What do I need to do to maximize the chances of a good outcome with a twin pregnancy?
As the expectant mother, your role in improving outcome is pivotal.
Ensure you are getting appropriate and adequate diet. Do not hesitate to ask for dietary advice from your midwife or obstetrician, if you are unsure. The dietician may be involved, although this is rarely necessary.
Allow yourself adequate rest and avoid unnecessary physical and mental stress.
Never ignore any physical symptoms. Contact your midwife or hospital immediately: it may be an early warning of a complication.
Keep all your antenatal appointments. You may be amazed at the amount of incipient problems detected at these seemingly routine reviews.
What should I expect from the antenatal care?
Various centres will have different management policies. Any policy will be geared towards early detection of problems and timely intervention.
You are likely to be seen frequently in the antenatal clinic probably every two weeks after twenty-four weeks of gestation. This is likely to be flexible, depending on the progression of your pregnancy. If you develop any major complication, such as twin-to-twin transfusion syndrome (rare) or pre-eclampsia (not so rare), you are likely to be admitted into hospital. Premature delivery is virtually inevitable in any such case.
You are likely to have serial ultrasound scans after every two to four weeks to keep track of growth or any restriction. The situation will cause more concern if only one twin appears to be affected. Ultrasound scanning will also detect other problems.
Suppose I am carrying a higher-order multiple, such as triplets?
You are likely to have an even closer follow-up. Many obstetric units operate a policy of routine admission of all mothers expecting triplets at some point in the pregnancy, e.g. 24 or 26 weeks. This is even in the absence of apparent complications.
If you are carrying quadruplets or more, expect to almost certainly be in hospital from somewhere around twenty weeks to the time of delivery.
Why would I be admitted at twenty weeks when the chance of survival is nil if they were born at that stage?
The aim of hospital admission is to maximize rest, which is crucial in such pregnancies. This is meant to allow optimal blood supply to the womb. In addition, it means if you develop problems such as vaginal bleeding (which can be very severe), these can be managed promptly if you are in hospital.
The higher the number of fetuses you are carrying, the higher the potential for complications.
Can I expect home-leave for weekends if I am to have a long admission in hospital?
It will depend on your circumstances. However, many people find the idea of home-leave illogical as it defeats the purpose of admission and goes against the primary reason for admission. Admission is a safeguard against the unpredictability of complications.