Multiple Pregnancy

Understanding Multiple Pregnancy

A multiple pregnancy means carrying more than one baby, such as twins or triplets. The way babies develop depends on how many placentas and sacs they have.

Types of Twin Pregnancies

Dichorionic diamniotic (DCDA)

Two placentas, two sacs, two babies. This happens when two eggs are fertilised, or when one egg splits very early. Each baby has its own placenta and amniotic sac.

Monochorionic diamniotic (MCDA)

One placenta, two sacs, two babies. The fertilised egg splits slightly later. These babies always share a placenta and are genetically identical.

Monochorionic monoamniotic (MCMA)

One placenta, one sac, two babies. This is rare and higher-risk because both babies share the same sac as well as the placenta. These babies are always identical and need close monitoring.

Triplets

• Can be trichorionic (each baby has its own placenta)
• Dichorionic (two babies share a placenta, one is separate)
• Monochorionic (all three share one placenta)

If babies share a placenta, they are identical (monozygotic).
If they do not share a placenta, they are usually non-identical (dizygotic or fraternal).

What Does a Multiple Pregnancy Mean for Me?

Most women with multiple pregnancies go on to have healthy pregnancies and healthy babies. However, multiple pregnancies do carry a higher chance of complications, which is why extra care and monitoring are required.

Common Minor Symptoms

• Morning sickness
• Heartburn
• Swelling of legs and feet
• Backache and tiredness
• Varicose veins

These are common and manageable with support.

Medical Conditions That May Be More Common

• Anaemia – because growing babies need more iron
• Pre-eclampsia – high blood pressure with protein in urine
• Increased bleeding after delivery
• Higher chance of assisted delivery or caesarean section

Doctors and midwives are trained to recognise and manage these situations early.

Prematurity (Early Birth)

Babies in multiple pregnancies are more likely to be born early.

• About 60 in 100 twin pregnancies deliver before 37 weeks
• About 75 in 100 triplet pregnancies deliver before 35 weeks
• In comparison, only 10 in 100 single pregnancies deliver early

Babies born early may have breathing, feeding, or infection-related challenges and may need care in the neonatal unit. Parents are supported throughout this period.

Many babies born early do very well with the right medical support.

Problems With Growth

Sharing a placenta may sometimes affect how well nutrients are delivered to each baby. Therefore:

• Babies’ growth is monitored closely
• Extra scans are done to ensure each baby is growing well

Twin-to-Twin Transfusion Syndrome (TTTS)

This condition can occur in monochorionic twin pregnancies where babies share a placenta.

• One baby (donor) receives too little blood
• The other baby (recipient) receives too much blood

TTTS may be mild or severe. Regular scans help detect this early. If needed, treatment will be arranged at a specialist centre.

Early detection makes a significant difference.

What Extra Care Will I Need During Pregnancy?

You will be followed up in a specialist twins clinic, usually involving:

• An obstetrician
• A fetal medicine specialist
• Experienced nurses and midwives

You will have more frequent antenatal visits and scans.

Scan Frequency

• Dichorionic twins: Scan every 4 weeks
• Monochorionic twins: Scan every 2 weeks from 16 weeks onwards

Medications & Supplements

• Daily iron and calcium supplements
• Low-dose aspirin from 12 weeks may be advised if you have risk factors for pre-eclampsia

Screening for Down Syndrome and Other Conditions

You will be offered screening at 12–14 weeks. Even in multiple pregnancies, combined screening helps assess the risk for chromosomal conditions. A detailed anomaly scan is done at around 20 weeks. Your doctor will guide you further if any concerns arise.

Advice and Information During Pregnancy

• Birth planning and pain relief options
• Planning timing and mode of delivery
• Care after birth, including contraception
• Looking after your babies after delivery

When Should My Babies Be Born?

You may go into labour naturally earlier in multiple pregnancy. If not, delivery is usually advised by:

• 37 weeks – dichorionic twins
• 36 weeks – monochorionic twins
• 35 weeks – triplets

Continuing beyond these weeks increases risk, so planned delivery is often safer.

How Will I Have My Babies?

Birth planning is usually discussed around 34 weeks.

Twins

If the first baby is head-down, vaginal birth is often possible. The position of the second baby may change after the first is born. Caesarean section may be advised if the first baby is breech or if complications arise. Both vaginal birth and caesarean section have benefits and risks. The decision is individualised.

Triplets & Monoamniotic Twins

Caesarean section is usually recommended for safety.

Labour and Birth With Twins

• Continuous monitoring of babies’ heartbeats is recommended
• Epidural pain relief is commonly advised
• After the first baby is born, the second baby is carefully assessed
• Most second twins are born within 30–60 minutes
• A senior obstetrician, anaesthetist, paediatrician, and experienced midwives will be present

You will be closely supported throughout labour.

Breastfeeding

Breast milk is the best nutrition for babies. Most mothers can produce enough milk for twins. Lactation counsellors will support you if needed.

How Will I Cope With Two Babies at Once?

• Accept help from family and friends
• Establish routines gradually
• Consider maternity leave planning early
• Seek local support groups

You don’t have to do everything alone.

Key Points to Remember

• Multiple pregnancy occurs in about 1 in 80 pregnancies
• Most women have healthy babies
• Extra scans and antenatal care reduce risks
• Early planning improves outcomes
• Support continues even after birth