Twin pregnancy: pregnant with twins, what pregnancy follow-up?

Have you just been told that you are expecting twins and are you a little worried about this twin pregnancy? Don’t panic: a few additional examinations and greater vigilance will simply be necessary!

What are the risks of a twin pregnancy?

A huge surprise, intense anxiety and / or great happiness, the announcement of a twin pregnancy rarely leaves future parents indifferent!

The first thing to know when talking about twin pregnancy is that unfortunately it is a particularly at risk pregnancy. The risks of prematurity, toxemia of pregnancy (high blood pressure during pregnancy), or delayed fetal growth are greater than for a simple pregnancy. According to Prof. Yves Ville, gynecologist-obstetrician specializing in twinning and head of the gynecology-obstetrics department at the Necker Hospital in Paris, “on all pregnancies, 20% of neonatal intensive care admissions are linked to twin pregnancy“. Being pregnant with twins therefore requires a special and close monitoring, in order to avoid complications and prematurity of babies as much as possible.

Twin pregnancy: the first ultrasound, an important moment

It is during the first ultrasound that the follow-up of the twin pregnancy is played out. Indeed, there are different types of twin pregnancies, which do not require the same month-by-month and week-by-week follow-up.

The first trimester ultrasound, performed during the 11th or 12th week of amenorrhea (SA) will thus determine the chorionicité, that is, the placental type of twin pregnancy and their number. This first step is essential and must be carried out as early as possible, according to the French National College of Gynecologists and Obstetricians (CNGOF), because the earlier the diagnosis is made, the more reliable it is.

The ultrasound will then determine if it is a bichorial twin pregnancy, i.e. with two placentas or a monochorial twin pregnancy, with a single placenta for the two twins.

From there, all the care and follow-up of the twin pregnancy will follow.

Bichorial twin pregnancy: follow-up every month

In a bichorial twin pregnancy, the twins are connected to the mother by two different placentas. They can be real or fraternal twins, that is, monozygotic or dizygotic twins.

Because they do not share the same placenta, twins of a bichorian pregnancy are not prone to blood exchange problems. However, their growth and evolution must be closely monitored. Monthly ultrasound follow-up by an obstetrician gynecologist in an appropriate structure (hospital or clinic) is therefore recommended. This ultrasound will, in addition to the usual examinations, ensure the proper development of both fetuses. We will estimate their size and weight. And if there is a weight mismatch greater than 20-25% between the two babies, even closer ultrasound monitoring is advised by the National College of Obstetricians and Gynecologists.

In addition, it is recommended to schedule the delivery of a bichorial twin pregnancy. from 38 weeks of amenorrhea (SA) and before 40 SA.

Monochorial, mono or biamniotic twin pregnancy: ultrasounds every two weeks

When the two twins share the same placenta, or in the case of a monochorial pregnancy, specialists recommend a ‘doppler ultrasound ‘every two weeks and no longer every quarter or every month. Because in this configuration, the complications are more serious. An intrauterine growth retardation of one of the two fetuses, a transfusion-transfusion syndrome when there is an inequality in the level of blood exchange, or an anemia polycythemia (Twin anemia polycytemia syndrome or TAPS in English) when ‘ there is a transfusion of blood from one fetus to another, are as many possible complications in a monochorial twin pregnancy.

Rare cases of monoamniotic monochorial pregnancies

And in the rare case that this monochorial pregnancy is also monoamniotic (a single amniotic sac), care must also be taken that the cords of the two babies do not get tangled. An entanglement of cords is indeed at high risk of fetal mortality.

Twins in my womb: will my childbirth be triggered?

In the case of a monochorial and biamniotic pregnancy, it is recommended to induce childbirth from 36 WA, or in any case not to exceed 38 WA and 6 days with very close monitoring.

For a monoamniotic monochorial pregnancy, intensification of surveillance is required from 27 to 30 weeks old. It can be performed in a type III maternity hospital (that is to say with a neonatal intensive care unit) or externally, but in connection with a maternity unit of this type. Childbirth from 32 weeks and before 36 weeks is recommended by gynecologists.

End of twin pregnancy: earlier sick leave

Regardless of the type of twin pregnancy, it is customary to put the patient to rest earlier than for a simple pregnancy. The goal is to avoid as much as possible a too premature childbirth (before 33 weeks) and likely to harm the health of the babies. While it’s also not about cutting out all activity, it’s best to cut back on activity at certain times of the day, and rest more and more as the term approaches.

The minimum work stoppage is 12 weeks before term and 22 weeks after childbirth for a twin pregnancy For a triple pregnancy, prenatal rest is increased to 24 weeks and postnatal rest to 22 weeks.

What about weight gain?

On average, during a twin pregnancy, weight gain increases by 30%. It is therefore likely that you will take between 15 and 20 kilos.

How does the birth of twins go?

Childbirth is often initiated as part of a twin pregnancy. The goal is to avoid arriving when the placenta (s) no longer function (s). Because the placenta ages faster in the context of a twin pregnancy, whether it is monochorial or bichorial. The choice of motherhood is important here because it is about being able to face all situations. It is recommended to choose a maternity unit that includes a neonatal service in the event of prematurity, as well as an anesthesiologist and an obstetrician-gynecologist present at all times.

Giving birth to twins is not not systematically by cesarean section, even if it is often preferred by the medical team for more safety.

The choice of whether or not to opt for a cesarean is up to the patient, once the team has informed her of the risks of vaginal birth.

According to Professor Yves Ville, it is above all the configuration in which the twins will find themselves on D-day that will determine the procedure to be followed. ” If the first baby to present is upside down and there is not a large growth gap between the two, a vaginal birth is possible. », He explains. For the delivery of the second baby, the obstetrician will perform intrauterine maneuvers so that it presents itself in a good configuration. On the other hand, if the first baby is in breech, the cesarean section is more than recommended.

Prof. Ville estimates the 25% risk of giving birth by caesarean section per baby. In the case of a twin pregnancy, there is therefore a 50% risk of having to give birth by cesarean section. It is also not uncommon for the patient to want to attempt a vaginal birth but for a cesarean section to be finally put in place at the last moment.

Note that given the risk of complications, giving birth to twins is generally more medical than a simple childbirth. So expect to be well surrounded on D-Day!