A twin pregnancy carries two fetuses and has higher risks than a single pregnancy, including preterm birth, preeclampsia and growth problems. The key early step is an ultrasound to see whether the twins share a placenta, since this decides how closely they are watched.
Key symptoms
- More nausea and vomiting than usual
- Faster weight gain and a larger belly
- Back pain, shortness of breath and fatigue
- Early contractions or pelvic pressure
What you find on exam
- Fundal height larger than expected for dates
- Two fetal heartbeats on Doppler
- Blood pressure at every visit for preeclampsia
- Signs of preterm labor
Tests
- First-trimester ultrasound to define chorionicity and amnionicity
- Serial growth ultrasounds; every 2 weeks from 16 weeks in monochorionic twins to detect twin-twin transfusion
- Glucose screening and blood count for anemia
- Cervical length when preterm birth risk is high
Treatment basics
- Low-dose aspirin to lower preeclampsia risk
- Iron and folic acid, extra calories and weight gain targets
- Betamethasone if preterm birth is likely before 34 weeks
- Delivery timing by type: dichorionic about 38 weeks, monochorionic diamniotic 34 to 37 weeks
- Twin-twin transfusion: laser treatment at a fetal center
Red flags
- Preterm contractions, fluid leak or bleeding
- Sudden belly growth or a fluid difference between the twins
- High blood pressure, headache or vision changes
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.