Multiple pregnancy – risk factors and monitoring for twin and triplet pregnancies
4 Min Read
A ‘multiple pregnancy’ is a term used to describe when you are having twins or triplets. It also applies to pregnancies with more than 3 babies, but it’s likely that there will be a specialist plan if you are having quadruplets or more as this is much more uncommon. You will usually find out if you’re having a multiple pregnancy at your first scan, between 11 and 14 weeks gestation.
The common symptoms associated with single pregnancies such as morning sickness, backache, tiredness, heartburn etc. are all more common when you have a multiple pregnancy, but there are also some more serious risks that could occur, such as:
- Post-partum haemorrhage (blood loss after birth)
- Need for a caesarean section or assisted delivery (such as forceps/ventouse)
- Gestational diabetes
- Prematurity (there is a 60% chance of going into labour early with twins and a 75% chance with triplets)
- Problems with growth (please see our article ‘Why isn’t my baby growing normally: The causes and the care you may receive’)
- Twin-to-twin transfusion syndrome (TTTS) (where one baby gets too much blood from the shared placenta and the other has too little)
Your consultant and midwives should be aware of these risks and should monitor you carefully throughout your pregnancy and when you go into labour.
If you have a multiple pregnancy, you will be offered additional ultrasound scans throughout your pregnancy. These are mainly to check your babies are growing normally. The number of scans you have depends on whether your babies are sharing a placenta (monochorionic) or have their own placenta (dichorionic).
If you have a monochorionic pregnancy, there is the possibility of TTTS and a higher risk of your babies not growing properly because the placenta isn’t working well enough for both babies. Therefore you will be offered scans every 2 weeks from 16 weeks gestation.
If you have a dichorionic pregnancy (the most common type of twin pregnancy), you will be offered scans every 4 weeks from 24 weeks gestation.
For triplets, scans will be offered depending on your specific circumstances.
You should also be looked after by a team who has experience with multiple pregnancies so you can have a care plan which is specific to you and your babies. If you are having a particularly complex multiple pregnancy, you may be referred to a specialised fetal medicine unit.
Labour and birth
Your specialist team will discuss your birth options with you during your pregnancy. It will be recommended for you to have your babies in hospital so that there is medical support available. You may also need to be transferred to a specialist unit if your babies are very premature or small for their gestation.
Multiple pregnancies often need to be induced, or an elective c-section booked, at an early gestation rather than continuing to full term because this is found to be safer for the babies. Your antenatal team will normally aim for delivery as follows:
- If you have dichorionic twins – around 37 weeks
- If you have monochorionic twins with their own amniotic sac (monochorionic diamniotic/MCDA) – around 36 weeks
- If you have monochorionic twins with the same amniotic sac (monochorionic monoamniotic/MCMA) – around 32-34 weeks
- If you are having triplets – around 35 weeks
It is possible to have a vaginal delivery if you have had a straightforward pregnancy with dichorionic twins and if your babies are growing well. However, the babies must be in the correct position. If the baby nearest the cervix is breech (bottom-down), then a caesarean section will normally be recommended even if the pregnancy has been straightforward with two healthy babies.
If you are delivering your twins vaginally, you should be monitored carefully throughout with a CTG (How they monitor your baby during pregnancy & labour).
For monochronic twins, triplets, or complicated dichorionic twin pregnancies, delivery is most commonly via caesarean section – this is either planned or can be emergency if you go into labour unexpectedly.
Once your babies are born, they might need some care on a Neonatal Unit (NNU) or Special Care Baby Unit (SCBU), especially if they are small for their gestation or very premature.
Are you concerned about the care you have received?
We have previously supported families where one or both of their babies in a twin pregnancy have died because a deterioration in the babies growth or health has not been recognised and/or appropriate care given.
If you have had a multiple pregnancy and believe that something went wrong during your antenatal care or labour, our specialist baby loss/birth injury team can advise you about whether or not you have a claim and help you get answers to your questions.