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.