Mr George Attilakos, Consultant Obstetrician and Multiple Pregnancy Specialist from The Portland Hospital, part of HCA Healthcare UK.
Parenting on Female First
Pregnancy is an exciting time for mums-to-be, but it can also be nerve wracking as well. For mums expecting more than one baby, such as twins or triplets, it’s not unusual to have lots of questions about how the pregnancy and birth will differ from a pregnancy with just one baby.
There are some differences mums of twins and triplets can expect, both during the pregnancy and at the birth itself.
More monitoring during the pregnancy
Expectant mums carrying multiple babies can expect more monitoring throughout the pregnancy, although the level on monitoring will vary depending on whether the babies share a placenta or have one each.
Mums can expect to have this established during an ultrasound in the first trimester. If the babies share a placenta (monochorionic twins), then the mum will need to have an ultrasound every two weeks from around 16 weeks. This is because, if the twins share a placenta, they have a higher risk of complications such as twin to twin transfusion syndrome (TTTS) or selective growth restriction which can lead to miscarriage or preterm birth. By monitoring the pregnancy, doctors can spot and, if necessary, treat any concerns early.
On the other hand, if the babies have two separate placentas (dichorionic twins) then the mum will need to have an ultrasound every 4 weeks for 20 weeks and will still require careful monitoring, as the risk of complications is higher than that of singleton pregnancies.
Triplet pregnancies will need ultrasound scans every 2-4 weeks depending mainly on the number of placentas.
Increased risk of developing some medical conditions in pregnancy
Carrying twins or triplets does put mums-to-be at a slightly increased risk of some medical conditions during pregnancy. One example is pregnancy-induced high blood pressure (pre-eclampsia). To try and reduce the risk of pre-eclampsia, women who are having a multiple pregnancy may be recommended to take a low dose aspirin tablet daily from 12 weeks.
In serious cases, pre-eclampsia can affect the growth of the baby by slowing down the flow of nourishment and oxygen to the foetus. If the foetus is at risk and/or the woman’s condition is not improving after being given medication, a Caesarean section, sometimes preterm, will often be performed. This is another reason why mums of multiples are given increased monitoring.
A multiple pregnancy may also make a woman more susceptible to maternal anaemia, which is when blood iron levels are low. It’s therefore important that a full blood count is performed regularly so that if a woman’s iron levels are low, she is given supplements to amend this.
Higher risk of early labour/premature birth
Multiple pregnancies have a higher risk of early labour than a single pregnancy does, resulting in a premature birth. Usually, twin pregnancies are advised to be delivered at 36-38 weeks and triplets at 35 weeks compared with the usual 39-41-week for a single pregnancy. However, in a twin pregnancy, the risk of delivering before 37 weeks is up to 60%, although the risk of delivering before 32 weeks is only up to 10%. For triplets the risk of delivering before 35 weeks is 75%.
Premature birth does come with a higher risk of complications, however obstetricians who specialise in multiple birth will minimise the potential for complications, for example by prescribing steroids for mothers to help prevent neonatal breathing problems.
If a mum expecting a twin birth has not gone into labour naturally by around 37 weeks (36 weeks for monochorionic twins), it’s normal to have a planned induction or elective caesarean at this stage. This is usually discussed in advance with their multiple birth specialist midwife or obstetrician to decide what’s best for the health of both mum and the babies. If the first twin is in breech position, a planned caesarean section is advised. For triplets, a Caesarean section is almost always advised.
Due to the increased risks associated with multiple births, it’s strongly advised that women who fall into this group deliver in a hospital so any complications or problems can be diagnosed and dealt with promptly. Where possible, it’s best to opt for a multiple birth specialist unit with obstetricians, sonographers and midwives experienced in the area.
Tagged in Parenting