Home Natural farming What twins look like at 5 weeks. All about multiple pregnancies - how to carry twins without problems? Twins or twins - objective signs

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What twins look like at 5 weeks. All about multiple pregnancies - how to carry twins without problems? Twins or twins - objective signs

In January 2009, eight babies were born at once in Los Angeles - six boys and two girls. Moreover, all of them turned out to be healthy and viable. This is not the first case of a unique multiple pregnancy. Although, of course, this happens very, very rarely.

Nature has designed it so that during one pregnancy, a woman normally carries and gives birth to only one child. Therefore, the development of several embryos at once is in any case considered a pathology, even if it proceeds without complications. But exactly how many babies are considered multiple births?

What is multiple pregnancy?

There is a little confusion with the definition. Most women believe that this is a pregnancy with at least triplets, or even more babies. However, this is not quite true.

According to scientific definition, multiple pregnancy is a condition in which two or more fertilized eggs develop at once.

When occurring naturally, that is, when no means are used to stimulate ovulation, and conception does not occur through IVF, this phenomenon is not so common. On average, out of the total number of births, cases where several babies are born at once do not exceed 2%. Wherein:

In one case out of 87 it will be twins.
There will be one triplet in every 6,400 births.
And the case when four babies are born at once occurs once in 51 thousand births.

It is interesting that today in developed countries Multiple pregnancies are twice as common as they were 20 years ago. Scientists still cannot explain this fact with accuracy.

Why does it occur?

There are many reasons for multiple births. Not on last place Genetics is high on their list. Indeed, if a woman had similar cases in her family, then the likelihood that she will give birth to at least twins will be higher. Although in practice this ability is inherited quite rarely.

Today doctors identify several main reasons:

Increased levels of follicle-stimulating hormone (FHS), which provokes the maturation of several eggs at once.
Age over 35 years, in which failure of ovulation and the formation of two eggs at once occur more often.
At elevated level pituitary gonadotropins - hormones that are responsible for the functioning of the sex glands.

In addition to such completely natural reasons, multiple pregnancies often occur:

After discontinuation of gestagen-estrogen contraceptives. If you conceive within one month of stopping birth control, you are twice as likely to become pregnant with twins.
When using the method in vitro fertilization.
When taking medications to stimulate ovulation.

Currently, multiple pregnancies arising from for medicinal reasons, accounts for approximately 30–80% of multiple pregnancies.

Kinds

Multiple pregnancy can be different. Not in the sense that two or three babies develop, but depending on how many eggs there were initially. Doctors share:

Polyzygotic (dizygous) multiple pregnancy in which two or more eggs are fertilized. Moreover, this can happen either simultaneously, when for some reason two eggs are formed in one cycle, or in the early stages of an existing pregnancy. Moreover, each fetus has its own membrane and placenta, and the babies end up looking just like brothers or sisters, with a different genetic makeup.
Monozygotic (identical) multiple pregnancy develops when two embryos are formed from one fertilized egg. According to one version, this occurs due to the fact that the egg was initially formed with two or more nuclei. According to another, at an early stage of development it simply split into two or more. Babies in this case have a common placenta and are always same-sex twins. Moreover, genetically they are completely identical to each other.

With any type of multiple pregnancy, twins, triplets, and even four babies can be born. However, 70% of cases occur in fraternal twins.

Signs

Most often externally and subjective feelings such a pregnancy is practically no different from a singleton pregnancy. Although there are several signs by which you may suspect you have twins. Especially if you have already had such cases in your family. These include:

A bright, clearly defined line on a pregnancy test.
Early toxicosis, which is more severe.
Appearing on early stages severe fatigue, swelling of the legs and heaviness in the back, which usually appear in the second trimester.
Large belly.
Early and more active movement of the baby.

Such signs are very subjective and can also occur when normal pregnancy because of individual characteristics body. Therefore, those that the doctor can determine will be more reliable. Namely:

A depression at the bottom or on the anterior wall of the uterus, which occurs due to the adhesion of the fetuses to each other.
Listening to a distinct heartbeat in different parts belly. In this case, heart sounds, as a rule, have unequal frequency.
Phonoelectrocardiography is a study carried out at approximately 20 weeks of pregnancy, which allows you to register several heart sounds and accurately determine how many babies you are growing.
Abnormal AFP test result. This is a blood test for alpha-fetoprotein levels, which is usually performed in the second trimester, from 16 to 18 weeks, in order to exclude various malformations.

The main method of confirming multiple pregnancy will be ultrasound, which helps determine it starting from the 6th week of pregnancy. Moreover, the accuracy of the method is 99.3%. All other studies are used only as auxiliary.

How does it develop?

It is very important to detect multiple pregnancies in time. After all, it develops a little differently and will require more attention and care for its health. Unfortunately, complications with multiple pregnancy are more common, the main ones being:

Various disorders in the circulatory system that can occur due to the fact that the volume of circulating blood increases by 60%, while in a singleton pregnancy it increases by only 40%.

Early birth. Average duration The gestation period for twins is 37 weeks, and for triplets only 35.
Bleeding during pregnancy and childbirth, as well as anemia.
Preeclampsia, which usually occurs more severely.
Varicose veins.
Due to the fact that the enlarged uterus displaces the diaphragm, shortness of breath, heartburn, and heart rhythm disturbances may occur.

First trimester

Usually, the expectant mother finds out that she is expecting several babies after 6 weeks through an ultrasound. And the twin pregnancy calendar by week in the first three months will be like this:

Until the 7th week, the foundation of the future nervous system, brain and internal organs is laid in babies. Their height is now approximately 4–5 mm, and their weight can reach 1.5 grams.
At 12 weeks of pregnancy, twins make themselves known by the sound of their hearts beating. Moreover, their height is approximately 5 cm. But even such tiny ones already have the outlines of their limbs and heads.
We are now 16 weeks pregnant with twins, which means we can try to determine the sex of the babies, who have already grown to 10–11 cm and weigh as much as 100 grams.

At sixteen weeks, the doctor will definitely prescribe you an ultrasound, a general, biochemical blood test, a general urine test, determination of the Rh factor and testing for infections.

Second trimester

This waiting period will be the calmest for you. Toxicosis usually remains a thing of the past and your health will noticeably improve. True, increased weight can cause pain in the legs and lower back. The pregnancy calendar in the second trimester highlights the following important weeks:

22 weeks pregnant with twins, the mother can already feel and determine the movements of her babies, because their height reaches 15–20 cm, and their weight can reach up to 300 grams. They are able to hear and respond to stimuli.
24th week of waiting, the babies reach a height of approximately 30 cm and a weight of 600 grams. They actively grow, move and push.
Week 27. From this time on, the growing children are quite viable, their height reaches 35–36 cm, and their weight reaches 900 grams. On the face you can see the outlines of the eyebrows, nose and even the first eyelashes.

Usually at this stage, if there are no complications or suspicions of them, doctors prescribe only routine ultrasound and visits to the antenatal clinic.

Third trimester

The final months of pregnancy can be very difficult for a mother. Heavy weight causes problems with joints and walking. The enlarged uterus puts pressure on the internal organs. And kids become more active during this period, even though they no longer have enough space. A twin pregnancy progresses week by week in the last trimester as follows:

At week 32, the formation of the skeleton is finally completed, the outlines of the body and head become more proportional. Weight can reach 1.5 kg, and height up to 40–45 cm.

The 34th week is significant because the mother may begin to be bothered by false contractions, the duration of which does not exceed a few minutes. Also from now on you should limit as much as possible physical activity.
36 weeks of pregnancy. The weight of twins reaches 2.5 kg for each baby, and the height can reach 48 cm. At this stage, it is not at all easy for a mother to carry such weight, she gets tired quickly and doesn’t walk much. She is often bothered by pain in her joints and spine.

A multiple pregnancy ends with birth earlier than a normal pregnancy, usually at 37 weeks. However, by this time the twins already have fully formed organs and are quite viable. Your doctor will help you calculate your pregnancy period accurately.

In addition to regular ultrasound, in the second trimester, the doctor will prescribe you a so-called triple test, determining the level of hCG and AFP, which will help determine how well your babies are growing and developing.

Waiting Features

Pregnancy with twins, and especially triplets, requires close attention. Much of what is possible during a normal pregnancy, future mothers of many children prohibited. Multiple pregnancies always have more high risk interruption or development of pathologies. Therefore, be prepared for the following:

You need to visit a doctor and get tested much more often. After the 20th week, visits should be every 2 weeks, and starting from the 30th week - every week.
You will have to give up intimacy even in the early stages, since your risk of miscarriage is twice as high, even in the absence of other complications.
You need to eat for three, or even four, which is quite difficult to do with the uterus pressing on your stomach. Therefore, eat a little, but every 2-3 hours, at least 6 times a day.
The daily calorie intake for a mother of twins is 3500 kcal, for a mother of triplets – 4500 kcal. Therefore, food should be as varied as possible. Include vegetables, fruits and nuts in your diet.
You will have to give up your usual sports, but special gymnastics for pregnant women should become your mandatory companion.
The longer the period, the more rest you need. For up to 20 weeks, this is a minimum of 4 hours a day, for a later period – up to 8 hours.
You should also start wearing a prenatal bandage earlier, from about 20–22 weeks.

Features of childbirth

Usually, in case of multiple pregnancy, doctors advise going to the maternity hospital 2-3 weeks before the expected date of birth in the case of twins, and 4 weeks in the case of triplets. Even if the pregnancy proceeded without complications and you feel well.

As for the method of delivery, everything will depend on the condition of the mother and her babies. If the pregnant woman feels well, there were no complications during the entire waiting period, all tests are normal and both babies are in the correct cephalic presentation, then a natural birth is quite possible.

With the normal development of the situation, babies are born one after another with a break of 15 minutes to 1 hour. Although usually this time does not exceed half an hour. But in the case of triplets, doctors most often resort to cesarean section.

Double or even triple births are not an easy test. It is very important to be attentive to your condition, visit a doctor on time and not ignore the symptoms that bother you, no matter how insignificant they may seem.

Pregnancy with two future babies at once is not only double joy and enormous responsibility, because inside the fair sex two people live and develop at once.

Twin pregnancy refers to the specification of multiple pregnancy - the process of carrying more than one fetus at the same time. Children born from this condition are called twins.

According to official statistics Before the era of in vitro fertilization began, every eightieth woman gave birth to twins. The development and mass introduction of reproductive technologies has increased the incidence of multiple pregnancies several times.

Multiple pregnancy

Multiple pregnancy is a general concept and usually defines the presence of more than one fetus in a pregnant woman. Depending on their number, it can be twins, triplets, and so on.

Common reasons

There are only two basic reasons for multiple pregnancy:

Maturation of several eggs at once in one uterus.
The division of the zygote into several parts after fertilization.

In the first case, on ultrasound there is no septum between the twins, in the second there is one, but the degree of separation of the embryos may differ. If the zygote splits in the first days, then the degree of isolation of future children will be high. If this process drags on for several weeks, then the likelihood of conjoined twins becoming very high becomes very high.

There are a number of indirect and direct signs indicating a multiple pregnancy.

Medical signs

results ultrasound examination.
Abnormally high AFP blood test results.
The sound of two hearts, diagnosed by the Doppler system.
Significant expansion of the uterus, determined when diagnosing the height of the uterine fundus.

Early signs of twin pregnancy

A very bright and saturated stripe on an express test to determine pregnancy, caused by a significant increase in the blood hormone HcG.
The presence in the family of women who previously carried multiple pregnancies.
Earlier onset of toxicosis, which is more difficult to tolerate than during normal pregnancy. In this case, it forms faster acne and signs of severe fatigue, characteristic of the middle, rather than early stages of gestation.
Earlier (from the fifteenth week) the babies move due to the close presentation to the walls of the uterus.
Large belly.

Fetal development in twins

The development of two babies at once during pregnancy is quite similar to classic singleton pregnancy, however, for the mother this process is more problematic, primarily due to possible additional complications.

In the first trimester, twins each grow in a separate zygote. By the end of the first month, the zygote is implanted into the endometrium. In the second trimester, children have their own fingerprints, begin to drink amniotic fluid and even squint, ultrasound already shows their exact gender. The third trimester is the final formation of children.

Representatives of the fair sex will have to visit the doctor more often for additional monitoring of the condition of the body and fruits, rest more, and consume the required amount of vitamins and fruits. Often, from the beginning of the third trimester, she will be offered to be kept in storage until 36 weeks and the onset of labor.

Possible complications

Multiple pregnancy implies possible additional complications for both the mother and future children. The most common of them:

Incorrect position of the fruits.
Polyhydramnios.
Previa of placental structures.
Severe fatigue, shortness of breath and palpitations.
Anemia.
Prematurity and fetal development disorders.
Intrauterine growth retardation and, accordingly, very low birth weight of babies.

1–10 weeks

Your body is actively reacting to pregnancy. The mammary glands swell and increase. By the eighth week, the embryos are already about three centimeters long and can already be detected using ultrasound.

The symptoms of sensations coincide with classic singleton pregnancy, only toxicosis and other negative sensations appear earlier. After the eighth week, future babies finish embryonic development, and by the 10th–11th the hearts are formed, the voice-forming apparatus begins to form. The weight of your babies is about five grams.

10–20 week

The uterus with two future babies is actively expanding, you begin to wear large clothes. Twins are actively growing at a rapid pace; from the 16th week, their gender can be determined by ultrasound. Their movements become more and more active (from the twentieth week they are clearly noticeable), while the coordination of the hands and head is poorly expressed. The main metabolic organ is still the placenta, but the rudiments of the excretory and digestive system are already present: future children swallow amniotic fluid and at the same time expel decay products through urination.

By the sixteenth week, the body length of twins is about 17 centimeters, weight up to two hundred grams. In the twentieth, they gain another 100 grams and up to ten centimeters in height, while they can respond to sounds.

20–30 week

A rapidly growing uterus provokes the appearance of stretch marks; the metabolism in women during this period is significantly accelerated. Future babies literally compete for the best position in the womb; the result of the struggle is constant tremors.

By 24–25 weeks, the growth of the fetus is already about thirty centimeters, the weight reaches 700 grams. The appearance of the babies is almost close to newborns, their noses are finally formed, and the formation of facial features is completed.

The woman gradually returns to frequent urination, extensive swelling occurs, and fatigue becomes more profound. By the 28th week, future children will reach the threshold of viability and, in the event of premature birth, will most likely be saved. By the thirtieth week, each baby weighs about a kilogram, height up to 35 centimeters. The formation of the body is 95 percent complete.

30–40 week

Calm and only calm - for mothers, one of the most important phases begins, namely, the final third trimester. Babies are almost ready to see the world, their bone skeleton is formed, calcium and iron are gradually accumulating, and the pancreas is developing. The size of the bodies has almost caught up with the head and now, in general, the body looks familiar.

From the 32nd week, false contractions may appear, not exceeding a few minutes. Mother's sleep due to big belly and others negative factors very inconvenient, besides this, representatives of the fair sex suffer from heartburn. From the 36th week, the pregnant woman is scheduled to be hospitalized in the maternity hospital.

By 37 weeks, future babies are considered fully term and ready to be born. The sucking apparatus is formed, the height of the child reaches 55 centimeters, and the weight is about 2.3–3 kg, which is slightly lower than in a singleton pregnancy.

Pregnancy with twins, as mentioned above, has some features - in particular, this is a larger list of possible complications for the mother and future children, a more active manifestation of symptoms of toxicosis and other negative factors, lower weight and height of individual fetuses, as well as a high probability of premature birth.

Pregnancy with twins after cesarean section

Caesarean section is a rather complex operation, which significantly increases the risks for the mother and fetus in subsequent pregnancies, especially if the patient has a multiple pregnancy.

In case of twins and a normally unhealed scar on the uterus, doctors often recommend terminating the pregnancy even with normal metabolic processes and the absence of other negative factors. If a woman who has previously undergone a cesarean section carries twins until the thirtieth week, in any situation the attending physician performs a repeat operation - this will partially remove the risk of uterine rupture and other processes that can even lead to death.

Second pregnancy with twins

A second multiple pregnancy is very rare. Partially, the low probability of such an event is increased by IVF, but the process of pregnancy and childbirth in this situation significantly overloads the body. In any case, the pregnant woman is placed under very strict registration in the antenatal clinic. At the same time, it is recommended to go into confinement from the second trimester in order to monitor the condition of the body of future babies and the fair sex in a hospital setting.

Childbirth during a multiple pregnancy usually occurs earlier than 40–42 weeks, closer to 36–38. Future children are fully formed, although their weight and height are below the classical norm, so to prevent possible consequences, the babies are immediately sent to intensive care.

Unfortunately, even qualified specialists It is far from always possible to predict the exact course of such childbirth due to a number of features, in particular.

Features of the behavior of babies, each of which can interfere with the birth of another.
Possible monoplacental structure, often leading to the death of one of the newborns due to oxygen starvation.
Asynchronous conflict of fetal position: one of the babies may have a breech presentation, while the second may have a cephalic presentation. During the birth process, sometimes there is a catch and simultaneous exit of both into the pelvic opening. Which is fraught with serious consequences for the mother and future children.

Nowadays, with multiple pregnancies and the absence of direct contraindications, doctors often recommend natural childbirth, albeit under the strict supervision of a doctor. If the mother has a narrow pelvis, polyhydramnios, breech presentation of one of the fetuses, high weight of the unborn babies, anomalies in intrauterine development (one placenta, hypoxia, breech presentation, etc.), then the specialist will probably prescribe a cesarean section.

Useful video

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Ultrasound of twins - 16 weeks

Ultrasound of twins - 20 weeks (twins)

Ultrasound of twins - 22 weeks

Question answer

What is the probability of pregnancy with twins after IVF?

IVF significantly increases this likelihood, since several embryos are implanted into the uterus: if more than one takes root, a multiple pregnancy is formed.

What size is the belly when pregnant with twins? What is the normal weight?

During the development of a multiple pregnancy, the belly of the fair sex is larger in size than that of women with one unborn child. However, its exact dimensions depend on the type of attachment of the fetus to the uterus (along the front or back wall), the size of the unborn children themselves and other factors.

The mother's weight standards during pregnancy with twins differ from the standards for weight gain during a singleton pregnancy. To do this, you need to make a simple calculation and calculate your body mass index (BMI).

IDMT = weight in kilograms / current height in meters squared

If your BMI during pregnancy was less than 18.5, then weight gain of 13–18 kilograms is considered normal. With an IDMI of 18.5 to 25, the norm is 11–16 kg. From 25 to 39 - 7–11 kg and the body mass index was more than thirty - from 5 to 9 kg.

Are there any peculiarities in the movement of twins during pregnancy?

Twins subjectively begin to move faster than one child. In fact, both types of pregnancy develop approximately the same, it’s just that in the case of twins, the fetuses take up more space and are located closer to the upper edges of the woman’s epithelium, which feels the movements more clearly and strongly.

It is also worth noting that from the second trimester of pregnancy, both future children move more actively together than one, essentially “fighting” with each other for free space in the mother’s belly.

Is it possible to have a second pregnancy with twins after a previous twin pregnancy?

If you have not used IVF, then the chance of a repeat multiple pregnancy in a woman who has already given birth is negligible. However, if it did happen or reproductive technologies were involved, the next birth and, accordingly, gestation is carried out under the strict supervision of doctors, who often prescribe a cesarean section to minimize risks for the newborn and the mother.

Update: October 2018

The situation when a woman becomes pregnant with not one, but several future babies at the same time is not such a rare occurrence and occurs in approximately 0.7 - 1.5% of cases of the total number of pregnancies. It should be noted that twin pregnancies account for 99% of total number multiple pregnancies and 1% are triplets. Although quadruplets and quintuplets are not excluded.

Doctors believe that the maximum number of fetuses that women can bear without threatening their own health and the health of their children is 6. An interesting fact is that a greater number of multiple pregnancies are observed in African continent, while in China and Japan, cases of twins/triplets are rare.

Pregnancy with twins, triplets...

A multiple pregnancy is called one when several fetuses simultaneously develop and grow in a woman’s sac. Multiple pregnancies are classified according to several factors. Depending on the number of fetuses, pregnancy is classified as twins, triplets, quadruplets, and so on. The number of fertilized eggs also matters, that is, multiple pregnancies can be single or double.

Fraternal twins occurs more often and its frequency is 70%. The mechanism of occurrence of fraternal twins comes down to the fact that 2 eggs mature in the ovary or ovaries at the same time, which can meet with sperm either during one sexual intercourse or as a result of two intercourse, provided that the period between them is no more than 7 days.

Fertilization of two eggs is possible with sperm from both one partner and (not that uncommon) from two men. A clear example of such fertilization is the film “Cuckoo”. If identical twins have exactly the same set of genes and are like two drops of water, then the similarity of fraternal children is only general, like between brothers and sisters born in different time.

Identical twins always of the same sex, while fraternal children are of different sexes. In a non-identical multiple pregnancy, each fetus has its own personal placenta and amnion, therefore such a pregnancy is called bichorionic biamniotic. In the case of a monozygotic pregnancy, the egg is divided into several after fertilization. Depending on the time period when the egg is divided, the following are distinguished:

bichorionic biamniotic identical twins (separation occurred at the stage of movement of the fertilized egg through the tube to the uterus - the first 3 days);
monochorionic biamniotic identical twins (division occurred within 3–8 days after conception, with 2 embryos being formed, each in its own amnion, but with a common chorion/placenta);
monochorionic monoamniotic twins (egg division in the period 8–13 days after fertilization, while the embryos have a common chorion and are located in a common amniotic sac);
Siamese or conjoined twins, when division occurred later than 13 days (such twins can grow together at the tailbones, lumbar regions spine, chest or skull bones).

The prognosis of pregnancy/childbirth is most unfavorable in the case of monochorionic monoamniotic twins.

Why does multiple pregnancy occur?

There are many known factors that predispose to the conception of twins:

Heredity

This factor is considered the most indisputable. If the spouses were related to twins, then the likelihood of pregnancy with several fetuses increases several times. Moreover, it has been noted that twin pregnancies are passed on through generations.

Woman's age

It is noted that what more years a woman, the higher her chances of becoming pregnant with twins or triplets. This age limit is the 35th birthday, that is, on the eve of premenopause and the onset of menopause, not everyone menstrual cycles occur with ovulation. In turn, anovulatory cycles alternate with ovulatory ones, when a surge of hormones occurs, a powerful stimulation of ovulation occurs, as a result of which 2 or more eggs mature at the same time.

Ovulation stimulation

When prescribing infertility treatment, they usually use hormonal drugs stimulating follicle maturation (clomiphene or gonadotropin). Under the influence of these drugs, several follicles can mature at once.

Hormonal contraception

Often multiple pregnancies are caused by taking combined oral contraceptives. After discontinuation of the drug, the “dormant” ovaries are activated and begin to rapidly synthesize their own hormones, which leads to the maturation of several eggs. This situation is called the rebound effect.

In Vitro Fertilization

The development of reproductive technologies, in particular IVF, is one of the reasons for multiple pregnancies. The bottom line is that after “conception in vitro,” several grown eggs are grown, and up to 4 of them are implanted with the mother. If in the 80s the percentage of multiple pregnancies after the use of assisted reproductive technologies reached 30, today it is 50%.

Parity

Most often, multiple pregnancies occur in multipregnant women. Moreover, it is noted that the greater the number of births in the anamnesis, the higher the woman’s chances of becoming the mother of twins or triplets.

How does a multiple pregnancy differ from a single pregnancy?

Signs of twin pregnancy

Signs appear from the very first days, and based on them, a woman may suspect that not only a single baby is developing in her womb, but two. So, the initial signs of pregnancy, such as:

increased sense of smell, intolerance to certain odors
the appearance of more pronounced engorgement of the mammary glands
early onset age spots the woman's face is alarming, and she is in a hurry to take a pregnancy test.

And here a certain surprise awaits her - the test strip is very pronounced and greasy. The described symptoms are explained by a doubling of hCG, which increases the intensity of the initial symptoms and the brightness of the test strip.

Toxicosis

In addition, during pregnancy with twins, early toxicosis begins much earlier than during normal pregnancy, lasts more severely and longer, up to 16–17 weeks. And there is a reason for this fact. The main culprit of toxicosis is the fetus, and if there are several of them, the signs of toxicosis will be more intense. If during the pregnancy of one fetus a woman can only be bothered by heartburn and nausea, then during pregnancy with twins, unpleasant sensations are expressed in vomiting, increased salivation, excessive fatigue and drowsiness. Rarely does a mother-to-be manage to avoid symptoms early toxicosis, which also distinguishes pregnancy with twins from pregnancy with one fetus.

Belly during pregnancy with twins

The abdomen begins to increase earlier, so by 12 weeks the uterus in a singleton pregnancy only protrudes slightly above the womb, and if there are several fetuses, it can almost reach the navel. Accordingly, the woman begins to feel the movement of the fetus earlier, firstly, due to the tightness of the babies, and secondly, due to overextension and thinning of the walls of the uterus.

Weight during pregnancy with twins

Weight during multiple pregnancy also deserves special attention. The weight gain in a woman pregnant with twins is more significant and increases rapidly, starting from the first weeks.

Diagnosis of fetal defects

Another feature of twin pregnancy is the result of the “triple test” - the diagnosis of congenital deformities and developmental defects of the baby. The analysis data is not indicative, since alpha-fetoprotein, human chorionic gonadotropin and placental lactogen are synthesized in greater quantities than during pregnancy with one fetus, so the results may be false positive.

Swelling, shortness of breath

Preeclampsia

Gestosis during pregnancy with several fetuses is diagnosed in almost half a percent of cases, and they develop earlier and are more severe. On the one hand, this is due to an increase in blood volume and increased glomerular filtration in the kidneys, which causes an increase blood pressure, edema and proteinuria, on the other hand, the occurrence of gestosis is provoked by chronic diseases of the mother, which, as was said, worsen in 100% of cases.

Anemia

In addition, due to blood dilution (increasing plasma volume), hemoglobin and red blood cells decrease - a common phenomenon and is called physiological anemia during pregnancy. However, as the gestational age increases, erythiropoiesis gains intensity, which leads to depletion of the iron depot in the woman’s body and triggers the mechanism iron deficiency anemia.

Constipation

An overstretched uterus puts pressure on the intestines, so when pregnant with twins, women often suffer from constipation and puts pressure on the urinary tract, which causes the frequent development of gestational pyelonephritis.

Managing a twin pregnancy

Women carrying twins are at high risk and require careful monitoring throughout the entire period of expecting children. Thus, such pregnant women are prescribed visits to antenatal clinics more often than during normal pregnancy, every 14 days until 28 weeks, and then every 7 to 10 days. In addition, maternity leave is issued at 28 weeks rather than at 30 weeks of pregnancy. sick leave it lasts a total of 160 days.

Such pregnant women should pay special attention to nutrition. If the weight gain during pregnancy with one fetus is generally 9–13 kg, then during pregnancy with twins it can reach 20 kg. Accordingly, it increases daily calorie content diet (up to 4000 – 4500 kcal).

Considering the increased demands for minerals and vitamins, therefore vitamin and mineral complexes It is recommended to start taking it from the moment the fact of multiple pregnancy is confirmed.

Folic acid, which is prescribed in the first 12 weeks of pregnancy (see) to prevent malformations of the brain and spinal cord at 0.4 mg/day, is prescribed for pregnant twins at 1 mg/day. Anemia is also prevented by prescribing iron-containing drugs from 15 to 20 weeks, 80 to 100 mg per day.

Complications

In addition to the listed features and complications of multiple pregnancy, pregnancy with twins also has specific complications:

the phenomenon of the death of one of the embryos or anembryony (this phenomenon occurs in 15 - 20% of cases, and the reasons are not precisely established; the fertilized egg stops developing and either undergoes reduction - resorption or remains in the uterus until birth);
feto-fetal blood transfusion syndrome (FFH) - the presence of anastomoses between the fetoplacental systems of both fetuses (found in monozygotic monochorionic twins), redistribution of blood occurs, and one fetus gets more of it, and the other gets less, and both fetuses suffer;
fusion of children - Siamese twins;
antenatal death of one baby;
congenital “deformities” in one of the twins;
chromosomal disease in one of the children;
reverse arterial perfusion.

Case Study: I had a 30-year-old multi-pregnant woman registered with me. She had a second one desired pregnancy, but, fortunately or unfortunately, twins. Interestingly, the patient’s previous birth ended in a cesarean section, so she was automatically included in the high-risk group for elective surgery. When registering, the woman assumed that her period was short, in accordance with menstruation, 10 - 11 weeks. But at the very first gynecological examination, I suspected something was “off” and sent the patient for an ultrasound (the uterus was enlarged to 15-16 weeks). To our mutual joy, twins were confirmed, and the subsequent pregnancy proceeded well. However, at 22 weeks, the woman ignored the recommendations and carried bags of potatoes, which ended very badly: a late-term miscarriage. But a couple of years later, the same patient becomes pregnant again and the situation repeats: twins. Again, my colleague and I are almost blowing away specks of dust from her, but at 22–23 weeks she wanted to travel (she went to her husband by train, who was on a long business trip), disregarding our advice and warnings. And, of course, the situation repeated itself (but in a different hospital). The result is disappointing: a burdened obstetric history, a scar on the uterus,...

Twins after IVF

Many childless couples resort to trying IVF. The essence of in vitro fertilization is to remove mature eggs from a woman, fertilize them “in vitro,” as they say, in a test tube, and then introduce the fertilized eggs into the uterine cavity. Today, the introduction of one to four eggs is allowed (depending on the quality and quantity of fertilized eggs obtained in vitro).

Therefore, the percentage of multiple pregnancies after IVF reaches 70 - 80. A multiple pregnancy is already a serious test for a woman, and one that occurs after the use of assisted reproductive technologies is fraught with multiple complications due to pronounced disorders in the reproductive system and the presence of extragenital diseases and requires careful monitoring and monitoring of the dynamics of tests .

In the first trimester, it is important to regularly examine the hormonal levels of a woman’s body, especially hCG and estradiol levels.
In the second/third trimesters, a twin pregnancy that occurs after IVF is at risk of developing cervical insufficiency and miscarriage. Therefore, when pregnant with more than two fetuses, a woman undergoes reduction of “extra” embryos.

Reduction (removal) is optimally performed at 9–11 weeks of pregnancy. There are 3 reduction methods: transcervical, transvaginal and transabdominal. Transabdominal reduction is considered the safest when under control ultrasonic monitoring with a needle inserted into the uterus, piercing the anterior abdominal wall, the embryo is pierced.

Case study: A young woman, 28 years old, after unsuccessful attempts to get pregnant and undergoing several courses of treatment, resorted to the IVF method. As a result, she had a long-awaited pregnancy with two fetuses. Until 22 weeks, the pregnancy proceeded wonderfully, without complications characteristic not only of multiple, but also of singleton pregnancies. The woman strictly followed medical recommendations, took the necessary medications and regularly attended antenatal clinics. But at 22 weeks, the patient was admitted to the hospital with broken water and severe external bleeding. It is clear that the pregnancy could not be saved.

Diagnosis of twin pregnancy

How to determine pregnancy with twins?

A doctor may suspect a multiple pregnancy already during the first gynecological examination. In this case, a soft uterus is palpated, the size of which does not coincide with the period of delayed menstruation. But an initial examination, collection of anamnesis and complaints only allows us to make a presumptive diagnosis. It is possible that big sizes uteri are associated with the presence of myomatous nodes.
The diagnosis is reliably confirmed only by ultrasound, during which the presence of two or more embryos is determined.
Determining the level of hCG in early pregnancy is an indirect confirmation of multiple pregnancy, since an increase in hCG levels is also possible with trophoblastic diseases ().
Further ultrasound examination in due time (22 - 24 and 32 - 34 weeks) allows not only to determine the number of fetuses and amniotic fluid, but also to identify signs of developmental delay in one of the babies or both, developmental abnormalities, type of placentation (mono- or dichorionic ), localization of the placenta/placenta, presence of a septum (one or two amnions), position/presentation of the fetuses. In addition, ultrasound can detect fusion between twins and helps determine delivery tactics.

Childbirth, complications, indications for abdominal delivery

Women who are pregnant with more than one fetus rarely reach term.

Patients carrying twins are more likely to give birth at 36 weeks
If there are triplets, birth occurs at 33–34 weeks
with quadruplets, labor begins at 31–32 weeks

Therefore, all women expecting more than one child are hospitalized at least 14 days before the expected birth. Children born as a result of multiple pregnancies are often premature and require intensive care. However, it has been noted that the maturation of the lungs in twins occurs earlier, which distinguishes them from those born during a singleton pregnancy, so they adapt better and can breathe independently.

Labor management tactics depend on various factors. The leading role is played by the position and presentation of babies, especially the first. The presence/absence of water and intrauterine hypoxia of babies, the regularity and intensity of contractions, extragenital and gynecological diseases, and the woman’s age are also determined.

Women are allowed into spontaneous childbirth if the first or both fetuses are cephalic, the condition of the children and mother is satisfactory, and labor is regular.

Indications for surgical delivery are primarily determined by the position and presentation of the babies, so, when the first is breech and the second is cephalic, it is advisable to deliver the woman abdominally to prevent a dangerous complication - fetal collision (head interlocking). Also, a cesarean section is performed in case of transverse position of the fetus/fetus, in case of presentation of the pelvic end of both fetuses, in case of intrauterine hypoxia of one/both children, anomalies of labor, and in the case of an existing scar on the uterus. If polyhydramnios, severe gestosis, large babies, and if there are more than two twins, surgical delivery is also indicated. Difficulties in childbirth arise in the case of monoamniotic monochorionic twins. In such children, umbilical cord entanglement and torsion are often observed, so it is advisable to deliver such a pregnancy through a cesarean section.

Postpartum and complications arising during childbirth:

anomalies of labor;
hypoxia of one/both twins;
, especially the second fetus (a sharp decrease in intrauterine pressure after the birth of the first child);
death of children during childbirth and after birth (high rates of perinatal mortality);
high risk of bleeding during separation of the placenta and in the early postpartum period.

Case Study: A 20-year-old primiparous woman was admitted to the maternity ward with complaints of contractions and rupture of amniotic fluid. The woman had never been observed anywhere before, and, accordingly, had never had an ultrasound. Estimated gestational age is 32 weeks. During an external obstetric examination, I palpated only one (!) large and a bunch of small parts of the fetus. With difficulty, but identified 2 different places, where fetal heartbeats were heard. When conducting an internal examination, it was established: there is no amniotic sac, the opening of the uterine pharynx is 7–8 cm, the legs are present. The woman on the gurney was transferred to the delivery table, I stood up to the table myself (we don’t have time for a caesarean section). And then the nightmare began. Not only was it the first birth, premature, with twins and the first fetus in the breech position, but the woman in labor behaved simply disgracefully. She tried to get off the table, reached with her hands to her crotch, trying to push the child back (the midwife and the nurse could barely hold the woman down), kicked everything and everyone who came within her reach. With great difficulty, we finally gave birth to our first baby. The child was very ill and was not breathing. After an internal examination, I opened the amniotic sac and discovered another surprise - the second child was also walking with his legs. I had never done a fetal rotation, and I had never even seen how it was done, so the nightmare repeated itself again. We gave birth to a second child, also difficult, but better than the first. After the placenta passed, I left the labor room with the words: “Today you almost killed your children” (I was replaced by a colleague). But it's good that everything ends well. After 5 days in the maternity ward, the woman and her children were transferred to the nursery, from where the large family was discharged in satisfactory condition.

The birth of a new life in a female body is always a miracle. However, an even greater miracle is when the expectant mother finds out that the baby in her tummy is not alone. For many married couples, this comes as a complete surprise, while others deliberately want to give birth to twins. What are the specifics of multiple pregnancy, what risks does it carry? What should a woman prepare for?

Multiple pregnancy - what is it?

In medicine, a multiple pregnancy is considered to be a pregnancy in which more than two fetuses develop in the uterus of the expectant mother at once.

The most common option is twins - 1:87 in relation to normal childbirth with one child. Triplets and quadruplets are born much less frequently - 1:6400 and 1:51000, respectively. A unique case was recorded in 1998 in Saudi Arabia

Interestingly, the incidence of multiple births differs significantly in different countries. For example, in China and Japan this is only 1–2 cases out of a thousand, but in Africa this option is more common - 10–15 cases per thousand births. As for Russia, over the past two decades, multiple pregnancies have become twice as common.

IN African countries Twins are born more often than on other continents

For humans, unlike animals, bearing two or more children at the same time is considered atypical, and therefore some experts even perceive multiple pregnancy as a condition that is on the border of normal and pathological. The reason for this is increased stress on the female body and numerous risks for the development of children.

Since ancient times, multiple births have been regarded as a miracle of nature and have given rise to many legends. For example, the ancient Greeks and Romans considered it a divine gift. No wonder in ancient mythology pairs of twins of royal origin or divine nature appeared. Thus, the names of the legendary Castor and Pollux became the names of the stars in the zodiac constellation of the twins (they symbolize their heads).

In antiquity, multiple births were considered a blessed gift of the gods

Classification of multiple births

There are two types of multiple births.

Polyzygotic

Polyzygotic (or dizygotic, non-identical) multiple pregnancy occurs when two or more eggs in a woman's body ovulate and are subsequently fertilized. As a result, babies of one or different genders

, having approximately 50% of the same genetic characteristics (that is, just like ordinary blood brothers and sisters).

Fraternal twins can even look very different from each other. So, two twin girls, Lisa and Masha, went to the kindergarten where I once worked as a teacher. Their mother was Russian, and their father was Uzbek. And what’s surprising: one of the sisters was black-haired and dark-skinned with a typically Asian face, but the second was born light-skinned blonde with blue eyes.

Fraternal twins can be different genders and are not exact copies of each other.

Each polyzygotic twin has its own aqueous membrane (amnion), chorion (villous membrane) and placenta. They are also called bichorionic or biamniotic polyzygotic twins. The frequency of such multiple births is approximately 66% of cases.

Each fraternal twin has its own placenta, aqueous membrane, and villous membrane.

Eggs are released from different follicles of one or both ovaries. In this case, fertilization occurs approximately simultaneously
It is extremely rare for several eggs to ovulate in the same follicle. They are also fertilized at the same time.
The second egg ovulates and is fertilized some time after the first - against the background of already developing pregnancy(the difference usually does not exceed a week).
Several eggs matured in one cycle can be fertilized by the sperm of different sexual partners.

Monozygotic

A more rare case (33%) is the splitting of one fertilized egg. As a result, two fetuses are formed (sometimes more), which are genetically absolutely identical. These babies are always same-sex, have the same facial features (an exact copy of each other), physiological characteristics, mental capacity, temperament, psychology, etc. Brothers or sisters even have an identical arrangement and shape of teeth, and in childhood they get sick almost simultaneously. It is well known that twins are connected by an inextricable emotional bond (this is not surprising, because they were originally one fertilized egg).

Identical twins are absolutely identical at the genetic level, because they were once a single organism

Interestingly, the formation of monozygotic twins largely depends on the specific period at which the separation of the fertilized egg occurred:

First 72 hours. The inner layer of zygote cells has not yet been formed, and the outer one has not changed either. Therefore, two chorions are formed with two separate amniotic cavities (bichorionic or biamniotic monozygotic twins). In this case, the placenta can be common or two separate ones are formed.
The first 4–8 days. During this period, the inner cell layer is already formed and the chorion is formed. However, the amniotic membranes have not yet formed, so the embryos will develop in separate amniotic cavities (water sacs). Such twins are already called monoamniotic, monochorionic monozygotic twins.
After 13 days. The division of the fertilized egg at such late stages will be only partial. After all, the embryonic disc is already formed. As a result, an anomaly will arise - children will be born, fused with each other.

If a woman is pregnant with triplets (or there are even more fetuses in her uterus), then monozygosity and polyzygosity are often combined in different combinations. For example, two identical twins and one identical twin may be born.

Video: why twins are born (Elena Malysheva’s TV program “Life is Great!”)

Factors provoking multiple pregnancies

Many factors contribute to multiple births. However, this issue has not yet been sufficiently studied in medicine.

Causes of polyzygotic pregnancy:

Stimulation of ovulation, when the female ovaries for some reason do not produce follicles themselves. As a result, the organs begin to work hard, producing several eggs capable of fertilization in one cycle.
Carrying out IVF. The program for this procedure involves ovarian hyperstimulation. As a result, several eggs are formed. To increase a woman's chances of pregnancy, two or more embryos are placed in her uterus. Often only one of them takes root, but sometimes all of them take root.
Hereditary predisposition to periodic maturation of more than two eggs in the same cycle.
Number of births. With each subsequent pregnancy, the chances of conceiving twins increase.
The woman's age is over 35 years. The number of anovulatory cycles increases. However, hormones accumulate, and at a certain point two eggs may mature at once.
Taking hormonal contraceptives with their subsequent cancellation. After this, hormones often begin to be produced with double force.

During IVF, several eggs are fertilized

Monozygotic pregnancy is provoked by slightly different factors:

The influence of toxic substances.
Violation of the ionic composition of the medium.
Lack of oxygen.
Delayed implantation.
The woman is over 30 years old.
Hereditary predisposition.

Signs and diagnosis of multiple pregnancy

In the early stages, only ultrasound can accurately determine multiple pregnancy. So, already at a period of five weeks you can see two (or more) embryos in the uterus, and also differentiate multiple pregnancy from hydatidiform mole or fibroids.

Before the advent of ultrasound, diagnosing multiple pregnancy was quite difficult. This could only be reliably done in the later stages, and sometimes only during childbirth.

In addition, the presence of twins can be suspected if the level of the hCG hormone in the blood is too high, which does not correspond to the gestational age. At the same time, progesterone will also increase.

Table: hCG norms during pregnancy with twins and one fetus

Gestational age in weeks	Multiple pregnancy	Singleton pregnancy
1–2	50–340	25–156
2–3	208–9740	101–4870
3–4	2220–63000	1110–31500
4–5	5120–164600	2560–82300
5–6	46200–302000	23100–151000
6–7	54600–466000	27300–233000
7–11	41800–582000	20900–291000
11–16	12280–206000	6140–103000
16–21	9440–160200	4720–80100
21–39	5400–15600	2700–78100

An expectant mother may suspect that she is pregnant with twins even based on the results of a routine pregnancy test. The treasured second stripe will become bright too early, sometimes even before the delay. This is again due to a high level of hCG, but in the urine.

In case of multiple pregnancy, the second stripe may become bright very early

When the doctor examines the expectant mother in a gynecological chair, due to the presence of two embryos, the uterus will be too large: the size does not correspond to the period of the missed period.

Another sign of multiple pregnancy in the early stages is too severe toxicosis (this is severe nausea, vomiting, aversion to smells) and very swollen mammary glands (although, of course, some people experience this condition during a standard pregnancy with one fetus).

As for the second trimester of gestation, the following signs are characteristic of multiple pregnancy:

Noted a sharp increase uterus. The abdominal circumference will significantly exceed the norm typical for bearing one child. In addition, the height of the bottom of the organ will be greater.
By palpation, the doctor can identify large parts of the fruit (these are two heads, two pelvises), as well as many small parts.
The heartbeat will be heard in two different areas of the abdomen, and there will be a silent zone between them. Moreover, the heart rate of fetuses often varies (up to ten beats per minute).
A woman may feel movement too early. The reason for this is that the amount of free space in the uterus is rapidly decreasing, and even minor movements of the fetus can be recorded. So, if during the first singleton pregnancy movement begins at about 20 weeks, during the second - from 18 weeks, then when expecting twins, movements can be felt already from 15 weeks.

During a multiple pregnancy, a woman usually feels the first movements much earlier.

Ultrasound examinations when carrying twins are also carried out in the second and third trimester. It makes it possible to evaluate the character fetal development: number of placentas, uniform development of babies, recording conjoined twins.

Specifics of pregnancy in a woman carrying twins

Multiple pregnancy often becomes a challenge for female body. After all, compared to regular ones, it places more stringent demands on health.

All patients expecting twins should attend antenatal clinics more often than is necessary for a singleton pregnancy.

The duration of pregnancy is inversely proportional to the number of fetuses. For example, with twins it will be approximately 37 weeks, with triplets - already 35 weeks (the gestation period for one child is the standard 40 weeks). This is due to the fact that an overstretched uterus becomes increasingly difficult to hold babies.

When expecting twins, a woman begins to feel all the possible “delights” of pregnancy, including complications, earlier, and they are more pronounced:

Toxicosis. It appears earlier than during normal pregnancy. It is more severe and continues until the 17th week (when carrying one child, it ends by the 13th week).
As the fetuses grow, the enlarging uterus causes a displacement of the diaphragm. The heart of the expectant mother suffers from this: she early begins to feel a rapid heartbeat, weakness, shortness of breath, and fatigue.
The growing uterus puts pressure on the stomach and intestines. The result is constipation, belching, and heartburn in the early stages.
Compression of the inferior vena cava leads to early varicose veins.
Squeezing Bladder provokes more frequent urination(even in the second trimester, when a woman carrying one fetus experiences some relief in this regard).
The volume of circulating blood in a woman’s body increases. If when carrying one child this figure is 40–50%, then with multiple births it is already 50–60%. As a result, there is a lack of vitamins and macroelements, especially iron. Therefore, early anemia almost always accompanies women expecting twins: they have to take medications throughout the pregnancy.
When carrying two fetuses, the risk of developing polyhydramnios is higher, and this negatively affects the kidneys of the expectant mother.
Preeclampsia. If during a normal pregnancy 30% of expectant mothers encounter it, then during a multiple pregnancy it is already 50%.
All those expecting twins experience swelling in the second half of pregnancy; arterial hypertension. This is how the body responds to the growing needs of the fruit.
Gestational diabetes develops more often.
If before pregnancy there was a certain chronic illness, then it will definitely worsen, because the body is under a lot of stress.
If the twins are fraternal, then the likelihood of incompatibility between the blood of the mother and the fetus increases. After all, they may well have different group and Rh factor.
With multiple pregnancy, isthmic-cervical insufficiency very often occurs - a pathology in which the cervix opens slightly before childbirth (especially if the woman has already given birth). This is due to a mechanical factor: the large volume and weight of the uterus, its overstretching. This condition develops after 22 weeks and progresses rapidly. The expectant mother is given stitches on the cervix, and if she is expecting triplets, a special pessary is additionally used (since the stitches can cut through under stress).
When two or more placentas are attached to the uterus, one of them may be located low or presentation may occur.

Photo gallery: specifics of multiple pregnancy

In multiple pregnancies, edema cannot be avoided. Women carrying twins suffer from anemia from an early stage. In multiple pregnancies, varicose veins are more likely and occur earlier due to early compression of the inferior vena cava. In multiple pregnancies, toxicosis begins earlier, ends later and is more severe. One of the placentas in the uterus may be too low

An expectant mother expecting twins (and even more so triplets) urgently needs enhanced nutrition. If an ordinary pregnant woman should receive approximately 2500 kcal per day, then one expecting twins should receive at least 4500 kcal. In addition, you need to not only saturate the body (lean on flour products), and eat foods rich in nutrients. During pregnancy, such a woman usually gains 16–21 kg, but if the fetus is alone, this figure is 9–14 kg.

To prevent premature birth, the gynecologist usually recommends limiting physical activity: in addition to sleeping at night, the expectant mother needs to lie down more during the day. If there is a threat of premature birth, bed rest is required.

Multiple pregnancies after a cesarean section require special attention. There are two main dangers here:

Scar rupture due to too much heavy load to the uterus.
Premature placental abruption or placental previa.

Multiple pregnancy after a cesarean section requires artificial delivery.

Features of childbirth with multiple births

The birth of a patient carrying twins is fraught increased risks. They require presence more medical personnel (two midwives, two neonatologists), highly qualified doctors, clear orientation of doctors in situations where it is urgent to perform certain manipulations.

Perinatal mortality during multiple pregnancy is 3–4 times higher than when carrying one child (approximately 10%). However, this is due, first of all, to the complicated course of pregnancy itself and an insufficiently thorough approach to delivery.

Taking into account the expected due date (it occurs earlier than when carrying one child), the woman is sent to the maternity hospital in advance: for twins - a couple of weeks, for triplets - a whole month. If labor does not begin at 37 weeks (35 weeks for triplets), then it is advisable to perform artificial stimulation.

Particular care must be taken to monitor the condition identical twins: This is associated with a high probability of umbilical cord torsion. Therefore, such patients sometimes undergo a cesarean section earlier than the planned due date (for example, at 33–34 weeks). Surgical delivery is also used in the following cases:

A woman is carrying triplets.
The position of one of the fruits is incorrect.
One of the fruits is large.
One of the babies shows signs of hypoxia.
Labor weakness observed during previous births.
The previous birth took place by caesarean section.

When a woman has multiple pregnancies, she is much more likely to have a caesarean section.

With natural (vaginal) delivery, the process is often associated with complications. For example, in the first period, approximately 30% of women in labor experience premature rupture of amniotic fluid. Moreover, it may be accompanied by prolapse of the umbilical cord. Since the uterus is overstretched, contractions are often weak: as a result, the dilatation of the cervix is greatly delayed.

The period of expulsion of the first fetus is often long (weak attempts due to overstretching of the abdominal wall muscles). In this case, the woman is given drips with oxytocin (pain relief should be minimal). The presenting part of the second child tends to enter the birth canal at the same time as the first, which further increases the time. Prolonged labor is fraught with infection of the uterine cavity and the occurrence of infantile hypoxia.

During the birth process, the doctor monitors the heart function of both children. After the birth of the first baby, the condition of the second is monitored.

Another scenario is rapid labor due to prematurity of the fetus. In this case, there is a high probability of perineal rupture.

Another complication is premature placental abruption. It occurs after the birth of the first baby: the pressure inside the uterus sharply decreases and the volume of the organ decreases. As a result, severe bleeding occurs with the development of hypoxia in the fetus. To prevent such an outcome, doctors urgently pierce the remaining amniotic sac (another baby should appear no later than 15 minutes later).

In addition, after the birth of the first child, the umbilical cord is tied not only from the fetal side, but also from the maternal end. After all, if the twins are identical, then the other baby may suffer due to bleeding from the vessel.

The period of expulsion of the placenta also poses an increased danger in case of multiple pregnancy, since after it there is a high probability of bleeding.

In this regard, the woman is administered uterotonic drugs (increasing the tone of the uterus) within two hours after childbirth. In addition, doctors carefully examine the afterbirth to ensure its integrity. Sometimes, again, due to an overstretched uterus, the placenta comes out with difficulty, so an oxytocin drip is required. If there is no effect, then the afterbirth is separated manually.

The postpartum period after the birth of twins is often fraught with complications. This is, first of all, slow recovery of the uterus and postpartum endometritis. To prevent these conditions, women are prescribed drugs to contract the muscles of the organ and anti-inflammatory drugs.

Video: natural birth or cesarean for twins? (doctor explains)

Risk factors for fetuses

Multiple pregnancy is not only difficult for the mother’s body (the likelihood of all kinds of complications doubles), but also carries quite high risks for babies:
Developmental defects are recorded twice as often.
Delayed development of one of the fetuses is recorded 10 times more often. If the twins are dichorionic, then this is 20% of children, if monochorionic - 30%. In general, the developmental delay of twins is 1.7% and 7.5%, respectively.
Cerebral palsy develops 3–7 times more often in a child born from a mongrel family, and 10 times more often from a child born from triplets.

Intrauterine mortality occurs 3–4 times more often.

The main danger when carrying twins is disturbances in the circulatory system between the fetus and the placenta.

Due to asymmetric blood circulation in the placenta (identical twins), blood flow to one of the fetuses may decrease (5–25% of cases). As a result, he does not receive enough nutrition: he suffers from hypoxia, lags behind in development, has much less weight and may even die. At this time, another child experiences hypertension, dilation of the heart, etc. due to excess blood. In addition, there are cases of connection between large vessels, as a result of which blood from the artery of one child can enter the vein of another.

Due to uneven blood circulation or abnormal connections of blood vessels, one of the fetuses may receive less nutrition, lagging behind in development

Termination of multiple pregnancies is much more common than termination of singleton pregnancies. The risk is especially high in the second and third trimesters. Women who are pregnant with twins are under special supervision of a specialist. To avoid miscarriage, doctors prescribe special medications to women that relax the uterus throughout pregnancy. In the later stages of pregnancy, a woman is observed with particular inattention. If the drugs are not enough, then the woman will be hospitalized until birth occurs.

During pregnancy with twins, the load on the cardiovascular system increases, so the expectant mother may experience problems with heart function. If you experience any symptoms of a malfunction of the cardiovascular system, then you should urgently consult a doctor, because the consequences can be negative.

Reasons for the birth of twins Identical (monozygotic) twins. The fertilized egg is early stages development begins to divide into two absolutely identical parts. Each part develops independently. U monozygotic twins

Dizygotic twins (fraternal). When two eggs mature in a woman’s egg at the same time and two sperm manage to fertilize them at the same time, we are talking about fraternal twins. Children born are similar to each other, like brothers and sisters who were born at different times, because each child has a different genetic structure. The appearance of children, their character, blood group and gender may be different. Fraternal twins share approximately 50-60% of their genes, which is the same as regular sisters and brothers.

“Siamese twins” (those that are conjoined) in all cases develop from one egg. The egg does not separate completely, so the children remain fused to each other.

Causes of multiple pregnancy

Of course, the hereditary factor plays a huge role. Approximately 10 out of a hundred women who gave birth to twins have a history of multiple pregnancy among relatives.

If long time If you take hormonal contraceptives and then abruptly stop taking them, this can trigger the simultaneous maturation of two eggs.

Women aged 35-40 years have a very high chance of becoming pregnant with twins. At this age (before the onset of menopause), a final hormonal surge occurs. For this reason, very often at this age women become pregnant with twins (triplets, etc.).

The hormone that stimulates the ovary is produced better during long daylight hours. In spring, the sun warms up well, the activity of sex hormones increases and the likelihood of conceiving twins increases.

Also, the cause of multiple pregnancy can be the intervention of modern medicine. To treat infertility Lately actively use reproductive technologies. A very common method is IVF (in vitro fertilization), when the conception of a child occurs in a test tube, and not in the womb of a woman. It often happens that couples who have not been able to have children for a long time have twins or even triplets!

Features of the course of multiple pregnancy

Carrying twins to term is no easy task. Women who bear two children at the same time are heroines, and these are not just words. Already at the gestation stage, twin children are at biological risk. A woman's body is programmed to carry and feed only one baby.

In the first three months, in 20-25% of women, one of the fertilized eggs dies; the fertilized egg, which has frozen, stops its development and gradually dissolves over time. But in some cases, the remains of a frozen fertilized egg remain in the uterus until birth occurs.

With twins, the volume of circulating blood increases by approximately 50-65% (compared to 40-50% in a singleton pregnancy). Plasma volume increases and hemoglobin levels decrease, especially in the second trimester. In women, the process of hematopoiesis is active; they have much more red blood cells than in the initial stages of pregnancy. This condition can cause iron deficiency anemia in some women as limited iron stores are depleted.

If a woman is pregnant with twins, then she can tolerate toxicosis and morning sickness much worse. Toxicosis is provoked by various factors, one of which is human chorionic gonadotropin, that is, HCG (its increase). The level of hCG is much higher during twin pregnancies than during singleton pregnancies, which explains why toxicosis in women pregnant with twins is much stronger.

Toxicosis disappears in the twelfth to fourteenth week of pregnancy (exactly the same as in a singleton pregnancy).

Mothers of twins are much more likely to have complaints of heartburn, lower back pain, and sleep problems.

Since there are two children, the uterus has to increase in size much more so that the children do not feel crowded there. The enlarged uterus begins to compress the diaphragm and the work of the lungs and heart becomes difficult; the pregnant woman gets tired very quickly and experiences shortness of breath. Pregnant women often experience constipation and frequent urination.

More common are late toxicoses, which are manifested by protein in the urine, edema, and high blood pressure.

If a woman is pregnant with two children, this does not mean that she can feel the movement of the children earlier than women who are carrying one child. During a twin pregnancy, embryonic movements can be felt around 18-20 weeks. If the woman has already been pregnant and can distinguish the movement of the child from work gastrointestinal tract, then she may feel the movement a little earlier.

The weight of a woman pregnant with twins should also be controlled. During a singleton pregnancy, weight gain from 8 to 12-15 kg is considered normal (it all depends on what body weight the woman had before pregnancy). And with multiple pregnancies, normal weight gain is 18-20 kg. During pregnancy, the diet should be rich, healthy and high in calories. If there is swelling, then you should reduce your fluid intake to 1.5 liters per day.

Women who are pregnant with twins need to enrich their body with plenty of folic acid to prevent the development of birth defects. If a woman with a singleton pregnancy is recommended to take 0.4 mg of folic acid per day, then in case of twins the dose should be increased to 1 mg.

A woman with twins is sent to the maternity hospital approximately 2-3 weeks before the birth. Childbirth usually takes place at 36-37 weeks. The most favorable time for the birth of twins is 36-38 weeks.

A woman can give birth to twins on her own; natural childbirth proceeds normally. But in some cases, complications may occur, such as prolapse of umbilical cord loops, prolapse of small parts of the fetus (legs, arms), hypoxia (oxygen starvation), premature rupture of amniotic fluid, premature abruption of the placenta of the second child after the passage of the birth canal of the first child, weak labor activity (due to overstretching of the uterus), postpartum hemorrhage.

But nature took care of the twin children. They have a much higher ability to adapt than one baby. It has been proven that twin babies' lungs mature much earlier so that babies born prematurely can breathe on their own. In the postpartum period, the adaptation period for identical twins and fraternal twins is slightly different. If fraternal twins adapt without problems after giving birth, then identical twins endure this process a little more difficult. Children from monozygotic twins are prone to breathing problems, swelling, and icteric syndrome.

Caesarean section for twins

Indications for cesarean section for twins: overdistension of the uterus due to polyhydramnios, very large fetuses, breech or transverse presentation of the first child of twins, extragenital diseases, the birth canal after 38 weeks is not prepared for childbirth, severe gestosis, the age of the first-time mother along with other indications, especially if there was before long-term infertility or complicated pregnancy, fetal hypoxia.

Women pregnant with twins have a high risk of loss during childbirth. large quantity blood. To avoid large blood loss and transfusion of someone else's blood, a woman can donate her own blood plasma during pregnancy. The plasma is stored until delivery occurs. If necessary, this plasma is transfused. Autotransfusion drugs can also be used to facilitate the collection of blood during surgery. After washing, the patient is transfused with her red blood cells. Thus, the risk of losing a large amount of blood is minimal.

Multiple pregnancy is not a pathology, but doctors believe that such a pregnancy should be monitored especially carefully. It is best to give birth to twins in maternity hospitals high level, in which there is a fashionable qualified intensive care unit for newborn babies.

How to eat healthy when pregnant with twins?

There is no special diet designed for twin pregnancy. Nutrition should be balanced and healthy. The products consumed must provide children with all the necessary substances so that they can develop and grow normally. We know that twins are usually born before their due date, so during this period children should receive enough nutrients, otherwise they may be born with low birth weight.

TO daily norm the usual diet, you need to add 300 calories per baby, that is, if you have twins, you need to add 600 calories per day. In order for twins to develop normally, a woman needs to increase her daily diet and reduce physical activity.

Not all women pregnant with twins can simply eat well, because severe toxicosis occurs and taste preferences change greatly. Frequent occurrences occur. Indigestion. In such cases, you should consult a doctor.

In the second and third trimester, it becomes even more difficult to gain the desired weight, because the uterus squeezes the stomach and the woman, having eaten very little, already feels full. In this case, you should try to eat small portions five to six times a day.

You need to include foods that are rich in iron in your diet. This will help avoid iron deficiency anemia. Iron supplements are not recommended because they can often cause constipation.

Regarding prenatal vitamins and supplements that contain omega-3 polyunsaturated fatty acids, be sure to consult your doctor first before taking them.

Multiple pregnancy is a very responsible process and hard work, but at the same time it is a huge gift of fate.