Antenatal Care & Routine Testing
As soon as you have confirmed your pregnancy with a home testing kit you should make an appointment with your GP. Your GP will notify your local hospital and community midwife and you will receive your first antenatal appointment at some time between 8 and 12 weeks. This is known as your booking-in appointment.
You will probably be asked to bring a urine sample along to your booking-in appointment and may even be asked to give a blood sample. Height and weight and general questions about your health will be asked. You will be asked questions relating to your family history and any previous pregnancies so as to document a basic picture of your health and your pregnancy so far.
You will be given information relating to your pregnancy and antenatal care and the midwife may even discuss issues such as diet and work and even ask your thoughts on breast or bottle feeding.
Of course at this stage, you are still unlikely to realise you are carrying a multiple pregnancy. Maybe you have your suspicions but it can only be confirmed at your dating scan which will normally take place anytime between 10 and 14 weeks.
Dating Scan
The purpose of the dating scan is to tell how many weeks pregnant you are and to estimate your due date. It will also reveal if you are indeed carrying a multiple pregnancy.
If the scan shows a multiple pregnancy your antenatal care will allow for greater monitoring of both you and your babies. Firstly, they will want to confirm the type of twins you are having because this is a main factor in determining the level of care you will require. An Identical twin pregnancy is thought to be higher risk than a fraternal twin pregnancy due to the babies sharing a placenta and sometimes the same amniotic sac.
Screening Tests
Routine blood tests will be taken to test for:-
- Anaemia
- Blood Group
- Rhesus Status
- Rubella Status
- Infections such as HIV and Hepatitis B
Rhesus Typing is a test to determine what rhesus status you are. Most people are rhesus positive but for those that are rhesus negative regular checking for antibodies is necessary.
People who are rhesus positive (RhD positive ) have a protein known as D antigen on the surface of their red blood cells. People who do not have the D antigen are known as RhD negative.
Rhesus status only matters if an RhD-negative mother is carrying a RhD-positive baby (the child inherits this from an RhD-positive dad). If some of your baby's blood gets into your own bloodstream, your immune system may react to the D antigen in the baby's blood as if it were a "foreign invader" and produce antibodies against it.
If you are found to be rhesus negative you will be checked for antibodies and you will be given an injection known as Anti D which prevents women developing antibodies during their pregnancy.
Nuchal Translucency Test
This test can be carried out by ultrasound between weeks 11 and 13 so often during your dating scan. Nuchal Translucency is a collection of fluid under the skin at the back of a baby’s neck. It can be measured using ultrasound. The test is a screening test which estimates the risk of your baby having Down’s syndrome. If the assessment is high risk there are diagnostic tests available known as CVS or Amniocentesis. These tests will give a definite diagnosis but they do carry a small risk of miscarriage.
Anomaly Scan
You will be offered an Anomaly Scan at around 20 weeks. This scan is to check that your babies are developing properly. The sonographer will take a much closer look at your babies and detailed measurements will be taken. She will also look for signs showing conditions such as cleft lip and palate, spina bifida and other abnormalities of the major organs. Although it sounds scary, it’s all routine stuff and the same for any singleton pregnancy.
Extra Scanning for Multiple Pregnancy
The growth of your babies will be monitored closely by Ultrasound and will make up a large part of your antenatal care. Several scans will be offered and particularly with an identical twin pregnancy you may receive ultrasound scans every fortnight and even weekly if necessary. An identical twin pregnancy is at risk of the condition known as Twin to Twin Transfusion Syndrome. It is through ultrasound that signs of this condition can be detected and treated if found.
Midwife Appointments and Consultations
It is more likely that your antenatal care will be based at your hospital where they are equipped to deal with a multiple pregnancy. You are likely to have fortnightly appointments and have the routine checks such as urine, blood pressure and even blood tests. These checks will be followed by a consultation with a consultant doctor or registrar specialising in multiple births.
