Expecting twins? Congratulations!  You may already know that frequent visits to your obstetrician (OB) or maternal-fetal medicine specialist (MFM) are on the horizon.  Twin pregnancies can increase your risk of complications and the need for more specialized medical attention. 

What should you ask your doctor if you’re pregnant with twins? Jennifer Humphrey, MSN, RN, of the Fetal Care Center at Connecticut Children's has ideas to make the most out of your prenatal checkups. 

Ask your OB/GYN or MFM these 5 things if you’re pregnant with twins.

1. What type of twins am I expecting?

The answer is more complex than “identical” or “fraternal.” Your OB/GYN or MFM will tell you whether or not your twins are sharing a placenta or amniotic sac, or both. Your twins fall into one of these three categories:

  • Dichorionic-diamniotic twins—also called di-di twins, are babies that each have their own placentas and amniotic sacs.
  • Monochorionic-diamniotic twins—also called mono/di or sometimes mo-di twins, are babies that share a placenta and therefore a blood supply, but have their own sacs. The twins won’t get “tangled up” in each other’s spaces, but they could share the overall space unevenly.  
  • Monochorionic-monoamniotic twins—also called mono-mono or sometimes mo-mo twins, are babies that share both the placenta and the sac, so their umbilical cords could become entangled. 

If this all seems complicated, you’re correct. That’s why it’s important to have a specialized, experienced medical team you can trust to take care of your twin pregnancy.


2. Are my babies the same size? 

In a healthy, uncomplicated twin pregnancy, babies usually grow at about the same rate but discordance of up to 20% is considered normal. If one is significantly smaller than the other, it could mean a number of things. Your MFM may refer you to a fetal care specialist, depending on the course of your high-risk twin pregnancy.

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3. How will I give birth to my twins? Will my babies need a NICU stay? 

Twins tend to delivery early, on average at 35 weeks’ gestation.  All twin pregnancies are different and that is why you will work closely with your OB and MFM team to consider the safest options for delivery and care of your babies after birth. There is a team of doctors and nurses in the Neonatal Intensive Care Unit (NICU) that can provide specialized care for your infants if that is required.   It is so important to keep the communication open with your entire medical team, from pregnancy all the way through delivery.

>Related: What Do NICU Levels Mean? Newborn Hospital Care, Explained.

4. Do I need to worry about twin-twin transfusion syndrome? (TTTS)

Your MFM will tell you there is a possibility of developing TTTS. TTTS, which complicates 10-15% of all monochorionic twins, is a condition that happens when two babies share one placenta, causing blood to flow unevenly between the two of them. One twin, called the “donor twin,” shares too much blood with the “recipient” twin, which leads to complications of the developing kidneys, bladder and heart.  Less commonly, this can lead to a condition called twin anemia polycythemia sequence (TAPS).

TTTS and TAPS only occur in monochorionic multiple pregnancies If your MFM diagnoses you with this condition and refers you to a fetal care center for diagnostic testing, treatment such as fetal surgery, and ultimately delivery, you can take comfort in knowing that your team will provide the highest quality care for you and your family.

>Related: Is Your Pregnancy High Risk? You’re Not Alone

5. Are there any symptoms I should watch out for during my twin pregnancy? 

As with any pregnancy, some common symptoms can be:

  • Nausea and vomiting 
  • Fatigue 
  • Frequent urination
  • Breast tenderness

Call your OB or MFM if you have any of these symptoms:

  • Headache
  • High blood pressure
  • Swelling