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What is typical prenatal care for twins?

post #1 of 13
Thread Starter 
I have my first visit w/ my OB on Monday (13.5 weeks) and I'd like to be prepared. My visit was canceled due to a delivery last week, but the nurse went ahead and scheduled me for an US b/c I was so big and just 'knew' it was twins. The things I am most interested in are how many US and when, when do weekly visits start, ect. I live in a really small town and will be going to a community hospital, not real high-tech, KWIM? I have had 2 births w/ this Dr. and have been happy with them. The last one was fantastic! Normally you have 12 (exam), 16 (AFP), 20(US), 24, 28, 32 (US), 34, 36, 37 (exam if you want), 38 (exam), 39 (exam), 40 (exam) and one scheduled after your EDD, they already made those visits before we found out it was twins. I know w/ twins it will probably start the weekly visits earlier, but what type of exams are done when, ect. And what about the AFP/tripple screen test? It is accurate or should I just skip it? I don't want to go overboard w/ the US, ect., but I'd like to know exactly what is "standard" for a twin pregnancy? Any other tests done, ect.

Yes, I know I am not choosing a homebirth.

Thanks!
post #2 of 13
I'm not sure if my care was typical or not, I do think it was overboard considering I had fraternal twins. But I really liked my ob and she has a very high rate of vaginal deliveries.

16-17 weeks - Level II u/s. Because of this we didn't do the AFP, a level II would have been the next step had there been anything detected in the AFP, kwim?


20 weeks - internals from here on out. Visits were bi-weekly until 24 weeks then weekly thereafter. I had internals at every visit. Biophyscial profiles started at 28 weeks and were weekly. So like I said, too much. I was contracting from 20 weeks on so some of these were necessary, others not.

My OB also asked for a second level II to check for growth at 20-21 weeks and another growth u/s around 30 weeks to check for any growth discrepencies between the babies.

In retrospect I wish I'd declined some of this. I ended up delivering at 33w 5days after 5 days trying to stop contrax.
post #3 of 13
I know my care was not typical but I'll let you know what I did anyway in case it helps someone else (or you, of course!). Really, it's ultimately up to you - hospital or home - so please just consider all your options then discuss with your provider your wishes, kwim? I had my first visit at 14 weeks with my hb midwfie that I'd used in the past. I suspected/hoped for twins at that point - I was measuring about 18 weeks by then & the mw felt the baby kick from the outside (I had been feeling movement since 9 weeks). I chose to keep my care super low-tech (no doppler (except a few times during labor on baby B after baby A was born), just fetoscope, no bloodwork of any kind, did NOT want an u/s at all but got scared into it at 26 weeks which is when we confirmed the presence of twins, no ve's at all except a couple during labor after baby A was born). I basically kept the typical singleton OB pre-natal visit schedule (every 4 weeks until the 32-34 weeks I think, then every 2, then every one starting at 36 weeks), I just didn't do all the labs & stuff. She measured my fundal height, took my bp, I checked my urine, and I weighed myself. I think, from what you've posted in another thread about your situation, you'd be safe to bypass any additional u/s's at this point since yours appear to have separate sacs/placentas & you know you ovulated twice. I was also very sure mine were DZ since I took clomid, so I wasn't very concerned about possible TTTS (and at my 26 week u/s the tech said they had separate everything).
post #4 of 13
You are probably going to get a million answers for this one!
But, I found out I was having (mono-di) twins at 14 weeks, went on with my same practice until just after the 21-week, level II u/s, then switched OB's to the most natural-childbirth oriented one in town. I didn't see him until around 26 weeks, when I also had an u/s with his practice. Then had an u/s, urine check and chit-chat with my doc at 30 and 33 wks (iirc) and maybe one or two other appointments just to touch base. I had my boys at 35w 1d, but I would have probably had at least 2 more u/s had I gone longer (closer to every 2 weeks until 38 weeks, then every week thereafter). Since mine were thought to be mono-di, they were on the lookout for TTTS. Had they been di-di, the u/s would have been less frequent. I NEVER had an internal exam until I was in labor (4cm) and would not have requested one until then anyway. I declined the quad-screen/AFP (though I would have with a singleton, too, for other reasons); however, with a multiple pg that test is inaccurate/not useful.
post #5 of 13
Oh gosh, let me see if I can remember!

I found out I was having twins at 6W4D. I did fertility treatments so my RE did an early ultrasound.

Had first OB appointment at 12 weeks. He did an ultrasound at that point b/c he wanted to see the twins for himself and try to determine the number of placentas.

I declined the AFP but did have the gestational diabetes testing at the same week as a singleton mom (it was negative woo hoo!).

I had an apt. at 12 weeks, 16 weeks, and 20 weeks. At the 20 week apt. my blood pressure was high so I started going every 2 weeks. At the 24 week appointment I had an even higher BP so I started going every week. At 28 weeks I had a pre-term labor scare and spent about 12 hours in the hospital. I had a bio physical profile in the hospital to check on the babes. I had weekly appointments for the rest of the pregnancy, and two more PTL scares and was hospitalized for 2 nights for one and 3 nights for the other.

I had the "big" u/s at 23 weeks and I got to find out the sexes--which was really exciting. I also had a BPP every week starting at 32 weeks.

I had a pretty easy vaginal delivery at 37W5D. My kids were 5lbs12oz and 6lbs15oz.
post #6 of 13
My schedule with my normal ob didn't change, but I had 2 drs so I had double appts. My twins are mono-di and thus at risk for TTTS. First visit and u/s was 7w4d and confirmed twins (possible mono/mono). Second appt was 10 weeks normal ob visit was warned I'd likely need anti labor meds and bedrest at 20 weeks. Third appts were normal ob and U/S confirming mono/di twins. I had appt with my ob and my perinatologist every 3 weeks until 32 weeks (u/s every 3 weeks to check for TTTS). At 32 weeks we started going every other week for both and at 36 weeks we now go every week sometimes 2x a week (but only because my blood pressure has been creeping up). I'm past 38 weeks now and nothing but partial bedrest for blood pressure has been needed

I got the AFP for twins but not the quad screening. I did not get the GTT since the Dr decided to just diagnose me since I had it last time. I actually don't think I have it this time, but meh.
post #7 of 13
My OB normally does not do anything 'special' for twin pregnancies until the last trimester. (Other than doing a level II u/s at 20 weeks instead of just the one normal one). The last trimester you go and see her once a week (instead of bi-weekly).

It really depends on your caregiver. I didn't get to have my OB's low-stress approach, since we were diagnosed with TTTS and that's all kinds of sky-high craziness as far as monitoring goes.

She does get people turned on to the Luke eating plan, hooks them up with the local moms of multiples club (so they can get a support network into place before the babies arrive).

She is a gem though. She was encouraging me to go for VBAC until it became clear that the TTTS was causing problems for Dylan. She's pretty experienced in multiples births/is confident in women's bodies barring a real reason why she shouldn't be.

I'm sure there are some multiple moms who would want the extra visits/scrutiny earlier, and that's fine. I would have preffered to go her low-key route. I know other doctors in her practice handle it differently. So it seems to be a very individual thing.
post #8 of 13
I had 3 us because they were mono/di twins and I refused all the others.

I did some biophysical profiles (3?). They wanted them twice a week, I agreed to 1 X a week after 35 weeks.

I never had an internal us and 1 vaginal exam when I was having some serious contractions at 33 weeks (that took a shot of terbutaline to stop, but it worked great).

I also refused most of the bloodwork, etc. (Boy did they LOVE ME!!)

We delivered at almost 38 weeks at 71/2 lbs each.
post #9 of 13
My ob treats twins as normal until the last 3 months but I'm not sure what he does differently during the last 3 months. However I had complications beginning at week 13 and saw the ob with u/s's every week.

The only blood test we had done was for GD. My ob said he doesn't like to do the other tests and only does them if the patient asks for them or if they are over 40.
post #10 of 13
I see a family practice doc (delivered other two kiddos). We found out it was twins at our 18 week ultrasound. He said I'd need to see a perinatologist so they'd be familiar with me should anything go wrong, to try to determine if they were mono-di, etc, and in case I deliver before 35 weeks as our local hospital isn't equipped with a nicu for anything earlier than that.

I saw the peri at 21 weeks and will see him again next week. We're hoping that will be the last time and then I can just see my FP doc after that. I guess it depends on how comfortable the peri is with that. My babes are mono-di, so the risk for TTTS is there, and we'll be monitored more closely. U/s every 4 weeks, appointments every 2 weeks starting now.
post #11 of 13

AFP and multiples

You asked about AFP. With multiples pregnancies, the AFP screen returns a higher number of false positives. With a positive result, you need to consider the risks and benefits of amnio.
post #12 of 13
Thread Starter 
Thank you all! I went yesterday and he answered lots of my questions. Basically it's the same until the last trimester, so in October I will go every 2 weeks, then every week a NST starting in November and all of December. That seems like a lot of testing to me, but he says it's to watch the babies for things like TTTS, ect. and to make sure thier HR are doing okay. Yesterday one was 134 and the other in the 140s. I think I'm going to pass onthe AFP test for now, since I will be having US every month the last 4 months. My OB can deliver at my hospital at 32 weeks, but babies may have to be transferred depending on how they are doing. I go to a small community hospital, and it is not equiped to do things like ventilators, ect. At 34 weeks they should be able to keep them at the local hospital, though. Hopefully I will have 2 healthy vag. birthed babies in late December!
post #13 of 13
I saw my regular OB monthly until around 24 weeks, I started having preterm labor, so then I also began seeing a perinatologist. I guess I saw the perinatologist about once a week (and the OB biweekly) until I delivered at 31+2 weeks.
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