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How are my babies developing?
Your babies’ hearts are almost completely developed and they very much resemble that of a new born.
How am I changing and what do I need to know this week?
Have you had your ‘booking appointment’ with your midwife yet? This appointment usually lasts approximately one hour. The midwife will take a detailed record of your medical history and you will be offered a number of routine blood tests. All the recommended advice on foods to avoid will be discussed and you will be informed about the care you will receive. You will also be given the key contact numbers for your pregnancy care team including the labour ward phone number. It is best to program these into your phone. Your blood pressure will be taken and your weight and height to calculate your Body Mass Index (BMI). If your BMI is 30 or more you will be offered advice, a referral to a dietician and a blood test called a Glucose Tolerance Test, which checks for gestational diabetes. This is usually performed at booking and again between 24-28 weeks in your pregnancy. A BMI of 30 or above can increase the likelihood of you developing this condition. For more information please read NICE guidelines (NG3) regarding diabetes in pregnancy.
If you have a previous history of mental health problems your midwife may recommend a referral to a perinatal mental health professional. The dietician, mental health professional, physiotherapist and infant feeding specialist are part of what NICE call an enhanced team. The team are there if you require their expertise. Your midwife will discuss this with you and make a referral if necessary.
Most multiple pregnancies are normal and healthy. However, there is an increased risk of complications for you and your babies which mean you need to be monitored more closely during your pregnancy than mothers who are expecting just one baby. This is to ensure that your babies are all growing well and that any possible complications are noted and monitored.
The NICE Clinical Guideline 137 recommends that your clinical care should be provided by a nominated multidisciplinary team: a core team of named specialist obstetricians, specialist midwives and a sonographer (the person performing the scans). All these people have experience and knowledge of managing twin and triplet pregnancies. Unfortunately, not all hospitals have specialist midwives for multiple births. If they do not then additional appointments should be arranged for you to see your community midwife. Twins Trust is campaigning to improve this situation. Check out our campaign centre here.
Remember to ask your midwife for the maternity exemption certificate FW8 to complete.
Have you been offered a screening test for Down’s Syndrome, Edwards’s Syndrome and Patau’s Syndrome yet?
Down’s Syndrome is a condition that causes learning disabilities. This means people with Down’s syndrome find it harder than most people to understand and to learn new things. It is impossible to know what level of learning disability a baby with Down’s Syndrome will have. It can vary from mild to severe. Some health problems are more common in people with Down’s Syndrome. Edwards’ and Patau’s syndromes are chromosome abnormalities. Unfortunately, babies born with either of these syndromes will have a wide range of problems that are usually extremely serious and most of these babies will die before they are born, be stillborn or die shortly after birth.
For more information on Down's Syndrome, Edwards' Syndrome and Patau’s Syndrome please visit www.downs-syndrome.org.uk or www.soft.org.uk. You can also visit Antenatal Results and Choices (ARC) at www.arc-uk.org. You can call ARC's helpline on 0845 077 2290.
This screening test is offered between 10 and 14 weeks of your pregnancy and is sometimes done at your dating scan. This is called the first trimester combined test and is the test the NHS recommends if you choose to have screening. The test will not harm you or your babies. The optimal time for this test is between 11 weeks and 2 days to 14 weeks and 1 day. If you decide to have the test a blood sample will be taken from you and at your dating scan the fluid at the back of each of your babies’ necks will be measured (known as the nuchal test). If you are expecting triplets or more the nuchal test alone is performed. The information from these two tests is used to work out the chance of each baby having Downs’s Syndrome, Edwards’ Syndrome or Patau’s Syndrome. Whether your babies are identical or non-identical and whether they share a placenta is very important in understanding your options because this affects the interpretation of these screening tests and any subsequent diagnostic tests you may be offered.
If you aren’t able to have the combined test before 14 weeks you will be offered a quadruple test instead. This screening is for the same conditions as the combined test but is not quite as accurate. You will be referred to the screening midwife prior to the test in order to explain the detection rates.
If you have a higher chance result you will be offered an invasive diagnostic test known as Chorionic Villus Sampling (CVS) or an Amniocentesis. About 3-4% of diagnostic tests result in a miscarriage in multiple pregnancy. It is up to you whether you have the further test. Making that decision can be difficult so you may like to speak with your hospital screening midwife or Antenatal Results and Choices www.arc-uk.org.
More information can be found in Twins Trust Healthy Multiple Pregnancy Guide. There are also non-invasive DNA screening tests for Down's Syndrome (often branded as the Harmony, Iona, or NIFTY tests) which are available from ten weeks. These are mainly available in the private sector at a cost of £400 - £500. These screening tests are currently not available for triplets and higher order multiples.
How can Twins Trust help me?
Reading our Multiple Pregnancy Guide can help you understand what to expect from your pregnancy. Follow the links below to resources that may interest you in week 10.
More useful links
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