Twin Pregnancy- All your doubts answered by Dr. Meenal Dhabalia, M.D

Though having twin pregnancy most of the time incite excitement and happiness in parents, it has its own set of guidelines, risk and complications. But worry not! Read this detailed post about twin pregnancy and all your queries will be answered!

Types of Twin Pregnancies

Do you know different types of twin pregnancy you can have! There can be two types of twin pregnancy.

Fraternal twins

A fraternal twin pregnancy occurs when two separate eggs get fertilised by two different sperms, and each fetus has their placenta and amniotic sac. In this, twins can be of same-sex or different sex.

Identical Twins

When a single fertilized egg splits into two, to form twin pregnancy, here both the twin shares same placenta and different amniotic sac. Twins may share a single placenta and single amniotic sac in some cases.

Genetically both babies are identical and are of same-sex. They inherit similar physical characteristics.

Factors that can lead to a twin pregnancy

Are there some predisposing factors in parents having Twin pregnancy?


Few important ones are

  • A family history of having twins
  • Advanced fertility treatment may result in more than one egg to fertilize and result in twin pregnancy.
  • In older women changing hormones may release more than one egg, thus increasing chances of twin pregnancy
  • Sometimes twins or multiple pregnancies happen without any predisposing factors.

How is twin pregnancy different from single pregnancy?

I can write a chapter on this. There are many differences.

To name a few critical differences:

  • Normally, the female body is meant to carry a singleton pregnancy without causing any burdens on female health physically as well as emotionally. Twin pregnancy is associated with much more increase in blood volume than a single pregnancy.
  • Normal weight gain in a single pregnancy is approx. 12 to 15 kg until delivery. In a Twin pregnancy, female may gain 17 to 20 kg of weight. This increased weight with increased blood volume may put pressure on the cardiovascular system.
  • Twin pregnancy requires more frequent doctors to visit than a single pregnancy. More ultrasonography, periodic blood test and more vitamins are needed.
  • Twin pregnancy requires your dietary need to take care of two fetuses. So pregnant women with twins have to take a balanced and healthy diet advised by their caretakers.
  • Preterm delivery is more common in twin pregnancy than a singleton. Take care, ladies!
  • A twin pregnancy can drain women emotionally and physically due to the changes in the body. They feel tired from early pregnancy.

Signs and Symptoms of Twin Pregnancy

Though symptoms of pregnancy largely remain the same in the first trimester for singleton and twin pregnancy, few signs stand out more in multiple pregnancies.

  • Early-onset of nausea and vomiting, and most of the times, it is severe.
  • Feeling tired from the onset of pregnancy.
  • Increase weight gain as soon as they miss the periods.
  • Emotional unrest and feeling irritated and depressed sometimes. It may be because of the massive out surge of pregnancy hormones.
  • Frequent urination from the early first trimester.
  • Constipation
  • Pregnant women with twins can have backache from early pregnancy.
  • A twin pregnancy can make breasts incredibly tender and sore.

Twin pregnancy week by week

Week 1 and 2:

Two weeks after fertilization, embryos multiply to form a ball of cells and invade into the endometrium of the uterus known as implantation. Twin pregnancy has more chances of having implantation bleeding than a singleton pregnancy.

Week 3 and 4:

From the third week after fertilization, the placenta starts forming for each baby separately. Placentas provide nutrition and oxygen to fetuses. In some rare cases, a single placenta may form in twin pregnancy.

Week 5 and 6:

Each baby’s spinal cord and brain start developing from their neural tubes.

Week 7 and 8:

Congratulations! Around seven weeks, your twin’s hearts start beating.

By 8th week, twins will have buds for limbs, and by the end of 8th week, all major organs start to develop.

Week 9 to13

  • Your twins start developing fingers followed by little toes.
  • Twins faces become more defined. Face profile will be more developed with the formation of nose, eyes and upper lips.
  • Tooth buds start forming under the gums.
  • By 12th-week fingernails begins to sprout.
  • By the end of 13 weeks, your twins are producing urine and begin to release urine into the amniotic sac. Kidneys and urinary tract of your babies are functional now.

Ohh The babies can start sucking their thumbs now!

Week 14 to 17:

The length will be approx. 4 inches from crump to rump.

  • Genitalia of babies is forming now.
  • Their Liver and spleen are producing red blood cells.
  • Upper limbs are becoming proportionate to rest of the body through lower limbs are still underdeveloped.
  • Your babies’ bones are getting hardened in a process called Ossification.

Week 18:

  • Twin babies’ eyes can detect light now
  • Be gentle and soft on voice, ladies! Your babies’ ears are beginning to pick up sounds now.
  • Facial features of twins are more defined now.
  • You can start feeling your babies’ little movement.

Week 19:

  • Arms and legs of twins are fully formed n proportional to the body.
  • Babies skin is now protected with a cheese-like substance called vernix.
  • Fat is beginning to deposit around the organs of your babies.

Week 20 to 22:

  • Hair and nails are continuing to grow.
  • In the female baby, the uterus is formed, and the vaginal canal is now forming.
  • Fetal movements will be more real n precise now
  • Babies body is now covered with thin protective layers of hair called lanugo.
  • Length of twins is now 51/2 to 61/2 inches from crown to rump and weight approx. 9 ounces.

Week 23 and 24:

  • Both the babies eyebrows are growing now.
  • Tooth buds for future teeth are in place.
  • Taste buds may be working now.
  • Their skin is red and wrinkled around this time

Week 25 to 27:

  • Babies start forming ridges in the palm and sole of feels.

Dear parents! May Your babies have their handprints on your hearts always, and their footprints will ever sparkle your homes with laughter.

There will be significant development of fingerprints and footprints around this time.

  • At 26th-week babies lungs start producing surfactant, which is very important for their breathing.
  • Did you notice…, they made grasping movements.

Week 28 to 32:

  • Babies can open their eyelids now donned with eyelashes.
  • They can suck their fingers
  • You can feel their hiccups.
  • Babies brain now can control their body temperature.
  • Bones are hardening, but their skull is still soft…this helps in their vaginal delivery.
  • They start shedding their protective layers of fine hair called lanugo.

Week 33 to week 36:

  • Nails now covers babies’ fingers and toes.
  • Heads full of hair now in most babies
  • Circulatory and musculoskeletal systems are nearly formed and functional.
  • Their lungs are ready to breathe outside the mother’s body.
  • Babies keep on gaining fat and weight.

Week 37 to week 40:

  • Your babies’ vital organs are now developed enough for life outside the mother’s womb.

Tests for Twin pregnancy:

Though the routine tests for singleton and twin pregnancy remain the same, twin pregnancy requires few additional tests. These include frequent Sonography and more doctor’s visits to monitor the optimal growth of both twins.

Few tests which require special mention are

● Hb or testing for Anemia:

Physiological Anemia is common and more profound in twins as there’s much more increase in blood volume as compared to the rise in red blood cells. So, do tests for Anemia early n more frequent.

● Pap Smear

This test is done to detect the cervical and vaginal infection as well as it acts as screening for cervical cancer.

● Urine test

This test is done in all the trimester to detect urinary infection, protein and sugar in the urine. Urinary infections are cause for preterm delivery in some twin pregnancies.

● Test for Gestational Diabetes

Increase in weight plus age of the patients put them in the risk of Gestational Diabetes.

● Sonography

Important dates for scan in twin pregnancy are.

1) Around 6 to 8 weeks of pregnancy to confirm twin pregnancy as well as to detect heartbeats in twins.

2) Nuchal scan around 11 to 13 weeks of pregnancy to rule out Neuro tubal defects and signs of down syndrome.

3) Anomaly scan around 20 to 22 weeks for detailed scanning of anomalies.

4) Growth scan between 28 to 32 weeks for growth of both fetuses and to rule out intrauterine growth retardation in the fetuses.

5) Obstetric scan with colour doppler is needed around 34 to 35 weeks to assure sufficient blood is flowing through the placenta to both babies.

Diet for twin pregnancy:

A healthy and balanced diet containing the right nutrients in pregnancy is crucial to ensure optimal growth of both babies.

Your diet should include

Complex carbohydrates” Energy food “::

Sources are whole wheat bread, brown or red rice, fruits and veggies

Proteins  “Food for growth.”

Good sources of proteins are Lean meat, Poultry, Tofu, Beans, Fish, Nuts, Egg whites

Healthy Fats  ” For glow n chubby babies.”

Vegetable oils, Olive oils, Nuts, Ghee

Calcium ” Food to build bones.”

Dairy products like Milk, Cheese and yoghurt and dark green leafy vegetables

Iron “To increase Hb in blood.”

Green leafy vegetables like Spinach, Red meat, Fruits intake should include pomegranate, plums and mangoes.

Folic acid “To alleviate congenital disabilities.”

Sources of folic acids are Green leafy vegetables like Spinach, Broccoli, Asparagus, Cantaloupe, Okra, Avocado, Corn, Oranges, Seeds and Nuts, Cauliflower, Chickpeas

Common Misconception

One apparent misconception about one humble fruit which has been made taboo to eat in pregnancy is  ” Papaya.” Fully ripe papaya can be eaten in pregnancy without any harmful effects on pregnancy.

Unripe papaya contains latex and papain in its covering, which can induce uterine contractions and miscarriages in some patients. So avoid eating unripe papaya in pregnancy.

Risk and complications in twin pregnancy :

A twin pregnancy can put the mother and babies at increased risk due to pregnancy-related complications. But worry not…taking due precautions and proper antenatal care under the guidance of doctor may increase your chances of a healthy pregnancy and healthy babies.

Few risks in twin pregnancy are as follows

1)   Preterm delivery:

Twin pregnancy delivers prematurely before 36 weeks of gestation in nearly half of the cases.

2)   Low Birthweight:

Twin babies are less in weight as compare to singleton pregnancy and delivery before term puts them more in the risk of low birth weight.

3)   Pre-eclampsia:

Increase in Blood pressure with swelling over the body, headache and excretion of proteins in urine define pre-eclampsia, which is common in twin pregnancy. Your doc may induce labour to deliver early as this condition put mother and babies at risk.

4)   Gestational Diabetes :

Increase in weight, older age of females and obesity does increase chances of Gestational Diabetes in twin pregnancy more than a singleton pregnancy.

5)   Iron-deficiency Anemia :

Chances of iron deficiency Anemia is much more rampant in twin pregnancy as the requirement of the twins are much more your diet can provide. In addition to this, there is a second-trimester physiological dip in Hb which again makes patients anaemic. Anaemia can lead to low birth weight babies and preterm delivery.

6)   Twin to Twin Transfusion :

This happens in identical Twins who share a single placenta. The connection between babies blood vessels allow one baby to get much more blood, and others get too less blood.

Labour and delivery for twin pregnancy :

Vaginal birth versus Caesarean section

Though nearly 40 per cent of twin deliveries happen vaginally,  there may be few indications where Caesarean section are safer and recommended electively.

The indications of CS are

  • First baby in breach position or legs or knee position
  • First twin in transverse lie
  • Low lying placenta or placenta previa
  • In twins sharing a single placenta
  • Previous Caesarean section
  • There has been a history of previous difficult vaginal delivery.

Discuss with your doctor about your options for delivering vaginal versus CS.

In Vaginal birth, more monitoring is needed. You may have to get admitted very early after the onset of labour. The doctor may advise you on starting IV drip to maintain hydration. They may add medicine to increase your contractions.

The doctor can’t allow you to be in labour for long. Fortunately, twin labour is short. Your caretakers will be continuously monitoring both babies heartbeats as well as uterine contractions. And in most of the cases, vaginal birth is assisted by episiotomy or vacuum applications in twin pregnancy.

Once the first baby delivers, second comes in a short time as the cervix is already dilated. In some cases, the doctor needs to give medication to increase uterine contractions if the second twin is in the right presentation and contractions reduce after the birth of the first twin.

Read detailed post on Labour and Delivery

Frequently Asked Questions to Doctors on Twin Pregnancy :

Though every pregnancy, whether single or multiple requires adequate antenatal care, it is the multiple (Twin being commonest ) pregnancy which requires the undivided attention of treating doctor—few essential points from my side.

Do I require frequent clinic visits?


  • Early visit the doctor as soon as you miss the periods
  • Frequent checkups in early pregnancy to confirm twin pregnancy, their heartbeats as well as the growth of both babies.
  • Detailed history in every visit and complete checkup.
  • Early blood test for Anemia which may be repeated in the second trimester and third trimester of pregnancy.
  • Sonography will be done more often in twin pregnancy to check optimal growth of both the babies apart from routine.

Do I need to double up my caloric intake in twin pregnancy?

No! It is a misconception that you need to eat double in twin pregnancy.

What you need to know is.

  • Calorie requirements in twin pregnancy increase by 40 per cent. What is required that women be told about the balanced diet with proper nutrients as are necessary for babies growth.

Do I need to take different prenatal vitamins than a single pregnancy?

No! You will be prescribed same prenatal vitamins as singleton pregnancy except your doc may choose to increase your folic acid and iron supplements.

Do I have to rush to doctors for every symptom?


Educate yourself about the danger signals when you have to notify your caretaker on urgent basis like

1)Leaking or rupturing bag of water any time apart from labour or preterm leaking.

2) Preterm pain in the abdomen

3) Reduce foetal movements

4) Sudden swelling on feet n body

5) Headache and Giddiness.

6) Excessive vomiting

7) Feeling tired and lethargic all the time

Do all twin pregnancies delivers preterm? Can bed rest reduces the risk of preterm delivery?


Not all but a little more than half of the twin pregnancies ends in preterm delivery.

And taking bed rest does not prevent preterm delivery. You may be asked by your doctor to reduce your activities if you show early signs of preterm delivery.

Are all twin pregnancies delivered by Cesarean section?

No! Nearly 40 per cent of twins deliver vaginally.

  • By 8th month, your doctor will be able to tell you whether you be able to deliver vaginally or it will be elective Cesarean section. Discuss if in doubt. You can opt for epidural analgesia if it’s going to be vaginal birth. But above all, listen to your doctor.

Is feeling depressed or not confident familiar in twin pregnancy?

Yes! The hormonal out surge may make you more emotional.

  • The emotional and psychological aspect of twin pregnancy cannot be ignored. You may feel depressed or not confident enough to take care of two babies. Speak up, Ladies! Discussing your fears and problems with your caretaker along with your family sort out so many issues.

Enjoy this wonderful though the exhausting journey of twin pregnancy ladies and at the end, you will be awarded two beautiful babies for life.

About the author

Dr Meenal Dhabalia, M.D (Gynaecologist & Obstetrician) 

She has a robust experience of 25 years as an Infertility Consultant, Obstetrician, and Gynaecologist,

LapaDr. Meenal Dhabaliaroscopic surgeon. Her expertise in Infertility treatment, High-risk pregnancy, and Gynaec endoscopy is well known. She is the Medical Director of Aditi IVF and Medical Centre, Dattani Park, Kandivali East, Mumbai. She is also the Chief Consultant in Aditi Superspeciality Hospital, Asha Nagar, Kandivali East Mumbai.

Read also- The First 1000 days of Baby’s Life- What You Should Know

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