Fetal Conditions
Twin & Multiple Pregnancies
Pregnancies with two or more babies require specialist monitoring due to increased complexity.
What is Twin & Multiple Pregnancies?
Twin and multiple pregnancies carry inherently higher risks than singleton pregnancies. The type of twin pregnancy matters significantly: dichorionic twins (separate placentas) have lower risk than monochorionic twins (shared placenta). Monochorionic twins face unique complications such as twin-to-twin transfusion syndrome (TTTS) and selective growth restriction that require specialist surveillance.
Why is it a Concern?
Multiple pregnancies increase the risk of preterm birth, pre-eclampsia, gestational diabetes, fetal growth restriction, and caesarean delivery. Monochorionic twins face additional risks related to shared placental circulation, including TTTS, which can be life-threatening if not detected and managed early.
Signs & Symptoms
- Rapid uterine growth or measuring large for dates
- Significant size difference between twins on ultrasound
- Excessive or reduced amniotic fluid in one twin
- Preterm contractions
- Signs of pre-eclampsia
How It is Monitored
Dichorionic twins are monitored with ultrasound every four weeks. Monochorionic twins require scans every two weeks from 16 weeks to screen for TTTS and growth discordance. Fetal growth, amniotic fluid volumes, and Doppler studies are assessed at each visit. Delivery timing is planned based on the type of twin pregnancy and any complications.
Why See an MFM Specialist?
MFM specialists have specific training in the complex surveillance required for twin pregnancies, particularly monochorionic twins. They can identify early signs of TTTS, interpret complex Doppler findings, and coordinate care including referral for fetal therapy if needed.
Dr. Kartik Balaraman Manages This Condition
Dr. Kartik provides dedicated twin pregnancy care with the appropriate surveillance protocol for each type. If you are expecting twins or multiples, contact Dr. Kartik to establish your monitoring plan.
Book ConsultationFrequently Asked Questions
What is the difference between identical and fraternal twins?
Fraternal (dizygotic) twins come from two separate eggs and always have separate placentas. Identical (monozygotic) twins come from one egg and may share a placenta, which requires more intensive monitoring.
What is twin-to-twin transfusion syndrome?
TTTS occurs in monochorionic twins when blood flow between the twins through shared placental vessels becomes unbalanced. One twin receives too much blood while the other receives too little. It requires close monitoring and may need intervention.
Will I need a caesarean?
Not necessarily. Many twins, particularly when the first twin is head-down, can be delivered vaginally. The decision depends on the position of the babies, the type of twin pregnancy, and any complications.
How often do I need ultrasound scans with twins?
Monochorionic twins need fortnightly scans from 16 weeks; dichorionic twins typically need scans every four weeks. Frequency increases if complications develop.
Can I deliver twins vaginally?
Yes, in many cases — particularly if the first twin is head-down. Your obstetrician will assess positioning and recommend the safest delivery mode.
Related Conditions
Preterm Labour & Cervical Insufficiency
When labour begins before 37 weeks, or when the cervix opens too early, putting the baby at risk of premature birth.
Fetal Growth Restriction (IUGR)
When a baby is not growing at the expected rate in the womb, requiring specialist monitoring.
Pre-eclampsia & Hypertension
Blood pressure disorders that can develop during pregnancy, requiring careful monitoring to protect both mother and baby.
Reviewed by Dr. Kartik Balaraman, Consultant OBGYN & Maternal Fetal Medicine Sub-Specialist ·
This page is for general education and does not replace personalised medical advice. If you have concerns about your pregnancy or health, consult a qualified specialist directly.