Q: My 22 years old wife had a missed abortion some time back and now she is pregnant with twins. Last week, she underwent scanning and the doctor noticed that one child has cleft palate. To add, I also have cleft palate. The doctor also suspects that water in uterus might flow from the fetus’ eyes into the brain. The other fetus is normal but underweight. What can causes these abnormalities?

A:The twin pregnancy has a higher risk of premature labour and anaemia, hypertension and sometimes irregular bleeding. The excess fluid and differences in the weights of the baby indicate that there is some discordant growth. The pregnancy needs to be followed with greater care, by repeat scans every month to see the condition of the baby and the fluid amount. A record of the fetal heart tracings after 32 weeks to check for fetal distress also needs to be done. Any anaemia, or high blood pressure, or pains need to be treated early, and your wife needs to have enough rest to avoid premature labour. She can however do light house work and regular walking, once a day. Nutritious high protein meals are essential. For the excess fluid, rest may help, but if it increases to uncomfortable levels, then medicine like indomethacin/ or tapping the fluid through the abdomen is sometimes done - remember this is only if the fluid increases too much (AFI> 25 cm). As for the cleft lip, it can always be repaired through plastic surgery after the baby is born. The baby that is smaller in weight, will improve with rest and good diet.