Multiple birth pregnancies are classed as high risk, therefore you should expect to be monitored a lot more closely than with singleton pregnancies.

I cannot stress enough how important it is to attend all antenatal care and monitoring, so if there are any complications, they will be detected early and maybe treated. However, it is also extremely important NOT to panic. Complications are rare and if you believe everything you read (as there is so much conflicting information out there), you’d be a paranoid wreck by the time your babies arrive.

Possible complications in a twin pregnancy

Vaginal bleeding

If you have any bleeding in pregnancy ALWAYS contact your midwife or doctor (no matter how light).

However, do NOT panic, try to put things into perspective. Bleeding in multiple pregnancy is nearly 3 times more likely. Also, the bleeding comes from the wall of the womb, not the babies.

The heavier the blood loss, the more likely it is to be serious, so ANY bleeding in pregnancy, ALWAYS get checked out!

I had several episodes of bleeding throughout my twin pregnancy. In fact, that is the reason I found out I was carrying twins at only 7 weeks, because I was bleeding, I had an early scan and found out there were 2 babies!! Then later on I had several other episodes of light bleeding/spotting. I went to the hospital each time, had a scan and everything was fine.


Pre-eclampsia is a rise in blood pressure with or without the presence of protein in the urine.This is the main reason for closely monitoring blood pressure and urine whilst pregnant. It is  nearly 3 times more likely to occur with a twin pregnancy.

Symptoms may include headaches, swelling of ankles, hands and/or face, nausea and vomiting, shortness of breath and can affect vision.

If you experience any of these symptoms, please contact your doctor or midwife straight away, as it can develop into eclampsia, which can be very serious for both mother and babies. You may need to be admitted to hospital for bed rest and in extreme cases you may need to be induced early. Sometimes, you may be given steroids to help your babies lungs develop, ready for being born early. Once the babies are born, these symptoms should resolve, but you would still have your blood pressure monitored for about 6 weeks after the birth.

Obstetric cholestatis

This is a liver condition where the normal flow of bile is impaired. Twin pregnancies are at greater risk of developing this condition, possibly due to the increase in hormone levels.

Symptoms include severe itching, fatigue and sleep deprivation, loss of appetite, urine dark in colour and pale stools.

If you experience these symptoms please contact your midwife or doctor immediately.You may need a blood test and ultrasound. You may be given medication and monitored closely. It could be necessary to deliver the babies early.


Twin to Twin Transfusion Syndrome

This can occur with identical twins, when they share a placenta and they share some blood supply. It is rare, but can be very serious. This happens when one twin gets too much blood (recipient) and the other twin gets too little (donor). The donor twin may be smaller and anaemic, as they have less blood volume, whilst the recipient has a larger blood volume which can put a strain on their heart.

This is a very serious condition, which is why at your first scan you be checked to see if the twins are monochorionic (having only 1 chorionic membrane). If this is the case, you will be very closely monitored for TTTS. If this does develop there are possible treatments that may be given, but you will be referred to a specialist centre.

For more information Tamba have a guide on TTTS.

Premature labour

It is very common for twins to be born prematurely. Almost half of twin pregnancies result in being born before 37 weeks. For this reason it is important to prepare yourself for the possibility that your babies may need to spend some time in the neonatal intensive care unit.


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