Two in one

Congenital abnormalities. These are conditions recognised at birth, or believed to have been present since birth – and there is an increased risk of this with a twin pregnancy. For this reason, a very thorough ultrasound examination of each foetus will be performed between 20–24 weeks of gestation. If the ultrasound session seems particularly long and ‘intense’ you’ll know why. If an abnormality is suspected following this ultrasound examination, a further investigation will be required. This may mean an amniocentesis.

Nausea. Early in the pregnancy, you may have more nausea because of the higher concentration of hormone being produced from the placenta.

Veins and other troubles. The increased size of the womb leads to greater pressure on the veins in the legs. This will increase the chances of developing a group of conditions which the obstetrician, but not the mum, calls ‘minor problems’. For example, varicose veins in the legs, haemorrhoids (piles) and sometimes swellings of the veins within the vaginal entrance (vulval varices) and these can certainly be uncomfortable and irritable.

Blood pressure. Multiple pregnancies do lead to more problems with high blood pressure and associated problems like eclampsia. So expect your antenatal screenings to be extra thorough. For more information see Reducing the risk of pre-eclampsia.

Rest. It was not uncommon, in my early general practitioner days, for obstetricians to advocate a period of bed rest during the antenatal period and sometimes mums expecting twins were admitted to hospital at 32 weeks to make sure they took things easy. Certainly, we still encourage a regular, daily rest period – and lying comfortably in bed is the best way to relax. So, nothing changes.

Hydramnios. This is an abnormally large amount of fluid surrounding the baby. It also occurs more commonly in twin pregnancies from about week 20. It can increase all those ‘minor problems’ associated with the enlarged womb and adds to any breathlessness you may experience as your pregnancy progresses.

Anaemia. Again, with twins you have a higher risk of anaemia. This can be due to the greater expansion in blood volume that occurs in twin pregnancy. Folic acid requirements are also greater because of the risk of anaemia.