Twin Pregnancy Monitoring in Nagpur
Twin pregnancies need more careful follow-up than singleton pregnancies. The most important first step is identifying whether the twins are dichorionic or monochorionic, because the scan schedule, risks and monitoring plan are different.
Twin pregnancy needs a planned scan calendar
The risk profile of twins changes depending on whether they share a placenta. Dichorionic twins usually have separate placentas, while monochorionic twins share a placenta and need closer surveillance for complications such as TTTS, TAPS and selective fetal growth restriction.
Dr. Kunda Shahane creates a structured twin pregnancy monitoring plan based on chorionicity, gestational age, fetal anatomy, growth pattern, Doppler, amniotic fluid and the mother’s health. She performs the scans herself and follows Fetal Medicine Foundation protocols for twin assessment.
Chorionicity decides the monitoring pathway
Chorionicity means whether twins have separate placentas or share one placenta. It should be documented as early as possible.
Dichorionic twins
Each twin has a separate placenta. These pregnancies still need serial growth and wellbeing monitoring — a first trimester scan, an anomaly scan at around 20 weeks and growth scans every four weeks after that — but they do not carry the risk of TTTS or TAPS.
Monochorionic twins
The twins share one placenta. They are scanned every two weeks from 16 weeks to look for TTTS, TAPS, selective growth restriction, fluid imbalance and Doppler changes, with middle cerebral artery Doppler added from 20 weeks.
Monoamniotic twins
Rare, and higher risk because both babies share one amniotic sac. Cord entanglement is present in nearly every monoamniotic pair. Dr. Kunda manages these pregnancies herself; delivery is by caesarean section, usually between 32 and 34 weeks.
Why early chorionicity matters
Chorionicity should be documented before 13+6 weeks, and usually at the 11–14 week scan, because the dividing membrane is easiest to assess before the amnion and chorion fuse. Later in pregnancy it can be harder to confirm if early images or reports are not available. Where it cannot be settled, the pregnancy is recorded as undetermined and monitored on the monochorionic pathway, which is the safer assumption.
Twin pregnancy monitoring schedule at a glance
The exact schedule is individualised. Monochorionic twins need more frequent scans than dichorionic twins.
| Pregnancy stage | Main scan / assessment | What Dr. Kunda checks | Why it matters |
|---|---|---|---|
| Early pregnancy | Viability Dating | Number of fetuses, heartbeat, gestational age, early pregnancy location and pregnancy dating. | Correct dating is essential for growth comparison, screening and later delivery planning. |
| 11–14 weeks | NT scan Chorionicity | Chorionicity, amnionicity, NT, early anatomy, nasal bone when appropriate, ductus venosus/tricuspid flow if indicated. | This is the key stage to classify twin type and start the correct surveillance pathway. |
| From 16 weeks in monochorionic twins | TTTS/TAPS screening | Deepest fluid pocket around each baby, bladder visibility, fetal growth, umbilical artery Doppler, MCA-PSV from 20 weeks and signs of twin imbalance. | Fortnightly scanning from 16 weeks detects around 90% of TTTS cases in time to act on them. |
| 18–22 weeks | Anomaly scan | Detailed anatomy of both babies, placenta, cord insertions, cervix, fetal heart views and twin-specific concerns. | Structural anomalies are assessed separately for Twin A and Twin B. |
| 20–24 weeks onwards | Growth trend Discordance | Estimated fetal weight of each twin, abdominal circumference, growth discordance, amniotic fluid and Doppler. | Weight discordance is calculated and documented at every scan from 20 weeks. |
| Third trimester | Doppler BPP/NST | Growth, amniotic fluid, Doppler, fetal wellbeing, presentation of each baby and maternal complications. | Helps plan surveillance frequency, referral, admission if needed, and delivery timing discussion. |
| Any time if symptoms or abnormal scan | Urgent review | Reduced movements, pain, leaking, bleeding, high BP symptoms, sudden fluid difference, growth concern or abnormal Doppler. | Twin pregnancies can change faster, especially monochorionic twins; early review helps avoid delay. |
Important: do not use a singleton schedule for twins
Twin pregnancy monitoring must be customised. The scan interval depends on chorionicity, fetal growth, amniotic fluid, Doppler, maternal health and whether any complication has appeared. Scan charges are listed on the pregnancy scan cost page; for the cost of a specific twin appointment, WhatsApp 8087471244 with how many weeks pregnant you are.
Monochorionic twins need special attention
Monochorionic twins share one placenta. Because of placental connections between the babies, they are at risk of twin-to-twin transfusion syndrome, twin anemia-polycythemia sequence, selective fetal growth restriction and sudden fluid or Doppler changes.
This is why monochorionic twins need a planned surveillance pathway from the second trimester, not just occasional routine scans. Scans run every two weeks from 16 weeks, and more often once a complication is suspected.
Detailed twin pregnancy assessment
Every visit should identify Twin A and Twin B clearly and compare both babies systematically.
Twin A / Twin B labelling
Position, presentation and placental location are documented so each baby can be followed consistently across scans.
Growth of each baby
BPD, HC, AC, FL and estimated fetal weight are measured separately for each twin, then compared for growth discordance.
Amniotic fluid around each twin
Fluid pockets are checked separately. Sudden difference in fluid can be important, especially in monochorionic twins.
Doppler assessment
Umbilical artery, MCA, ductus venosus or other Dopplers may be used depending on growth, fluid and fetal wellbeing.
Fetal heart review
Twin pregnancies may need careful cardiac views, and fetal echocardiography is advised when indicated.
Cervical length and preterm risk
Twins have higher risk of preterm birth. Cervical length is measured at the anomaly scan and again before 24 weeks where there are additional risk factors.
Conditions monitored in twin pregnancy
The aim is early recognition, clear counselling and timely referral or intervention when needed.
TTTS
Twin-to-twin transfusion syndrome can occur in monochorionic twins and is monitored through fluid, bladder, growth and Doppler findings.
TAPS
Twin anemia-polycythemia sequence may need MCA Doppler assessment and specialist interpretation in monochorionic twins.
Selective FGR
One twin may grow significantly less than the other. Growth discordance and Doppler guide surveillance and counselling.
Preterm birth
Twin pregnancies have higher chance of earlier delivery, so cervix, symptoms and obstetric coordination are important.
When referral is urgent
Sudden fluid imbalance, absent bladder in one twin, major growth discordance, abnormal Doppler, suspected TTTS/TAPS, hydrops, reduced movements, bleeding, leaking or pain should not be delayed.
How twin pregnancy monitoring is planned at Mayflower
Confirm dating, number of babies and chorionicity
Early scan reports are reviewed. If not already documented, chorionicity and amnionicity are assessed carefully.
Create a twin-specific scan schedule
Dichorionic and monochorionic twins need different scan intervals. The plan is adjusted according to risk and findings.
Perform detailed fetal assessment
Both babies are assessed for anatomy, growth, fluid, Doppler, placental/cord findings and fetal heart views.
Screen for twin complications
TTTS, TAPS, selective FGR, fluid imbalance, discordant anomalies, cervix shortening and preterm birth risk are considered.
Coordinate with obstetric and neonatal teams
If required, the plan includes fetal therapy referral, admission, steroid timing, delivery planning or neonatal counselling.
Who looks after the pregnancy afterwards
A scan finding on its own is of no use to anybody. What matters is the plan that follows it, and the same doctor who performs the scan writes that plan, counsels you about it and carries it out — including the maternal side of a twin pregnancy, where hypertensive disorders, anaemia and diabetes are all commoner than in a singleton pregnancy.
If you are already booked with another obstetrician, that does not change. You are seen for the fetal medicine surveillance and referred back to your own gynaecologist with the findings and the schedule, which is the commonest arrangement in twin care. Women booked under Dr. Kunda’s own care have their delivery, including caesarean section, conducted by her at a hospital in Dhantoli.
When should you book a twin pregnancy scan?
As soon as twins are detected
Early confirmation of chorionicity is one of the most important steps in twin pregnancy care.
At 11–14 weeks
NT scan, early anatomy, chorionicity and pregnancy dating can be reviewed at this stage.
From 16 weeks in monochorionic twins
Fortnightly surveillance begins, to look for early signs of TTTS, TAPS or growth imbalance.
What to bring for the visit
Bring all previous scan reports and images, IVF records if applicable, NT/aneuploidy screening report, NIPT report if done, obstetric notes, blood pressure records, sugar records and medication list.
Dr. Kunda Shahane’s note on twin pregnancy
In a twin pregnancy, my first priority isn't just 'are both babies growing well?' I need to know if they share a placenta. Chorionicity entirely dictates our monitoring plan because shared-placenta twins face very different risks. Establishing this early is crucial, so we know exactly how and when to watch the pregnancy.
Twin pregnancy monitoring FAQs
Why is twin pregnancy monitoring different from singleton pregnancy?
Twin pregnancy carries a higher chance of preterm birth, growth restriction, unequal growth between the babies, high blood pressure, diabetes and amniotic fluid imbalance, and in monochorionic twins the additional risks of TTTS and TAPS. Monitoring is therefore more frequent, and how frequent depends on chorionicity.
Why is chorionicity important in twin pregnancy?
Chorionicity tells whether twins have separate placentas or share one placenta. Monochorionic twins need closer monitoring because placental sharing can lead to TTTS, TAPS and selective growth restriction.
When should chorionicity be checked?
Chorionicity should be established early, ideally before 13+6 weeks and usually at the 11 to 14 week scan, because the dividing membrane is easiest to assess before the amnion and chorion fuse. If early reports are not available it can still be assessed later, using the layers of the dividing membrane and transvaginal imaging where required.
How often do twins need ultrasound?
It depends on chorionicity. Dichorionic twins have a first trimester scan, an anomaly scan at around 20 weeks and growth scans every four weeks after that. Monochorionic twins are scanned every two weeks from 16 weeks, and more often if a complication appears.
What is TTTS?
Twin-to-twin transfusion syndrome is a complication of monochorionic twins in which blood flow between the babies becomes unbalanced through shared placental connections. It is monitored by amniotic fluid, bladder visibility, growth and Doppler findings.
What is TAPS?
Twin anemia-polycythemia sequence is a monochorionic twin complication in which one twin may become anemic and the other may have thicker blood. Middle cerebral artery Doppler is recorded from 20 weeks onwards to screen for it.
Do all twin pregnancies need fetal echo?
Not all twins need fetal echo, but it may be advised when the heart views are incomplete, a cardiac concern is seen, the twins are monochorionic, the pregnancy followed IVF, or your doctor recommends detailed cardiac review.
Can one twin grow less than the other?
Yes. Growth discordance can occur in twin pregnancy. The size of the difference, the Doppler findings, the amniotic fluid and the chorionicity together decide how serious it is and how closely it is followed.
Is twin pregnancy always high-risk?
Twin pregnancy is considered higher risk than singleton pregnancy because of the increased chance of preterm birth, growth problems, high blood pressure, diabetes and twin-specific complications. Many twin pregnancies still run smoothly, which is what the monitoring schedule is designed to confirm.
Written and medically reviewed by Dr. Kunda Shahane, MBBS, MS (Obs & Gynae), FIFM, FMF (London) · Last reviewed: 9 September 2026
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Need twin pregnancy monitoring in Nagpur?
Book a twin pregnancy scan and counselling appointment with Dr. Kunda Shahane at Mayflower Fetal Medicine & High-Risk Pregnancy Centre, Dhantoli, Nagpur. Carry your early scan report so chorionicity, dating and the follow-up pathway can be reviewed correctly.
Mayflower Clinic, Surdham Complex, Behind Silver Palace Building, 2nd Lane from Panchsheel Square, Opp. Yashwant Stadium, Dhantoli, Nagpur – 440012 · Monday–Saturday, 10:00 AM – 6:00 PM · Sunday closed
Which twin scan you need, and when
Twin pregnancies are not one clinical problem. What is scanned, and how often, depends entirely on whether the twins share a placenta — which is why the first question is always chorionicity, and why it has to be answered early.
- Chorionicity scan — 11 to 14 weeksEstablishes whether the twins have one placenta or two. This is far easier to determine in the first trimester than later, and it sets the entire surveillance schedule for the rest of the pregnancy.
- Monochorionic twin surveillanceTwins sharing a single placenta need fortnightly scans from around 16 weeks, watching for twin-to-twin transfusion syndrome, selective growth restriction and anaemia-polycythaemia sequence. Dichorionic twins are monitored less intensively.
- Twin-to-twin transfusion syndrome (TTTS)The complication the fortnightly scans exist to catch. Diagnosis, staging and management, including laser therapy — first performed in Vidarbha at this centre.
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