Twin Pregnancy: What Every Expecting Mother Should Know

In short: Twin pregnancies are of three types according to the placenta and membranes: two separate placentas, one shared placenta with two sacs, or one shared placenta and sac. They are more likely with heredity, stimulation drugs, IVF and older age, and carry higher risks for the mother (preterm birth, anaemia, pre-eclampsia, bleeding after delivery) and for the babies (slow growth, twin-to-twin transfusion). Delivery is advised at 37 weeks for twins with two placentas and 36 weeks with a shared placenta.

Finding out you’re expecting twins is exciting news — but twin pregnancies are considered high-risk because they carry a higher chance of certain complications. With attentive prenatal care, many of these risks can be monitored closely and managed appropriately.

Twin pregnancies require close monitoring throughout the pregnancy to help protect the health and wellbeing of both the mother and the babies.

A twin pregnancy simply means more than one fetus is developing in the uterus at the same time.

What are the types of twins?

• Twins with separate placentas
• Twins sharing a placenta

The type of twins is best determined by ultrasound at 11–14 weeks. Twins who share a placenta need an ultrasound scan every 2 weeks from 16 weeks, to detect early problems such as twin-to-twin transfusion, which can often be treated.

What factors increase the likelihood of having twins?

• Genetic factors, as twin pregnancies run in some families.
• Use of ovulation-stimulating drugs.
• Assisted reproductive technologies such as artificial insemination and in-vitro fertilization (IVF).
• Advanced maternal age.

All these factors can increase the chances of having twins, but none of them guarantee it.

What are the potential complications that increase during a twin pregnancy?

• Increased risk of miscarriage
• Increased risk of premature birth
• Increased risk of fetal malformations
• Increased risk of anemia in the mother
• High blood pressure during pregnancy and preeclampsia
• Increased risk of newborns requiring intensive care after birth
• Increased risk of postpartum hemorrhage due to uterine atony

How does a woman pregnant with twins give birth?

This depends mainly on the position of the babies’ heads. If the first baby is head down and the pregnancy is otherwise uncomplicated, a vaginal birth is as safe as a planned cesarean section. A cesarean is usually advised if the first baby is not head down, if the twins share one amniotic sac, or if there are other complications.

When does a woman pregnant with twins usually give birth?

This depends on the number of fetuses and on whether they share a placenta (for example, twins with separate placentas around week 37, twins sharing a placenta around week 36, and twins sharing both placenta and amniotic sac around weeks 32–34):

• Two fetuses: around week 37
• Three fetuses: around week 35
• Four fetuses: around week 32

What are the complications of a twin pregnancy for the fetuses?

• Intrauterine growth restriction
• Blood transfusion between fetuses if the placenta is shared
• Premature birth and its associated complications
• Increased risk of miscarriage
• Increased risk of birth defects

If you’re expecting twins or planning a pregnancy and have questions about monitoring and care, the team at Dr. Najeeb Layyous’s clinic is here to help guide you through every step with personalized attention.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist