Pregnancy with twins, the ovum is larger. Causes of the ovum without an embryo. Abnormal development of the ovum

Pregnancy is the most important stage in the life of the fair sex, so every woman is in a hurry to testify and confirm the fact of future motherhood as early as possible. The very first question that worries all mothers is how does the baby develop?

When an embryo appears in the ovum

As a result of conception, the fertilized egg, after two weeks, enters the uterus and attaches to the endometrium - the inner mucous layer of the uterus. It is from this moment that cardinal changes begin to occur in the woman's body. One of the main ones is the release of chorionic gonadotropin (hCG) - a hormone that protects the fetus from harmful external influences. The production of the hormone provokes the first signs of pregnancy and a positive pregnancy test result about 5-7 days after conception.

It is worth noting that a full-fledged embryo has not yet formed at this time. And ultrasound diagnostics can consider the appearance of an embryo in a fertilized egg no earlier than 5-6 weeks later. On the screen of an ultrasound scanner, the ovum appears as a small dark gray oval in the uterine cavity. And the embryo, in turn, is visualized as a barely noticeable white formation, one might say a tadpole with a tail, which does not yet look like a human.

Why are there two embryos in the ovum?

When diagnosed at 6-8 weeks in the ovum of two embryos, we can talk about the presence of multiple pregnancy. On an ultrasound study, you can notice a difference in the size of embryos, but it is impossible to unequivocally determine whether twins or twins will be possible. Conception and formation of twins or identical twins is due to the following reasons:

• fertilization of two eggs with two different sperm;
• the formation of two merged gametes from one egg.

At the first development of the situation, pregnancy is called "bizygotic", while babies can be either same-sex or heterosexual. Due to the second reason, two identical copies of the embryos appear in the mother's womb.

Every woman dreams of giving birth to her own children, which is caused not only by the maternal instinct that is formed during childbirth, but also by the desire for self-realization. Children born in one (identical twins) are extremely rare. According to scientists, it is about one tenth of a percent. Identical twins are outwardly almost indistinguishable. This feature is due to the fact that their formation occurs from one cell (zygote) by dividing it in the early stages of pregnancy.

Sperm, penetrating the egg, fertilize it. Interaction occurs with only one sperm, which brings part of the male genotype into the cell of the female reproductive system.

It turns out that these twins are copies of each other not only externally, but also internally. Studies have shown that more than ninety percent of these twins are indistinguishable even fingerprints.

Identical heterosexual twins do not exist for the reason that the genotype in both embryos is identical. The only characteristic of identical twins that may occasionally be present is the formation of mirror twins. In this case, one of the children is right-handed and the other is left-handed, and their fingerprints are mirrored to each other. Often, even the internal organs are located in opposite places. Often, twins even have diseases of the same type, because the predisposition to pathologies in such organisms is the same. An interesting fact is that separated (living and raised in different families) twins not only have similar characters, but even their tastes and attitudes towards the objects around them are the same.

What are the features of the development of twins?

Firstly, identical twins in the womb have one common placenta, and secondly, due to uneven blood circulation, one of them is often underdeveloped. Sometimes there are situations when the mismatch in blood saturation (oxygen saturation) is so high that one of the fetuses (lacking in nutrition) dies. In addition, the development of Siamese twins is sometimes possible (a condition in which a complete separation of the fetuses has not occurred and they are related to each other). At best, their connection may be insignificant and amenable to an operative break, however, quite often there are difficult cases when children are spliced ​​by their heads or have one torso. In this case, surgical intervention is almost impossible. And successful attempts to separate such twins are rare and well known.

For many women, identical twins are a desirable target, however, their formation under the influence of any medical or non-medical influences is impossible. The division of the egg, which ultimately leads to the formation of twins, occurs spontaneously. After a series of studies by scientists, it was found that there is a certain genetic predisposition to the possibility of having twins. For example, women who have such children in their family have a significantly higher probability of having twins, including identical ones, much higher than the average level.

Thus, identical twins, although they are desirable women, are often a sheer punishment. Difficulties in childbirth, the possibility of the development of Siamese twins and even the death of one of the fetuses lead to the formation of a great risk for both children and the mother's body.

Sometimes an ultrasound scan reveals that the ovum has a deformed shape.

Such a diagnosis does not always indicate an abnormal course of pregnancy and fetal development. Only in conjunction with additional factors can this become an indication for abortion. In addition, it all depends directly on the type of deformation.

The main reason for the development of deformation of the ovum is the increased tone of the uterus. There is a significant reduction in the walls for various reasons: stress, the presence of infections or inflammatory processes, hormonal imbalance, diseases of internal organs, etc.

To eliminate the pathology, agents are used that contribute to the relaxation of the muscles of the uterus (magnesium, magnesium, etc.). It is also important to completely stop sex life, to avoid physical activity and stressful situations. The patient is prescribed semi-bed rest and complete rest. Such measures make it possible to preserve the pregnancy, provided that the fetal heartbeat is heard.

Abnormal development of the ovum

In addition to deformation of the ovum, the development of any anomalies is possible. Many of them are capable of provoking a miscarriage or fetal freezing. The most common anomalies are presented below.

Also, exposure to toxic substances or radiation can provoke the onset of pathology. To establish the exact cause, both partners need to undergo a complete examination. Testing for the presence of STIs, spermograms and the study of the karyotype are mandatory studies in this situation.

There are times when a similar pregnancy develops in a perfectly healthy couple. Then the chances of carrying a healthy child into a subsequent pregnancy increase dramatically. However, before planning, it is important to take a break (about six months) and allow the body to rest and recover.

With the simultaneous birth of two or more children at once, many myths and legends have long been associated with almost all peoples. And this did not happen by accident. After all, multiple pregnancy (twins) was often accompanied by various complications already in the process of its development, as well as postpartum problems. Currently, modern medicine is making every effort to maximize the safety of embryos and keep them alive. However, whatever the case with two or more embryos, he will need attention not only from the expectant mother, but also from the doctors.

Why do 2 fetal eggs develop in the uterus?

One of the most common types of multiple births is the conception and birth of twins. It develops as a result of one of two possible processes:

1) the simultaneous entry of different spermatozoa into two eggs and their fertilization.
2) the development of two zygotes from the same egg.

In the first case, the result of separate fertilization is two completely independent zygotes, and the type of such pregnancy is called "bizygotic". This type includes about 65% of all multiple cases.

In the case of the separate development of embryos, twins can be called according to characteristic features as follows:

• Monozygous (developing from the same zygote).
• Bihoral (has two placentas).
• Biamniotic (has two fetal bladders at once).

Bizygote characteristics

Bizygotic twins are divided into 2 types:

• Multiple ovulation (when fertilization occurs within the same ovulation cycle) is due to some features of hormonal production. This feature is used for "in vitro conception", or in vitro fertilization. The reason for this ovulation is called the increased production of folliculin due to stimulating hormone (FSH).
• Consecutive fertilization of two eggs (without inhibition of the second process). The interval between the eggs entering the uterus will be about 28 days.

Despite the difference in weight and maturity, the birth of such children will occur at the same time. On ultrasound, 2 fetal eggs will become noticeable 28-35 days after the first (singleton) pregnancy is detected. As for the sex of future children - bizygotic twins can be of either sex, or different sexes.

The likelihood of the formation of a bizygote is due to hereditary factors, most often it is transmitted to patients through the mother.

Characteristics and types of monozygote

The second case - the simultaneous development of two zygotes, or monozygous twins - still remains a mystery to specialists. The monozygote, which has 2 fetal eggs, brings the greatest difficulties in the course of such a pregnancy. For reasons still unexplored, the zygote, reaching a certain period, forms two separate halves, quite suitable for life. One of these embryos will be like a mirror image (cloned copy) of the second.

Separation of the oocyte and the formation of monozygous twins usually occurs from 2 to 16 days after the fertilization process has taken place. At the same time, there are some features due to the day of separation:

• On days 2-3, each half will have full potential to develop independently inside the womb. 2 fetal eggs will be formed in the uterus, each of them will have its own chorion and amniotic cavity (fetal bladder).
• On days 4-7 - the cell mass for the development of the chorion and placenta will be separated from the cells that serve as the basis for the formation of the embryonic body. The separation will affect only the detached part of the cells. The twins will have a common placenta, but two separate amniotic cavities, and will be called monochorionic (one placenta, but 2 different bladders).
• On the 8-12th day - the separation process will affect exclusively the embryos. At the same time, they will have both the placenta and the fetal bladder, and it will be called monochorionic monoamniotic.
• On days 13-15, the separation will be incomplete, therefore, defects will be observed in the further development process. Embryos can grow together in any part of the body (for example, “Siamese twins).

Even the cases when embryonic separation occurs in the early stages cannot be counted among the normal processes. The frequency with which all kinds of malformations can appear will be much higher than in the case of a single fetus.

In embryos from monozygous twins, not only sex, but also blood group, as well as a set of chromosomes, can be different. This may be due to:

• Pathology at the genetic level (chromosomal).
• Bookmark defects (due to external factors that influenced the first trimester - radiation, viruses, etc.).

To minimize the risks of developing defects and other defects that may affect the development of embryos, you will need not only constant supervision by qualified specialists, but also timely examination.

Features of diagnostics and monitoring of multiple pregnancies

Today, ultrasound diagnostics (ultrasound) makes it possible to identify several fetuses already at the beginning of their development. In this case, one of two types of examination is used:

• TA scan (transabdominal) - through the anterior wall of the peritoneum.
• TV (transvaginal) - The scanner is inserted through the vagina.

In total, a triple examination is carried out, at various times:

• for 10-14 weeks;
• for 20-24 weeks;
• for 30-34 weeks.

Tragnvaginal ultrasound examination reveals a 2 mm ovum (maximum 4 mm). This happens when menstruation is delayed for a period of 3 to 6 days, that is, much earlier than in the case of a TA scan.

As practice shows, 2 fetal eggs become clearly visible by the fifth or sixth week. After this, embryonic bodies are gradually formed, and their heartbeats can be fixed. Over time, when the gestational age becomes more significant, it is possible to establish the exact number of placentas, the absence or presence of septa separating the membranes, and also to indicate the dynamics of development of all fetuses. All these data help the doctor determine the timing of fetal growth. At the same time, the most close attention is always paid to the search for pathological abnormalities.

If the development of both fetuses proceeds normally, they will have similar features to the development of one fetus before the period of 30-32 weeks (with the usual type of pregnancy). The placental location of each fetus will be of little importance. The most favorable are the bottom, as well as the anterior and posterior uterine walls. The lower the placenta is located, the worse the quality of its nutrition will be. This is a biological feature in order to avoid central presentation, when the placenta will block the canal, excluding the possibility of a natural release of the fetus during delivery.

After a period of 32 weeks, the rate of fetal development is slightly reduced. The maternal organism, however, will have significant loads. In addition to an increase in maternal body weight (about 30%), there is an increase in the volume of blood circulating inside the body (about 10%), with the same level of erythrocytes. This explains the manifestation of anemia.

Due to the accelerated increase in the volume of the uterus, the term of delivery in the case of multiple pregnancies often occurs earlier than expected.

General requirements for the course of multiple pregnancies

Compared to the development of a single fetus, the type of multiple pregnancy requires special attention. Its characteristic differences will be as follows:

• an increased level of requirements for the mother's body;
• special care throughout the entire duration of pregnancy (especially with the monochorionic type) of the surrounding medical staff;
• in connection with an increased risk of developing placental insufficiency or the development of preeclampsia, special preventive measures are needed, which begin already in the second trimester;
• the need for a full-fledged protein menu, the appointment of drugs that include iron, the intake of vitamin groups;
• selection of a perinatal center (for delivery) of only the highest category - it is likely that qualified neonatal resuscitation will be required.

Caesarean section, as a type of operative delivery, is used much more often for a multiple case than in situations with a single fetus.

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Multiple pregnancy - definition and varieties (twins and twins)

Multiple pregnancy- this is a pregnancy in which not one, but several (two, three or more) fetuses develop in the woman's uterus at the same time. Usually the name of multiple pregnancy is given depending on the number of fetuses: for example, if there are two children, then they talk about pregnancy with twins, if three, then triplets, etc.

Currently, the frequency of multiple pregnancies ranges from 0.7 to 1.5% in various countries in Europe and the United States. The widespread and relatively frequent use of assisted reproductive technologies (IVF) has led to an increase in the incidence of multiple pregnancies.

Depending on the mechanism of the appearance of twins, there are dizygotic (double) and monozygous (identical) multiple pregnancies. Children of fraternal twins are called twins, and children of identical twins are called twins or twins. Among all multiple pregnancies, the frequency of twin twins is about 70%. Twins are always of the same sex and are like two drops of water similar to each other, since they develop from one fetal egg and have exactly the same set of genes. Twins can be of different sexes and are similar only as siblings, since they develop from different eggs, and, therefore, have a different set of genes.

A twin pregnancy develops as a result of the fertilization of two eggs at the same time, which are implanted in different parts of the uterus. Quite often, the formation of fraternal twins occurs as a result of two different sexual acts, carried out with a small interval between each other - no more than a week. However, fraternal twins can also be conceived during one sexual intercourse, provided that there is a simultaneous maturation and release of two eggs from the same or different ovaries. With twin twins, each fetus necessarily has its own placenta and its own fetal bladder. The position of the fetus, when each of them has its own placenta and fetal bladder, is called bichorionic biamniotic twins. That is, in the uterus there are simultaneously two placentas (bichorial twins) and two fetal bladders (biamniotic twins), in each of which the child grows and develops.

Identical twins develop from one ovum, which, after fertilization, divides into two cells, each of which gives rise to a separate organism. With identical twins, the number of placentas and fetal bladders depends on the time of separation of a single fertilized egg. If separation occurs within the first three days after fertilization, while the ovum is in the fallopian tube and has not attached to the wall of the uterus, then two placentas and two separate fetal sacs will form. In this case, there will be two fetuses in the uterus in two separate fetal bladders, each feeding from its placenta. Such twins are called bichorial (two placentas) biamniotic (two fetal bladders).

If the ovum divides on 3 - 8 days after fertilization, that is, at the stage of attachment to the uterine wall, then two fetuses are formed, two fetal bladders, but one placenta for two. In this case, each twin will be in its own fetal bladder, but they will feed from one placenta, from which two umbilical cords will depart. This version of twins is called monochorionic (one placenta) biamniotic (two fetal bladders).

If the ovum divides between 8 and 13 days after fertilization, then two fetuses will form, but one placenta and one fetal bladder. In this case, both fetuses will be in one for two fetal bladder, and feed from the same placenta. Such twins are called monochorionic (one placenta) monoamniotic (one fetal bladder).

If the fertilized egg divides later than 13 days after fertilization, then Siamese twins develop as a result, which are fused with different parts of the body.

From the point of view of safety and normal development of the fetus, the best option is bichorionic biamniotic twins, both identical and fraternal. Monochorionic biamniotic twins develop worse and the risk of pregnancy complications is higher. And the most unfavorable variant of twins are monochorionic monoamniotic ones.

The likelihood of multiple pregnancies

The probability of multiple pregnancy with absolutely natural conception is no more than 1.5 - 2%. Moreover, in 99% of multiple pregnancies are represented by twins, and triplets and a large number of fetuses in only 1% of cases. With natural conception, the likelihood of multiple pregnancy increases in women over 35 years old or at any age in the spring season against the background of a significant lengthening of daylight hours. In addition, in women in whose family twins or twins have already been born, the likelihood of multiple pregnancy is higher than that of other representatives of the fairer sex.

However, if pregnancy occurs under the influence of drugs or assisted reproductive technologies, then the likelihood of twins or triplets is significantly higher than with natural conception. So, when using drugs to stimulate ovulation (for example, Clomiphene, Clostilbegit, etc.), the likelihood of multiple pregnancy increases to 6 - 8%. If, to improve the chances of conception, drugs containing gonadotropin were used, then the probability of twins is already 25 - 35%. If a woman becomes pregnant with the help of assisted reproductive technologies (IVF), then the probability of multiple pregnancy in such a situation is 35 to 40%.

Multiple pregnancy with IVF

If a woman becomes pregnant using IVF (in vitro fertilization), then the probability of multiple pregnancy is, according to various researchers, from 35% to 55%. In this case, a woman may have twins, triplets or fours. The mechanism of multiple pregnancy with IVF is very simple - four embryos are simultaneously implanted into the uterus, hoping that at least one of them will take root. However, not one, but two, three or all four embryos can take root, that is, implanted into the wall of the uterus, as a result of which a woman develops a multiple pregnancy.

If during the ultrasound after IVF a multiple pregnancy (triplets or quadruplets) was detected, then the woman is offered to "remove" the extra embryos, leaving only one or two. If twins are found, then the embryos are not offered to be removed. In this case, the decision is made by the woman herself. If she decides to keep all three or four embryos that have taken root, then she will have a quadruple or triplets. The further development of multiple pregnancies that developed as a result of IVF is no different from the natural one.

Reduction in multiple pregnancies

Removal of the "extra" embryo in multiple pregnancies is called reduction. This procedure is offered to women who have more than two fetuses in the uterus. Moreover, at present, the reduction is offered not only to women who become pregnant with triplets or quadruples as a result of IVF, but also naturally conceived more than two fetuses at the same time. The aim of the reduction is to reduce the risk of obstetric and perinatal complications associated with multiple pregnancies. During reduction, two fetuses are usually left, since there is a risk of spontaneous death of one of them in the future.

The reduction procedure for multiple pregnancies is carried out only with the consent of the woman and on the recommendation of a gynecologist. In this case, the woman herself decides how many fruits to reduce, and how much to leave. Reduction is not carried out against the background of the threat of termination of pregnancy and in acute inflammatory diseases of any organs and systems, since against such an unfavorable background, the procedure can lead to the loss of all fetuses. The reduction can be carried out up to 10 weeks of pregnancy. If you do this at a later stage of pregnancy, then the remnants of fetal tissue will irritate the uterus and provoke complications.

Currently, reduction is performed by the following methods:

• Transcervical. A flexible and soft catheter connected to a vacuum aspirator is inserted into the cervical canal. Under ultrasound guidance, the catheter is advanced to the embryo to be reduced. After the tip of the catheter reaches the fetal membranes of the reduced embryo, a vacuum aspirator is turned on, which tears it off the uterine wall and sucks it into the container. Basically, transcervical reduction is essentially an incomplete vacuum abortion, during which not all fetuses are removed. The method is quite traumatic, therefore it is rarely used now;
• Transvaginal. It is performed under anesthesia in the operating room similar to the process of oocyte collection for IVF. The biopsy adapter is inserted into the vagina and, under ultrasound control, the embryo to be reduced is punctured with a puncture needle. Then the needle is removed. This method is currently the most commonly used;
• Transabdominal. It is performed in the operating room under general anesthesia similar to the procedure for amniocentesis. A puncture is made on the abdominal wall, through which a needle is inserted into the uterus under ultrasound control. The embryo to be reduced is pierced with this needle, after which the instrument is removed.

Any reduction method is technically difficult and dangerous, since pregnancy loss occurs as a complication in 23 - 35% of cases. Therefore, many women would rather face the severity of bearing multiple fetuses than lose their entire pregnancy. In principle, the modern level of obstetric care allows creating conditions for carrying multiple pregnancies, as a result of which completely healthy children are born.

The most prolific pregnancy

Currently, the most prolific recorded and confirmed pregnancy was the decay, when ten fetuses were simultaneously in the woman's uterus. As a result of this pregnancy, a resident of Brazil in 1946 gave birth to two boys and eight girls. But, unfortunately, all the children died before reaching the age of six months. There are also references to the birth of the tithe in 1924 in Spain and in 1936 in China.

To date, the most multiple pregnancy that can successfully result in the birth of healthy children without deviations is the gear. If there are more than six fetuses, then some of them suffer from developmental delay, which persists throughout their life.

Multiple pregnancy - delivery time

As a rule, multiple pregnancies, regardless of the method of its development (IVF or natural conception), ends earlier than the term of 40 weeks, since a woman begins premature labor due to excessively strong stretching of the uterus. As a result, babies are born prematurely. Moreover, the greater the number of fetuses, the earlier and more often preterm labor develops. With twins, as a rule, childbirth begins at 36 - 37 weeks, with triplets - at 33 - 34 weeks, and with a quadruple - at 31 weeks.

Multiple pregnancy - causes

Currently, the following possible causal factors have been identified that can lead to multiple pregnancy in a woman:

• Genetic predisposition. It has been proven that women whose grandmothers or mothers gave birth to twins or twins are 6 to 8 times more likely to have multiple pregnancies than other women. Moreover, most often multiple pregnancies are transmitted through a generation, that is, from grandmother to granddaughter;
• The age of the woman. In women over 35, under the influence of hormonal premenopausal changes in each menstrual cycle, not one, but several eggs can ripen, so the likelihood of multiple pregnancies in adulthood is higher than in young or young. The likelihood of multiple pregnancies is especially high in women over 35 who have given birth before;
• The effects of drugs. Any hormonal agents used to treat infertility, stimulate ovulation or menstrual irregularities (for example, oral contraceptives, Clomiphene, etc.) can lead to the maturation of several eggs at the same time in one cycle, resulting in multiple pregnancies;
• A large number of births in the past. It has been proven that multiple pregnancies mainly develop in re-pregnant women, and its likelihood is the higher, the more births a woman has in the past;
• In Vitro Fertilization. In this case, several eggs are taken from a woman, fertilized with male sperm in a test tube, and the resulting embryos are implanted into the uterus. In this case, four embryos are immediately introduced into the uterus so that at least one can implant and begin to develop. However, two, three, and all four implanted embryos can take root in the uterus, as a result of which a multiple pregnancy develops. In practice, twins are most common as a result of IVF, and triplets or quadruplets are rare.

Signs of multiple pregnancy

Currently, the most informative method for diagnosing multiple pregnancies is ultrasound, but the clinical signs on which doctors of the past were based still play a role. These clinical signs of multiple pregnancy allow a doctor or a woman to suspect the presence of several fetuses in the uterus and, on the basis of this, make a targeted ultrasound examination, which will confirm or refute the assumption with 100% accuracy.

So, the signs of multiple pregnancy are the following data:

• Too large size of the uterus, not corresponding to the date;
• Low position of the head or pelvis of the fetus above the entrance to the pelvis in combination with the high standing of the fundus of the uterus, which does not correspond to the date;
• Discrepancy between the size of the fetal head and the volume of the abdomen;
• Large belly volume;
• Excessive weight gain;
• Listening to two heartbeats;
• The concentration of hCG and lactogen is twice the norm;
• Fatigue of a pregnant woman;
• Early and severe toxicosis or gestosis;
• Obstinate constipation;
• Severe swelling of the legs;
• High blood pressure.

If a combination of several of these signs is identified, the doctor may suspect a multiple pregnancy, however, to confirm this assumption, it is necessary to perform an ultrasound scan.

How to identify multiple pregnancies - effective diagnostic methods

Currently, multiple pregnancies are detected with 100% accuracy during conventional ultrasound. Also, the determination of the concentration of hCG in the venous blood has a relatively high accuracy, however, this laboratory method is inferior to ultrasound. That is why ultrasound is the method of choice for diagnosing multiple pregnancies.

Ultrasound diagnostics of multiple pregnancy

Ultrasound diagnostics of multiple pregnancies is possible in the early stages of gestation - from 4 to 5 weeks, that is, literally immediately after a delay in menstruation. During an ultrasound scan, the doctor sees several embryos in the uterine cavity, which is undoubted evidence of multiple pregnancy.

The number of placentas (chorionicity) and fetal bladders (amnioticity), and not the dichotomy or mono-ovulation of the fetus, is of decisive importance for the choice of tactics for managing pregnancy and calculating the risk of complications. The most favorable course of pregnancy is with bichorionic biamniotic twins, when each fetus has its own placenta and fetal bladder. The least favorable and with the maximum possible number of complications is monochorionic monoamniotic pregnancy, when two fetuses are in the same fetal bladder and are fed from the same placenta. Therefore, during an ultrasound scan, the doctor counts not only the number of fetuses, but also determines how many placentas and fetal blisters they have.

In multiple pregnancies, ultrasound plays a huge role in identifying various defects or fetal growth retardation, since biochemical screening tests (determining the concentration of hCG, AFP, etc.) are not informative. Therefore, the identification of malformations by ultrasound in multiple pregnancies must be performed in the early stages of gestation (from 10 to 12 weeks), while assessing the condition of each fetus separately.

HCG in the diagnosis of multiple pregnancies

HCG in the diagnosis of multiple pregnancies is a relatively informative method, but inaccurate. The diagnosis of multiple pregnancies is based on the excess of the hCG level of normal concentrations for each specific gestational age. This means that if the concentration of hCG in a woman's blood is higher than normal for a given gestational age, then she has not one, but several fetuses. That is, with the help of hCG, it is possible to identify multiple pregnancies, but it is impossible to understand how many fetuses are in the woman's uterus, in one fetal bladder or in different ones, they have two placentas or one is impossible.

The development of multiple pregnancies

The process of developing multiple pregnancies creates a very high load on the mother's body, since the cardiovascular, respiratory, urinary systems, as well as the liver, spleen, bone marrow and other organs continuously work in an enhanced mode for a rather long period of time (40 weeks) to ensure that one, but two or more growing organisms are all necessary. Therefore, the incidence in women carrying multiple pregnancies is 3 to 7 times higher than in singleton pregnancies. Moreover, the more fetuses in a woman's uterus, the higher the risk of complications from various organs and systems of the mother.

If a woman, before the onset of multiple pregnancy, suffered from any chronic diseases, then they will necessarily become aggravated, since the body is under very strong stress. In addition, with multiple pregnancies, half of women develop preeclampsia. All pregnant women in the second and third trimesters develop edema and arterial hypertension, which are a normal reaction of the body to the needs of the fetus. A fairly standard complication of multiple pregnancies is anemia, which must be prevented by taking iron supplements throughout the entire period of bearing children.

For the normal growth and development of several fetuses, a pregnant woman must eat well and vigorously, since her need for vitamins, trace elements, proteins, fats and carbohydrates is very high. The daily calorie intake of a woman carrying twins should be at least 4500 kcal. Moreover, these calories should be recruited from nutrient-rich foods, and not chocolate and flour products. If a woman with multiple pregnancies eats poorly, then this leads to the depletion of her body, the development of severe chronic pathologies and numerous complications. During a multiple pregnancy, a woman normally gains 20 - 22 kg in weight, with 10 kg in the first half.

In multiple pregnancies, one fetus is usually larger than the second. If the difference in body weight and height between fruits does not exceed 20%, then this is considered the norm. But when the weight and growth of one fetus exceeds the second by more than 20%, they speak of a delay in the development of the second, too small child. A delay in the development of one of the fetuses in multiple pregnancies is noted 10 times more often than in single pregnancies. Moreover, the likelihood of developmental delay is highest in monochorionic pregnancy and minimal in bichorionic biamniotic pregnancy.

Multiple pregnancies usually end prematurely because the uterus is stretching too much. With twins, childbirth usually occurs at 36 - 37 weeks, with triplets, at 33 - 34 weeks, and with a quadruple, at 31 weeks. Due to the development of several fetuses in the uterus, they are born with a smaller weight and body length compared to those born from a singleton pregnancy. In all other aspects, the development of multiple pregnancies is exactly the same as that of singleton pregnancies.

Multiple pregnancy - complications

With multiple pregnancies, the following complications can develop:

• Early pregnancy miscarriage;
• Premature birth;
• Intrauterine death of one or both fetuses;
• Severe gestosis;
• Bleeding in the postpartum period;
• Hypoxia of one or both fetuses;
• Fetal collision (clutching of two fruits by their heads, as a result of which they simultaneously end up at the entrance to the small pelvis);
• Syndrome of fetofetal blood transfusion (SFFG);
• Reverse arterial perfusion;
• Congenital malformations of one of the fetuses;
• Delayed development of one of the fetuses;
• Fusion of fruits with the formation of Siamese twins.

The most severe complication of multiple pregnancy is fetofetal blood transfusion syndrome (FTS), which occurs with monochorionic twins (with one placenta for two). SFFG is a violation of blood flow in the placenta, as a result of which blood from one fetus is redistributed to another. That is, one fetus receives an insufficient amount of blood, while the other receives an excess. With SFFH, both fetuses suffer from inadequate blood flow.

Another specific complication of multiple pregnancies is fetal fusion. Such accreted children are called Siamese twins. Fusion is formed in those parts of the body with which the fruits are most in contact. Most often, fusion occurs with the chest (thoracopagi), abdomen in the navel (omphalopagi), skull bones (craniopagi), coccyx (pygopagi) or sacrum (ischiopagi).

In addition to the above, with multiple pregnancies, exactly the same complications can develop as with a singleton.

Childbirth with multiple pregnancies

If the multiple pregnancy proceeded normally, the fetuses have a longitudinal arrangement, then delivery is possible in a natural way. With multiple pregnancies, complications during childbirth develop more often than with single pregnancies, which leads to a higher frequency of emergency caesarean sections. A woman with multiple pregnancies should be hospitalized in a maternity hospital 3-4 weeks before the expected date of birth, and not wait for the onset of labor at home. The stay in the maternity hospital is necessary for examination and assessment of the obstetric situation, on the basis of which the doctor will decide on the possibility of natural childbirth or on the need for a planned caesarean section.

The generally accepted tactic of delivery in multiple pregnancies is as follows:
1. If the pregnancy proceeded with complications, one of the fetuses is in a transverse position or both are in breech presentation, the woman has a scar on the uterus, then a planned cesarean section is performed.
2. If a woman approached childbirth in a satisfactory condition, the fetuses are in a longitudinal position, then it is recommended to carry out childbirth through natural routes. With the development of complications, an emergency cesarean section is performed.

Currently, with multiple pregnancies, as a rule, a planned cesarean section is performed.

Multiple pregnancy: causes, varieties, diagnosis, childbirth - video

When they give sick leave (maternity leave) with multiple births
pregnancy

With multiple pregnancies, a woman will be able to receive a sick leave (maternity leave) two weeks earlier than with a singleton, that is, within 28 weeks. All other rules for issuing sick leave and cash benefits are exactly the same as for singleton pregnancies.