Lefate Lazarus Mankunyane, Dr PP Songca


The incidence of twin pregnancy is variable but increased because of use of assisted productive technology. Two-thirds of twins are dizygotic and one-third monozygotic. The dizygotic twin pregnancies arise from simultaneous shredding of two oocytes and fertilization by different spermatozoa, whereas monozygotic twin pregnancies arise from single fertilized ovum. Twin pregnancies are associated with both maternal and fetal complications compared to singleton pregnancies.


Management of twin pregnancy includes:


  • Diagnosis

High index of suspicion on history and clinical examination is important. Ultrasound investigation is the gold standard for diagnosis of twin pregnancy by seven weeks gestation transvaginally.


  • Determination of gestational age

Date of last menstrual period is reliable and very accurate if patient is certain of her last menstrual date. The use of ultrasound early in pregnancy helps with accurate assessment of gestational age and is very accurate if done before 24 weeks gestation.


  • Determination of chorionicity

The use of ultrasound early in pregnancy is accurate for assessing chorionicity and zygocity in first trimester which is important in management of twin pregnancy.


  • Antenatal care

All antenatal visits must take place at referral center. Patient should be warned of all possible complications.


  • Timing  of delivery

Monochorionic twins should be delivered at 35 weeks, triplets at 33 weeks and dichorionic at 37 weeks