What is a multiple pregnancy, and how is monitoring planned for twins and triplets? Why placental status matters, problems that may rise, and questions.
A multiple pregnancy is a pregnancy in which more than one baby develops together in the uterus; twin and triplet pregnancies fall into this group. In these pregnancies the likelihood of some problems may increase; for this reason monitoring is generally planned with additional assessments and according to whether the babies share a placenta. An increase in likelihood does not mean that a problem will be experienced. The doctor who follows you determines the frequency and scope of monitoring.
How does a twin pregnancy occur?
Twin babies can develop from a single egg (identical twins) or from two separate eggs (non-identical twins). Babies that share the same placenta are identical twins. The importance of this distinction for monitoring relates to the placental status described shortly.
Why does multiple pregnancy occur?
The increase in the frequency of multiple pregnancies in recent years is linked mainly to advanced maternal age and assisted reproduction techniques; multiple pregnancy is seen more often at an older age and after fertility treatment. The number of embryos transferred in IVF treatment also affects the likelihood of a multiple pregnancy.
What do chorionicity and amnionicity mean?
Chorionicity describes whether the babies share a placenta. The babies may have separate placentas or may share a single placenta; the second situation is known in everyday speech as a "shared placenta" and in medicine is called a monochorionic pregnancy. Amnionicity, on the other hand, describes whether the babies are inside the same membrane sac or in separate sacs. In ultrasound reports these situations may be written with abbreviations such as DCDA, MCDA or MCMA; you can ask your doctor what the abbreviation in your report means.
Why is placental status determined in the early period?
The most accurate period for determining chorionicity is the ultrasound done in the first trimester of pregnancy, that is, in its first period; this situation generally emerges at the first ultrasound. The reason for determining it early is that monitoring differs according to placental status: in pregnancies with a shared placenta, ultrasound monitoring is planned more often. If placental status cannot be clearly understood on ultrasound, a second opinion can be obtained from an advanced centre.
Which problems may become more likely in multiple pregnancy?
In multiple pregnancy, the likelihood of some conditions may increase compared with a singleton pregnancy. For you, these are counted as anaemia, pre-eclampsia, gestational diabetes, caesarean section and assisted vaginal birth, and bleeding after birth. For the babies, preterm birth, growth problems such as one baby remaining markedly smaller than the other, and the likelihood of a congenital anomaly may increase. Preterm birth is one of the most common problems of multiple pregnancy. In pregnancies with a shared placenta, conditions specific to the placenta can be seen in addition to these.
This list is by way of example and is not a closed list. An increase in likelihood does not mean that these conditions will be experienced; which will be considered varies from pregnancy to pregnancy, and the doctor who follows you makes the assessment.
What is looked at on ultrasound in multiple pregnancy?
In twin pregnancy, ultrasound serves several important purposes: determining chorionicity and amnionicity, calculating gestational age, screening for chromosome anomaly and structural anomaly, assessing the risk of preterm birth and detecting possible complications.
How are your additional check-ups and growth ultrasounds planned?
In multiple pregnancy your care is carried out within a care plan specific to you; this plan includes additional check-ups and ultrasounds that monitor the babies' growth. In pregnancies with a shared placenta, screening is applied more often. How often and when check-ups will be done is decided by your doctor according to your placental status and the course of your pregnancy; for this reason the plan differs from person to person.
In which situations might you need to be referred to an advanced centre?
When a complication is detected in a pregnancy with a shared placenta, or when an unusual finding is seen in monitoring, you may need to be referred to an advanced centre. The aim of this referral is a more detailed assessment of the situation.
How is chromosome screening interpreted in multiple pregnancy?
In multiple pregnancy, chromosome screening gives less definite results than in a singleton pregnancy. For this reason the interpretation of the screening results you read about for singleton pregnancies may not apply in the same way in a multiple pregnancy; you determine which method suits you by talking with your doctor.
Where and how is birth planned in multiple pregnancy?
In multiple pregnancies it is recommended that birth take place in hospital. The timing and mode of birth are planned by your doctor according to the babies' condition. Because this plan varies with the person, the timing or mode of birth you hear about in another multiple pregnancy may not apply to you.
How can you support yourself in multiple pregnancy?
- Keep up the planned check-ups and ultrasounds, even if their number looks high; monitoring in multiple pregnancy rests on these check-ups.
- Report newly appearing or changing symptoms without delay to the health professional who follows you.
- Write down your questions before the appointment; ask about the terms in the ultrasound report.
- If you use medicines, vitamins or supplements, mention this at check-ups, and do not make changes in these on your own.
What can you ask your doctor when preparing for a check-up?
- Ask whether the babies share a placenta and a membrane sac and how this affects my monitoring.
- Find out how your check-up and ultrasound plan will be made and in which situations the frequency may change.
- Ask which options are suitable for chromosome screening and how the results will be interpreted in multiple pregnancy.
- Ask which symptoms mean you should seek care straight away and whom you can reach outside working hours.
- If the pregnancy was formed with IVF treatment, mention this and ask whether monitoring changes accordingly.
- Talk about where and how birth will be planned.
Frequently Asked Questions
Is a shared placenta dangerous for the babies?
An imbalance in blood flow can develop between babies that share a placenta; this is the reason monitoring becomes more frequent in pregnancies with a shared placenta. Noticing such problems in time improves the babies' condition. Having a shared placenta does not mean that problems will be experienced; your doctor builds the monitoring plan according to this information.
Are nausea, tiredness and back pain greater in a twin pregnancy?
The common complaints of pregnancy such as nausea, tiredness and back pain may be seen more often in multiple pregnancy. The complaints being frequent does not mean that urgent symptoms can also be regarded as usual. Tell your doctor about your other complaints at check-ups.
Are anxiety and low mood seen in multiple pregnancy?
Anxiety and low mood can be seen in multiple pregnancy. You can tell the health professional who follows you what you are experiencing and ask for support.
Do the placenta and the membrane sac describe the same thing?
No. Chorionicity describes whether the placenta is shared, and amnionicity whether the membrane sac is shared. You can ask your doctor about the abbreviations in your ultrasound report.
Is it important to determine placental status in the early period?
Yes. Monitoring differs according to placental status. The most accurate period for determining it is the first-trimester ultrasound.
Can check-ups be more frequent in a pregnancy with a shared placenta?
Yes. In pregnancies with a shared placenta, ultrasound screening is planned more often. Your doctor determines the frequency according to the course of your pregnancy.
Can a second opinion be obtained if placental status is not clear?
Yes. When it cannot be clearly understood on ultrasound, a second opinion can be obtained from an advanced centre.
Does the increase in risks necessarily mean I will have problems?
No. These are likelihoods; which conditions will be considered varies from pregnancy to pregnancy. The doctor who follows you makes the assessment.
Are the screening interpretations I read for a singleton pregnancy the same for me?
Not always the same. In multiple pregnancy, chromosome screening gives less definite results. You should talk with your doctor about the method that suits you and the interpretation of the result.
Does the birth plan in another twin pregnancy apply to me too?
No. The timing and mode of birth are planned according to your babies' condition; the plan of another pregnancy may not apply to you.
Should I report new or changing symptoms between check-ups?
Yes. Report them without delay to the health professional who follows you. Common complaints do not mean that urgent symptoms can be regarded as usual.
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