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Multiple pregnancy

Expecting twins or more

Multiple pregnancy — carrying twins, triplets or more — is increasingly common. Over 3% of births in UHG are twins, a rise driven mainly by assisted reproduction techniques and later maternal age.

A multiple pregnancy is exciting, but it does carry more demands on your body and a higher chance of complications. The good news is that, with the right specialist care and closer monitoring, the great majority of multiple pregnancies have healthy outcomes. This page explains what to expect.

Types of twins and why it matters

The type of twin pregnancy you have affects the care you’ll be offered, so it’s worth understanding the terms.

Zygosity describes the type of conception:

  • Dizygotic (DZ) — non-identical / fraternal twins. Two eggs are fertilised by two different sperm. About two-thirds of twins are dizygotic. They share no more genes than ordinary siblings, and may be the same or different sexes. DZ twinning is more common in women who have had previous children, who have a family history of twins, or who are using fertility treatment.
  •  (MZ) — identical twins. A single embryo splits after fertilisation. About one-third of twins are monozygotic. They share the same genes and are always the same sex.

Chorionicity describes the placentas and membranes, and is determined by when the embryo splits:

  • DCDA (Dichorionic Diamniotic) — two placentas, two amniotic sacs. The most common arrangement. Lower risk of complications.
  • MCDA (Monochorionic Diamniotic) — shared placenta, two separate amniotic sacs. Higher risk of complications such as twin-to-twin transfusion syndrome.
  • MCMA (Monochorionic Monoamniotic) — shared placenta and shared sac. Rare, and higher risk.

Your dating and anomaly scans will determine your chorionicity, and this will guide how often you’ll be seen.

Your care with us

Multiple pregnancies are looked after by a consultant-led team, with:

  • More frequent antenatal visits than a singleton pregnancy
  • Additional ultrasound scans — typically every 2–4 weeks, depending on chorionicity, to check growth and amniotic fluid in each baby
  • Specialist input as needed — anaesthetist, neonatologist, maternal-fetal medicine specialist
  • Early discussion of place of birth, timing of birth, and mode of birth — usually starting around 24 weeks
  • A birth plan agreed by 28 weeks at the latest

You’ll be encouraged to attend antenatal classes — including a twins-specific session where available — and to think about practical preparation at home, where having two (or more) babies arrive will be very different from one.

Looking after yourself

A multiple pregnancy is particularly demanding of your body. Many of the “normal” pregnancy symptoms come earlier and more strongly — tiredness, breathlessness, back pain, heartburn, sleep disturbance.

  • Eat well and often — you’ll need roughly an extra 300 calories per baby per day. Iron, calcium and folic acid are particularly important.
  • Take your supplements — folic acid until 12 weeks (your team may recommend a higher dose), and vitamin D throughout.
  • Rest when you can — short rests through the day are more useful than long ones at night, especially later in pregnancy.
  • Stay active at a level that feels right — gentle walking, swimming, prenatal yoga. Avoid strenuous exercise.
  • Speak up if you’re struggling emotionally — mood swings, anxiety and tearfulness can be more intense with a multiple pregnancy.
  • Prepare practically — line up help for after the birth, set up feeding spots, and accept offers from family and friends.

Risks, what to be aware of

Most multiple pregnancies have healthy outcomes, but the risks of certain complications are higher than for a singleton. Your team monitors closely for each of these.

  • Premature birth The most common complication. More than half of twins are born before 37 weeks. Triplets and higher are almost always preterm. Your team will discuss steroid injections to mature your babies’ lungs if early birth seems likely.
  • Pre-eclampsia and high blood pressure More common in multiple pregnancy. Your urine and blood pressure will be checked at every visit. Tell us straight away about severe headaches, visual disturbance, swelling or pain under the ribs.
  • Gestational diabetes Multiple pregnancy raises the risk. You’ll be offered an oral glucose tolerance test (OGTT) in the second half of pregnancy.
  • Anaemia Iron stores are stretched. Many women with multiples need iron supplements; routine blood tests will pick this up.
  • Growth differences between babies Sometimes babies grow at different rates. Regular scans pick this up early.
  • Twin-to-twin transfusion syndrome (TTTS) Occurs only in monochorionic pregnancies (shared placenta) and is the reason these need scans every two weeks. Treatable, particularly when picked up early.
  • Cord and placenta complications Especially in MCMA pregnancies, where cords can become entangled. These pregnancies are monitored very closely and usually delivered earlier.

You’ll have time at each visit to ask questions about any of these.

Planning the birth

Most twin and triplet pregnancies are delivered in hospital, with a consultant obstetrician, midwives, an anaesthetist and a neonatal team available.

By 24–28 weeks, you’ll discuss with your team:

  • Place of birth — in our maternity unit, on the consultant-led labour ward
  • Timing of birth — usually before 38 weeks for twins, earlier for higher-order multiples
  • Mode of birth — vaginal birth is possible for many twin pregnancies (especially when the first twin is head-down), depending on chorionicity, positions of the babies, and your preferences. Triplets and higher are almost always delivered by caesarean
  • Pain relief — early discussion of options, including epidural
  • Monitoring — both babies’ heart rates will be monitored continuously in labour
  • What happens after birth — feeding plans, skin-to-skin, and whether either or both babies may need a short SCBU stay

We’ll talk through the decisions with you, and revisit the plan as your pregnancy progresses.