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Resources Centre / Twins Tips Introduction / Twins Tips / Ante-Natal Treatment for Twin Pregnancy & Multiple Births
Ante-Natal Treatment for Twin Pregnancy & Multiple Births
When you find out you are pregnant with twins, triplets or having a higher order multiple birth like quadruplets or even quintuplets, your first instinct may be to wonder if there's room in there for more than one baby!

We try to answer some of the first questions expectant multiple birth parents& ;ask about ante-natal treatment are care for twins and multiple pregnancy. Covering the main aspects of ante-natal care during your twin pregnancy, antenatal tests and screening, what to expect at your first antenatal appointment, common concerns in multiple pregnancies and general health and fitness advice.
What kind of antenatal care can I expect during my pregnancy?
When youre pregnant with twins, triplets or more, you should receive more than the standard 7-10 antenatal appointments and the two ultrasound scans arranged for single pregnancies. As multiple pregnancy is considered higher risk. it is usual to be referred to a consultant for antenatal care. Depending on your medical circumstances. most women having twins will be asked to attend the consultants clinic for a monthly check-up. whilst also seeing their midwife every four weeks in between (so you visit either the clinic or the midwife every two weeks.
It is very important not to miss these appointments. so that your blood pressure and urine can be checked for signs of pre-eclampsia and diabetes. and other common conditions such as anaemia can be detected.If your babies were conceived as a result of IVF treatment. your consultant may wish to see you more frequently than normal. to monitor your progress<
How will my medical care differ with twins?
Most doctors consider twin pregnancies higher risk. compared to a singleton pregnancy. but this doesn't automatically mean you'll have problems. Certainly your medical carers will monitor you carefully. more so than if you were pregnant with one baby.
You and your carers are a team. working together to ensure that your pregnancy goes full-term - or as close to full-term as possible. Roughly half of all twins are delivered before week 37. but unless and until there is an overwhelming reason to deliver early. keep your goal of going the distance firmly in mind.

The antenatal care you will receive depends partly upon whether you are carrying identical (also called monozygotic) or non-identical (also called fraternal or dizygotic)) twins. If your twin babies share the outer membrane and one amniotic sac (also referred to as monochorionic monoamniotic). you can expect increased scans and monitoring including a cardiac scan. This is due to the greater risk of twin-to-twin transfusion syndrome (TTTS). which occurs when one baby grows at the expense of the other and can cause serious problems.

If your identical twin babies share a membrane but have separate amniotic sacs (monozygotic-diamniotic). or are fraternal twins formed from separate eggs (each with their own membrane and amniotic sac). the risks to their health in the womb are much lower.

You should also have ultrasound scans more frequently in the last trimester (weeks 28 to 40) of pregnancy. to check the growth and position of the babies and placenta(s). Although twins are much more likely than single babies to be born prematurely (37 weeks is considered full term for a twin pregnancy). many women do reach 40 weeks or more. Some consultants will suggest induction of labour at this point. while others may be happy to continue monitoring the babies (often on a daily basis) until labour begins spontaneously.

Also. if you have an existing condition such as diabetes or epilepsy. your health and that of your babies during pregnancy will be more closely followed. You should expect to see your midwife and consultant more often.
What happens at my first antenatal appointment ?
Your midwife or GP will be able to offer advice on how to stay healthy during pregnancy. You will be offered a series of appointments to check on your health and the health of your baby. The number of appointments depends on your individual situation. For example. if it is your first child. you may have up to ten appointments. or around seven if youve had children before. Some appointments can take place at home if necessary.

The first appointment should be fairly early in your pregnancy. at around 11 or 12 weeks. A record of your medical history will be made and whether you will need any extra care during the pregnancy. You should be given information about pregnancy care services (including an outline of your antenatal care). diet and lifestyle advice. maternity benefits. and the routine screening tests available. At the first appointment. you will usually be asked to bring a urine sample which will be tested for the presence of protein. Your blood pressure will be taken. and your weight and height noted. (Routine weight checks throughout pregnancy are no longer recommended.)
Routine Tests

Other antenatal appointments should be determined by your specific health needs. Each should include checks of your babies' growth (by measuring the distance from the top of your womb the fundus to your pubic bone). your blood pressure. urine. and some routine blood tests to identify certain infections or conditions. These include:

Blood group and Rhesus D status
Asymptomatic bacteriuria
Hepatitis B virus and
German measles (Rubella)

You should be offered an ultrasound scan at 10 to 13 weeks (to estimate your babys due date and to check whether you are expecting twins. triplets or more). You should have another one at around 19 weeks to check for any physical abnormalities in the baby.

Screening During Multiple Pregnancy
During pregnancy. you may be referred for various tests. Screening tests are non-invasive tests (outside the body) that are offered to pregnant women. Some are recommended for all pregnant women and are to check the babys or the mothers health; others are for women who have certain risk factors or health concerns. Your midwife or doctor can help you and your partner decide what is best for you and your baby. and also understand the purpose. risks and benefits of each test.

You can decline to have these tests. but they do provide information that helps you deliver a healthy baby or babies. If you need it. genetic counseling is available. This will help you make decisions if you have a disorder that might be passed to your baby(babies) and the risks involved.

The tests may be done at your GP surgery. the local clinic or at the hospital antenatal department. Tests may include:
  • rhesus (Rh) typing (Rh-negative women may receive an injection after delivery to protect their next baby from anaemia);
  • HBV testing (if the mother has HBV. which causes hepatitis B. treatment after birth can prevent the baby from contracting the virus);
  • HIV testing (if the mother has HIV. treatment can reduce the babys chances of being infected);
  • other blood tests to identify the mothers blood group. or check for other conditions such as syphilis. anaemia or sickle cell trait - that can affect the baby. or immunity to rubella;
  • cervical smear test (to check for cervical cancer. gonorrhoea or chlamydia;
  • urine tests (to check for infections and blood sugar problems).

Ultrasound can provide an accurate view of your baby and its placenta. It is considered quite safe for both of you. It may be used to:
  • determine the size and age of your baby;
  • check the position of the baby and placenta;
  • check for physical problems in the baby or placenta;
  • determine a multiple birth;
  • aid other diagnostic tests.
  • AFP Tests Alpha-fetoprotein test screens for certain brain abnormalities. spina bifida and sometimes (with the triple plus test) for Downs Syndrome.

Blood sugar screening test - This checks for gestational diabetes. which can develop in the mother during pregnancy and usually disappears after birth. Untreated. it can lead to serious harm to the baby.

Amniocentesis - This is recommended for women over 35. who have a family history of certain genetic disorders or who have a positive triple plus. AFP or other test results.
Chlorionic Villus sampling (CVS) - This is similar to amniocentesis but is used to detect problems earlier in pregnancy.

Congenital abnormalities
. These are conditions recognised at birth. or believed to have been present since birth and there is an increased risk of this with a twin pregnancy. For this reason. a very thorough ultrasound examination of each foetus will be performed between 2024 weeks of gestation. If the ultrasound session seems particularly long and intense youll know why. If an abnormality is suspected following this ultrasound examination. a further investigation will be required. This may mean an amniocentesis.

Genetic Defects
At present there are no set guidelines on testing for genetic defects in unborn babies. However. in April 2001 it was announced that screening for Downs syndrome. cystic fibrosis and hearing impairment is to be made available to all pregnant women by 2004.
Nuchal translucency (NT) scan is the best screening test for Down's syndrome when you are having twins. The blood screening test that is normally offered at 16 weeks when you are expecting one baby does not work very well when there are two or more babies. This is because the blood test relies on the fact that babies with Down's syndrome tend to have higher hormones (hCG) and lower proteins (AFP) than normal babies. If one of your twins has Down's and the other is normal. the low levels of AFP from one. for instance. will be masked by normal levels from the other.

A nuchal translucency scan will measure the fluid at the back of both babies' necks so that each baby can be given its own individual risk. Before deciding whether or not to have a nuchal scan for twins. you need to think very carefully about what you would do if one baby has a high risk and one a low. The only way to know for sure if the babies are normal is to have a CVS or amniocentesis. and the risk of miscarriage following these procedures is doubled with twins. Also. if one baby is found to be affected and not the other. you may be faced with some very difficult decisions. Of course. if the twins are identical they will either both have Down's or they will both be normal.
Common Concerns with Twin Pregnancies

Nausea. Early in the pregnancy. you may have more nausea because of the higher concentration of hormone being produced from the placenta.

Varicose Veins. The increased size of the womb leads to greater pressure on the veins in the legs. This will increase the chances of developing a group of conditions which the obstetrician. but not the mum. calls minor problems. For example. varicose veins in the legs. haemorrhoids (piles) and sometimes swellings of the veins within the vaginal entrance (vulval varices) and these can certainly be uncomfortable and irritable.

Blood pressure. Multiple pregnancies do lead to more problems with high blood pressure and associated problems like eclampsia. So expect your antenatal screenings to be extra thorough. For more information see Reducing the risk of pre-eclampsia.

Rest. It was not uncommon. in& ;early general practitioner days. for obstetricians to advocate a period of bed rest during the antenatal period and sometimes mums expecting twins were admitted to hospital at 32 weeks to make sure they took things easy. Certainly. we still encourage a regular. daily rest period and lying comfortably in bed is the best way to relax. So. nothing changes.

Hydramnios. This is an abnormally large amount of fluid surrounding the baby. It also occurs more commonly in twin pregnancies from about week 20. It can increase all those minor problems associated with the enlarged womb and adds to any breathlessness you may experience as your pregnancy progresses.

Anaemia. Again. with twins you have a higher risk of anaemia. This can be due to the greater expansion in blood volume that occurs in twin pregnancy. Folic acid requirements are also greater because of the risk of anaemia.

Growth retardation. This can sometimes occur within the womb and often the twins differ considerably in size from each other. Surprisingly. the difference can be greatest amongst identical twins.

Premature birth. There is an increased risk and this means also that the birth weight of twins can be low. The average gestation time for singleton pregnancies is just over 40 weeks. For twins it is only 37 weeks. Labour starts early in 50% of twin pregnancies compared with 10% in singleton pregnancies. Doctors and midwives try to identify those mums likely to go into early labour and prevent this if possible. If it isnt. they will make sure the babies are delivered in a hospital with neo-natal facilities to care for premature babies.
Looking after Yourself & Your Babies
Your body will change in just the same way as any expectant mother. but you can expect the discomforts of pregnancy to be more marked due to the greater needs of two& ;developing babies. But, there's no need to eat for three or even for two. but you do need to eat:
  • a varied and healthy diet
  • 50 to 100 per cent more protein
  • 50 to 100 per cent more calcium
  • 50 to 100 per cent more iron
  • folic acid
  • vitamin B12
Whatever your natural activity level. rest is vital. Gentle exercise such as swimming and walking will be beneficial and the pressures on the perineum mean that pelvic floor exercises are even more important.

The last three months of a twin pregnancy are especially tiring so it is sensible to stop work at 28 weeks. As a twin pregnancy continues on average only to 37 weeks. booking in early for antenatal classes means you're more likely to complete the course. A small number of maternity units organise antenatal sessions to prepare for a multiple birth and there are a growing number of private classes catering specifically for expectant parents of twins, triplets and more. Go to our Resource Centre - Hospital & Antenatal Area for details of multiple birth antenatal classes in your area, also read our Twins Tips and see which may be the best type of class for you.

Despite all the reassuring advice, you will undoubtedly develop some anxieties. Antenatal care will certainly entail more ultrasound screening, tests and investigations and more appointment sessions. It should also include social support and advice, to plan for the extra load before. during and after delivery. Its important to develop support networks, family, friends, twins forums and most importantly, your local Twins Club, during your pregnancy as it gets rather busy afterwards!

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