Special considerations regarding antenatal care and pregnancy complications in dichorionic twin pregnancies

Twin pregnancies account for about 3.3% of all deliveries in the United States, with most of them being dichorionic diamniotic. Maternal physiological adaptation in twin pregnancies is exaggerated, and the rate of almost every maternal and fetal complication in twin pregnancies is higher than that in singleton pregnancies. Therefore, twin pregnancies necessitate closer antenatal surveillance by care providers, who are familiar with the specific challenges unique to these pregnancies. In addition, there is evidence that following women with twins in a specialized twin clinic can result in improved obstetrical outcomes. The importance of the first antenatal visit in twin pregnancies cannot be over emphasized and should preferably take place early in gestation, as that is the optimal period to correctly identify the number of fetuses and the type of placentation (chorionicity and amnionicity). This will allow the patients, families, and caregivers to make the appropriate modifications and tailor an optimal antenatal follow-up plan. This plan should focus on general recommendations such as weight gain and level of activity, education regarding the complications specific to twin pregnancies along with the relevant symptoms and indications to seek care, and close maternal and fetal monitoring. In this review, we summarize the available evidence and current guidelines regarding antenatal care in dichorionic diamniotic twin pregnancies.