A twin pregnancy is a type of pregnancy in which a woman carries two foetuses simultaneously. Twin pregnancies are caused by the fertilisation of two separate eggs by two different sperm (fraternal twins) or a single fertilised egg that splits into two embryos (identical twins).

Twin pregnancies occur in approximately 1 in every 30 pregnancies, making it a relatively rare occurrence.

Surveillance of Twin Pregnancy

Surveillance of twin pregnancies involves a series of tests and examinations that help doctors and healthcare professionals monitor the health of both the mother and the fetus. These are:

Ultrasound scans: They help doctors determine the gestational age of the fetuses, identify any abnormalities, and monitor the growth of the babies. Women carrying twins typically have more frequent ultrasound scans than those carrying a single fetus.

Most women carrying twins have an ultrasound scan every four weeks until around 28 weeks gestation, after which scans are performed more frequently.

Fetal heart rate monitoring: This involves using a handheld Doppler device or a fetal monitor to listen to the babies' heartbeats.

Doctors and other healthcare professionals may use foetal heart rate monitoring during routine prenatal visits or in the case of any concerning symptoms or complications.

Blood tests: Blood tests can help doctors monitor the mother's health and the health of the fetuses. Some blood tests commonly performed during twin pregnancies include:

Alpha-fetoprotein (AFP) test: This test measures the levels of a protein produced by the foetus in the mother's blood. Elevated levels of AFP may indicate a neural tube defect or a problem with the placenta.
Human chorionic gonadotropin (HCG) test: This test measures the levels of HCG in the mother's blood. HCG is a hormone produced by the placenta, and elevated levels may indicate a problem with the pregnancy, such as a molar pregnancy or multiple gestations.
Glucose tolerance test (GTT): This test checks for gestational diabetes, a condition that can occur during pregnancy and can increase the risk of complications for both the mother and the babies.

Complications in Twin Pregnancy

Twin pregnancies are considered high-risk due to the increased potential for complications.

Preterm labour: Twin pregnancies have a higher risk of preterm labour than single pregnancies. Preterm labour can lead to complications for both the mother and the babies, including respiratory distress syndrome, brain haemorrhage, and developmental delays.
Gestational diabetes: Women carrying twins have a higher risk of developing gestational diabetes, a condition in which the body cannot produce enough insulin to regulate blood sugar levels.
Hypertension: Women carrying twins are at an increased risk of developing hypertension, a condition in which there is an elevation in blood pressure that can cause damage to the mother's organs, such as the kidneys, and increase the risk of premature birth.
Preeclampsia: This is a serious condition that can develop in the latter half of pregnancy and is characterized by high blood pressure and damage to the mother's organs. Preeclampsia can also restrict blood flow to the placenta, which can cause harm to the fetus
Twin-to-twin transfusion syndrome (TTTS): TTTS is a rare condition that can occur in identical twin pregnancies when there is an imbalance in blood flow between the fetuses. This can lead to one twin receiving too much blood and the other too little, which can cause developmental delays, organ damage, and even death.

Twin pregnancies are a unique and exciting experience for expectant mothers and their families, but they also come with increased risks and complications. Surveillance and monitoring of twin pregnancies are essential to ensure that both babies are healthy and growing at the same rate.

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1. How often should women carrying twins have prenatal check-ups?

Women carrying twins should have more frequent prenatal check-ups than those carrying a single baby. Generally, prenatal visits for twin pregnancies occur every two weeks until 28 weeks, and then weekly until delivery.

2. What is twin-to-twin transfusion syndrome?

Twin-to-twin transfusion syndrome (TTTS) is a rare condition that can occur in identical twin pregnancies when there is an imbalance in blood flow between the fetuses. This can lead to one twin receiving too much blood and the other too little, which can cause developmental delays, organ damage, and even death.

3. Can twin pregnancies be managed differently than single pregnancies?

Yes, twin pregnancies may require specialised care, such as more frequent monitoring for complications, specialised ultrasound scans, and, in some cases, bed rest or hospitalization. Women carrying twins may also need to be monitored more closely for signs of preterm labour.

4. Can twin pregnancies be delivered at full term?

Yes, twin pregnancies can be delivered at full term, which is typically around 37 to 40 weeks. However, some women carrying twins may deliver earlier due to complications or because their healthcare provider recommends early delivery to prevent further complications.

5. Is bed rest recommended for women carrying twins?

Bed rest may be recommended for women carrying twins if they are experiencing complications, such as preterm labour, preeclampsia, or growth restriction.