We recommend the assessment of cervical length at the anatomy ultrasound, at 22-24 weeks, and at 28 weeks.However, the positive predictive value for preterm birth is low. Data from meta-analyses have shown that cervical shortening on transvaginal ultrasound examination identifies twin pregnancies that are at high risk for preterm birth.The use of FFN as a screening method for risk of preterm labor in asymptomatic women is not recommended.What are the preterm labor monitoring recommendations for twin pregnancies? The concordance rate of major congenital malformations is approximately 20% in monozygotic twins. The incidence of congenital anomalies is 3-5 fold higher in monozygotic twins than in singletons or dizygotic twins thus, we stress the importance of an early anatomy ultrasound. However, understanding the higher risk of false positives and false negatives associated with the use of cell-free fetal DNA in twin pregnancies, this test can be offered to patients who are over the age of 33 or 35 (depending on the kind of twins). The use of cell-free fetal DNA in twin pregnancies is currently not supported by ACOG. Cell-free fetal DNA from the mother’s plasma is available as a screening test for singleton pregnancies at higher risk of aneuploidy.Invasive diagnostic testing with chorionic villus sampling (CVS) or amniocentesis are available options.We recommend that all women carrying twins have integrated serum screening with a first trimester nuchal translucency measurement.For dizygotic twins, there is a higher probability that one or more of the fetuses will have a trisomy, resulting in a higher overall risk to the pregnancy. What are aneuploidy screening recommendations for twin pregnancies?Īll women carrying twins - regardless of age - are candidates for routine aneuploidy screening. No recommendation due to insufficient data. PRE-PREGNANCY BMI BODY MASS INDEX (Kg/M2) The Society of Maternal-Fetal Medicine also recommends that they take 1 mg of folic acid to prevent neural tube defects (most prenatal vitamins have 0.4 to 0.8 mg of folic acid so extra supplementation is recommended).īelow are the Institute of Medicine’s recommendations for weight gain while carrying twins. Because women carrying twins are at an increased risk of developing anemia, the Society of Maternal-Fetal Medicine recommends 30 milligrams of iron during the first trimester and 60 milligrams of iron until delivery.High-protein shakes are recommended given the high nutritional value.She must increase her daily dietary intake by about 600 calories per day, 300 calories more than a woman carrying a singleton gestation.
Because the patient most often experiences early satiety and loss of appetite, we recommend a consult with a nutritionist to address this and other issues. What are the nutritional needs for women carrying twins?Ī woman carrying twins has unique nutritional needs, especially for additional calories. Fetal imaging: Executive Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. * Reddy, UM, Abuhamad AZ, Levine D, Saade GR for the Fetal Imaging Workshop Invited Participants. Not recommended without an indication (e.g., abnormal growth).A maximum vertical pocket of 2-8 centimeters is normal.Assess bladder and amniotic fluid every 2 weeks.Assess every 4 weeks for uncomplicated Di-Di twins.Increased with aneuploidy malformations and twin-twin transfusion syndrome.High accuracy, if performed during the first trimester.
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