Pregnancy With Twins: What Extra Monitoring May Be Needed?

Finding out that you are expecting twins can be an exciting moment, but it also means that your pregnancy may need a different monitoring plan from a singleton pregnancy.

Twin pregnancies can have a higher chance of certain pregnancy complications, and the type and frequency of monitoring depend on several factors, including whether the babies share a placenta, whether they have separate amniotic sacs, how the pregnancy is progressing, and the mother's health.

This does not mean that every twin pregnancy will develop complications. Many women have healthy twin pregnancies with appropriate antenatal care and regular monitoring.

Understanding what additional monitoring may be recommended can help parents know what to expect throughout the pregnancy.

Table of Contents

• Why Do Twin Pregnancies Need Closer Monitoring?
• What Determines the Monitoring Plan for Twins?
• What Extra Scans May Be Needed?
• How Is the Babies' Growth Monitored?
• Why Does Placental Sharing Matter?
• What Other Aspects of Pregnancy Are Monitored?
• When May Fetal Medicine Input Be Recommended?
• What Can Parents Expect During Follow-Up?
• Key Takeaways
• Frequently Asked Questions

Why Do Twin Pregnancies Need Closer Monitoring?

Carrying two babies means that pregnancy can involve additional considerations for both the mother and babies.

Twin pregnancies have increased risks of certain complications compared with singleton pregnancies. These can include problems related to fetal growth, preterm birth, high blood pressure disorders, and complications associated with shared placental circulation.

However, the level of risk is not identical for all twin pregnancies.

One of the first things doctors establish is the chorionicity and amnionicity of the pregnancy — in simple terms, whether the babies share a placenta and whether they share an amniotic sac.

This information helps determine the appropriate monitoring schedule.

For parents looking for specialist pregnancy assessment, Kangaroo Care's fetal medicine services can be naturally linked here.

What Determines the Monitoring Plan for Twins?

Twin pregnancy monitoring is individualised.

Doctors consider:

• Whether the twins have separate or shared placentas
• Whether they have separate or shared amniotic sacs
• Fetal growth and development
• Maternal blood pressure and overall health
• Previous pregnancy history
• Ultrasound findings
• Any complications that develop during pregnancy

A pregnancy involving two separate placentas may require a different monitoring approach from a pregnancy in which the babies share one placenta.

This is why determining the type of twin pregnancy early can be an important part of antenatal care.

What Extra Scans May Be Needed?

Ultrasound plays an important role in monitoring twin pregnancies.

Depending on the type of twins and the clinical situation, scans may be performed more frequently than they would be during an uncomplicated singleton pregnancy.

Ultrasound may be used to assess:

• Growth of each baby
• Amniotic fluid around each baby
• Placental characteristics
• Fetal anatomy
• Blood flow when indicated
• Cervical or other pregnancy-related findings when clinically appropriate
• Differences in growth between the babies

The exact schedule is determined by the healthcare team.

Why Are More Frequent Scans Sometimes Needed?

When two babies are developing at the same time, doctors need to assess each baby individually.

A single measurement is not enough to understand how a twin pregnancy is progressing. Serial scans allow doctors to compare measurements over time and identify changes that may require closer observation.

This is particularly important in twin pregnancies where the babies share a placenta.

How Is the Babies' Growth Monitored?

Fetal growth is an important part of twin pregnancy care.

During ultrasound examinations, doctors measure different parts of each baby's body and use these measurements to estimate growth.

The healthcare team may compare the growth of the two babies as well as their growth over time.

Sometimes one baby may measure smaller than the other. A difference in size does not automatically mean that something is wrong.

Doctors consider the degree of difference, growth patterns over time, blood-flow findings, placental arrangement, and other clinical factors before deciding whether additional monitoring is needed.

If a growth concern is identified, your obstetrician or fetal medicine specialist can explain what it means and whether more frequent scans are appropriate.

Why Does Placental Sharing Matter?

The placenta arrangement is one of the most important factors in determining how a twin pregnancy is monitored.

Twins With Separate Placentas

When each baby has its own placenta, the babies have separate placental circulations.

These pregnancies can still require additional monitoring, but the surveillance plan may differ from pregnancies in which the twins share a placenta.

Twins Sharing a Placenta

When twins share a placenta, they can also share connections between their blood vessels within the placenta.

This can create specific complications that require specialised ultrasound monitoring.

One example is twin-to-twin transfusion syndrome (TTTS), which can occur in certain monochorionic twin pregnancies.

Because of these potential complications, pregnancies involving shared placental circulation may require closer ultrasound surveillance.

Your doctor will explain which type of twin pregnancy you have and what that means for your monitoring schedule.

What Other Aspects of Pregnancy Are Monitored?

Ultrasound is only one part of twin pregnancy care.

Your healthcare team may also monitor the mother's health throughout pregnancy.

This can include:

• Blood pressure
• Symptoms associated with pregnancy complications
• Weight and general well-being
• Blood test results when indicated
• Signs of anaemia
• Blood sugar when appropriate
• Fetal movements later in pregnancy
• Signs that labour may be starting prematurely

Twin pregnancies have a higher likelihood of preterm birth, so your healthcare team may also discuss symptoms of premature labour and when you should contact the hospital.

The exact monitoring plan depends on your individual pregnancy.

When May Fetal Medicine Input Be Recommended?

Some twin pregnancies can benefit from assessment by a fetal medicine specialist, particularly when specialised ultrasound or closer evaluation is required.

A referral may be recommended when:

• The twins share a placenta
• There are concerns about fetal growth
• There is a difference in size between the babies
• An ultrasound identifies a possible abnormality
• There are concerns about amniotic fluid
• Blood-flow assessment is required
• A specific complication associated with twin pregnancy is suspected
• The pregnancy is otherwise considered higher risk

A fetal medicine consultation does not necessarily mean that a serious problem has been diagnosed.

Often, the purpose is to obtain more specialised information and determine the most appropriate monitoring plan.

Parents can explore Kangaroo Care's fetal medicine and high-risk pregnancy care through the relevant internal service pages.

What Can Parents Expect During Follow-Up?

Twin pregnancy appointments may involve more frequent ultrasound examinations and closer communication with the obstetric team.

It can help to keep a record of your scan reports and understand what your doctors are monitoring at each appointment.

Useful questions to ask include:

• What type of twin pregnancy do I have?
• Do my babies share a placenta?
• How often will I need ultrasound scans?
• Are both babies growing as expected?
• Is there a difference in their growth?
• Do I need fetal medicine consultation?
• What symptoms should prompt me to contact the hospital?
• How will we monitor the risk of preterm birth?

Having clear answers can help you understand your pregnancy rather than simply following a schedule of appointments without knowing their purpose.

Key Takeaways

• Twin pregnancies may require closer monitoring than singleton pregnancies.
• The monitoring plan depends significantly on whether the babies share a placenta or have separate placentas.
• Ultrasound is used to monitor fetal growth, anatomy, amniotic fluid, and other aspects of the pregnancy.
• Serial scans help doctors understand how each baby is growing over time.
• Twin pregnancies with a shared placenta may require specialised surveillance for complications such as twin-to-twin transfusion syndrome.
• Maternal health, blood pressure, fetal movements, and signs of preterm labour may also be monitored.
• Some twin pregnancies may benefit from fetal medicine specialist input.
• More monitoring does not mean that a complication will definitely occur. It allows the healthcare team to identify concerns early and plan appropriate care.

Frequently Asked Questions

Do all twin pregnancies need extra scans?

Twin pregnancies generally require more specialised monitoring than singleton pregnancies, but the frequency and type of scans depend on factors such as placental arrangement, fetal growth, and whether any complications are present.

Why is it important to know whether twins share a placenta?

Twins who share a placenta can have specific complications related to shared placental circulation. Knowing the placental arrangement helps doctors determine the appropriate monitoring plan.

Can one twin be smaller than the other?

Yes. Some difference in size can occur between twins. Doctors assess the difference along with growth patterns, blood flow, placental arrangement, and other findings to determine whether additional monitoring is required.

What is twin-to-twin transfusion syndrome?

Twin-to-twin transfusion syndrome, or TTTS, is a potential complication of certain twin pregnancies in which the babies share a placenta. Unequal blood flow through connections in the shared placenta can affect the babies differently. Specialist ultrasound monitoring is important for pregnancies at risk.

Are twin pregnancies always considered high-risk?

Twin pregnancies generally receive closer monitoring because certain complications are more common than in singleton pregnancies. However, the level of risk and care required varies considerably between individual pregnancies.

Can I have a normal delivery with twins?

The recommended mode and timing of delivery depend on factors such as the babies' positions, placental arrangement, gestational age, maternal health, and pregnancy complications. Your obstetrician can discuss the safest delivery plan for your individual pregnancy.

Are twins more likely to be born prematurely?

Yes. Twin pregnancies have a higher likelihood of preterm birth compared with singleton pregnancies. Your healthcare team may therefore monitor the pregnancy closely and discuss signs of premature labour and appropriate planning.

When should I see a fetal medicine specialist during a twin pregnancy?

Your obstetrician may recommend fetal medicine assessment when specialised ultrasound, additional monitoring, or evaluation of a particular concern is required. This can be especially relevant when twins share a placenta or when an ultrasound identifies a potential concern.

What should I do if I notice reduced fetal movement?

Reduced or changed fetal movement should be discussed promptly with your maternity healthcare team, particularly later in pregnancy. Do not rely on an online article to determine whether a change in movement is safe to ignore.