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.