Is being pregnant with twins twice as complicated? 

It depends. Being twice as pregnant does not necessarily mean that you will have twice as many problems, but any problems that you do have may be exacerbated by carrying two babies.

Due to the opportunity for a routine dating scan, twin pregnancies now tend to be diagnosed by about 12 weeks gestation, or even earlier if a viability scan has been carried out. This means that an appropriate plan of care for the pregnancy can be devised, and the extra vigilance will ensure that any problems can be anticipated or dealt with promptly as they arise.

What are the risks to me?

There is an extra strain placed on your whole system, and it is likely that any of the minor disorders of pregnancy, such as tiredness, anaemia, indigestion, and backache, will be exaggerated in a twin pregnancy.

You may also be more predisposed to any of the complications mentioned above, such as hyperemesis, cholestasis and gestational diabetes. There is an increased risk of going into labour early with twins [either spontaneously or induced], but there is also an increased risk of needing an elective caesarean section, unless the first twin is cephalic. Immediately after the birth, there is an increased risk of bleeding, due to the enlarged size of the uterus, so you will usually have a hormone drip for the first 4 hours afterwards to help the uterus to contract.

What are the risks to the babies?

The main risk to twins is that they might be born prematurely, especially as they tend to be smaller and lighter at birth than a singleton baby of the same gestation. Sometimes one twin grows more slowly than the other and this will be carefully monitored by regular ultrasound scans. If the growth of one or both babies tails off considerably, it might be recommended that they are delivered early.

There are additional risks to monochorionic diamniotic or identical twins who are sharing the flow of nutrients through one placenta. A quite rare but more serious problem for these babies is twin to twin transfusion syndrome where some of the blood flow from one twin is directed into the other twin instead of into the shared placenta. The donor twin becomes anaemic and the recipient twins heart is put under a huge strain. This can usually be corrected during the pregnancy by a procedure which cauterises the problem blood vessel.