throughout pregnancy and delivery, with emphasis on monitoring frequency, complications and delivery planning.

1. Types of twin pregnancy

Dichorionic diamniotic (DCDA): each twin has own placenta and sac. Lowest risk. Monochorionic diamniotic (MCDA): one placenta, two sacs. Higher risk including TTTS. Monochorionic monoamniotic (MCMA): one placenta, one sac. Highest risk. Determining chorionicity at first scan (best at 11–13 weeks) is critical for planning.

2. Common complications

Preterm birth (very common, average gestation at twin delivery is 35–36 weeks). Twin-to-twin transfusion syndrome (TTTS) in monochorionic. Growth restriction. Preeclampsia (3-fold higher risk). Gestational diabetes (higher risk). Postpartum haemorrhage. Caesarean delivery often needed.

3. Monitoring frequency

DCDA: 4-weekly scans from 24 weeks. MCDA: 2-weekly scans from 16 weeks (TTTS surveillance). MCMA: weekly admission from 24–32 weeks. More frequent if complications develop. Maternal blood pressure, urine, glucose tolerance and clinical reviews regularly.

4. Nutrition and weight gain

Higher caloric requirements (additional 600 kcal/day in second/third trimester). Higher protein (extra 25 g/day). Iron and folate more critical due to demand. Weight gain target depends on starting BMI — typically 17–25 kg for normal-BMI twin pregnancy.

5. Activity and rest

Light activity continues as tolerated. Avoid heavy physical exertion. Rest periods through day from late second trimester. Specific bed rest no longer routinely recommended unless complications. Mental health support important due to higher anxiety.

6. Preterm birth prevention

Cervical length monitoring (transvaginal ultrasound at 18–24 weeks). Progesterone for short cervix. Cervical cerclage in selected cases. Steroid injections if preterm delivery anticipated (24–34 weeks) for fetal lung maturation. Recognition of preterm labour signs critical.

7. Delivery planning

Timing depends on chorionicity: DCDA — 37–38 weeks; MCDA — 36–37 weeks; MCMA — 32–34 weeks. Mode depends on presentation, complications, maternal preference and centre experience. Vaginal twin delivery is possible when first twin is cephalic and team is experienced. Caesarean often appropriate.

8. Postnatal considerations

Two babies, practical and emotional intensity. Higher postpartum haemorrhage risk (uterus overdistended). Breastfeeding twins is possible but demanding, early lactation support invaluable. Postnatal mental health surveillance heightened. Household help and partner leave especially important.