Multiple pregnancy is called if two or more babies are expected to appear. Children in this case will be twins. There are several reasons for “double happiness”.
Most often this can happen if a parent has twins or triples in the family. Matters and age women.
After 35 years, the chances of becoming a mother just a few crumbs increase slightly. With age, the physiological ability to conceive begins to decline, ovulation does not occur every month.
In the body, the level of the hormone that stimulates the growth of follicles rises, and ovulation can occur with the release of several eggs at once.
And, finally, recently, twins have begun to be born more often due to the wide distribution of such modern assisted reproductive technologies as stimulation of ovulation and IVF.
In any case, such future mothers are always under closer supervision of doctors, they have to attend antenatal clinics and undergo examination more often. But all the inconvenience pays off a hundredfold when healthy twins are born, and even triplets.
With multiple pregnancies, the duration of maternity leave increases. To the future mother of twins, he is issued at 28 weeks (during normal pregnancy, the disability certificate for pregnancy and childbirth is issued for a period of 30 weeks).
Gemini can be lenticular (dizygotic) or identical (monozygous). In the first case, pregnancy occurs as a result of fertilization at once 2 or more zygote eggs, matured in one or both ovaries.
Children born of such a multiple pregnancy are called twins or triplets, they can be of the same or of different sexes and usually resemble each other, like ordinary brothers and sisters.
In the second case, the only fertilized zygote is divided into 2 or more parts. The earlier this happened, the more the twins are separated from each other, which means that the conditions for their development are more favorable. For example, if the separation took place on the 1-3rd day of the zygote’s existence, each twin is surrounded by two fetal membranes, has either a separate placenta, or a common one, consisting of two that have merged together.
Accordingly, the food and blood circulation in them will be “separate” – therefore, the risk of complications decreases. If the egg begins to divide between the 4th and 8th days, the twins will have a common placenta, which means that the circulatory system will more or less communicate with each other.
The division on the 8th day means that the embryos will have a common placenta and amniotic bladder (amniotic sac). Since nothing divides babies, they swim in the amniotic fluid together and during movement along the birth canal can “catch” each other. In this case, doctors will offer the expectant mother to make a cesarean section before the onset of labor.
The division that began on the 13th day will be incomplete and will lead to the formation of so-called Siamese (accreted) twins. Identical twins resemble each other like two drops of water, they are always same-sex, they have the same color of eyes, hair, blood group, skin relief of finger tips, the shape and arrangement of teeth.
To carry out a multiple pregnancy is a very difficult matter, because the female body is more inclined to carrying one baby. For this reason, these future moms have a higher risk of complications. In a multiple pregnancy in the first trimester, in 15–20% of cases, the phenomenon of the death of one of the fetal eggs is observed.
It stops developing, gradually resolves, but its remnants can remain in the uterus until delivery. Usually, this does not affect the development of another twin.
But in some cases, there may be a threat of spontaneous abortion. Under such circumstances, the future mother is hospitalized and prescribed medications to relax the uterus.
In the second trimester of pregnancy, women awaiting the birth of any twins are diagnosed with physiological anemia. You should not worry: a similar complication in case of multiple pregnancy is considered “normal”.
Indeed, the volume of circulating blood increases by 50–60% (in ordinary pregnancy, by 40–50%), mainly due to the fact that there is more plasma. This leads to a “dilution” of blood and a decrease in the level of hemoglobin.
For the prevention of anemia, iron supplements and folic acid are prescribed.
Due to the increased load on the body in the second half of pregnancy, the risk of developing gestosis (increased blood pressure, the appearance of edema and protein in the urine) is increased. Urinary tract infections are also more common. The reason is simple.
The uterus “grows” faster than during normal pregnancy, and squeezes the internal organs more strongly. This leads to disruption of the normal flow of urine, which means that pathogens are more difficult to remove from the body.
In addition, the future mothers twins are much higher risk of spontaneous abortion at any time and preterm birth. According to one theory, the overstretching of the uterus muscles is to blame for such adverse developments.
To cope with this complication helps receiving drugs that relax the uterus.
During multiple pregnancies, the risk of disturbances in the intrauterine development of future children doubles, and it is higher in monozygotic twins. The most serious complication of multiple pregnancy with a monochorial pregnancy, when the crumbs have a common placenta, is feto-fetal transfusion. In this case, the blood flows from one twin to another – from the “donor” to the “recipient”.
The “donor” decreases the total blood volume, which leads to anemia, intrauterine growth retardation, decreased urine production and low water. The latter circumstance prevents the normal development of lung tissue. The “recipient” has the opposite effect.
Due to the fact that his blood volume rises sharply, the load on the heart, lungs and kidneys increases, heart failure occurs. The most frequent manifestations of it are polyhydramnios and fluid accumulation in different parts of the body.
In previous years, the forecast was the most unfavorable. But now doctors have learned how to cope with this complication. Future mothers do laser coagulation of the vessels of the placenta, that is, simply speaking, they share the blood flow of twins.
This endoscopic surgery saves the lives of future crumbs. When the time is right, the woman gives birth to ordinary twins, who then develop normally.
For future mothers who are expecting the birth of several babies, doctors treat with special attention. But a lot depends on the woman herself.
In order for doctors to notice the smallest problems in time and take appropriate measures, a pregnant woman should register with the antenatal clinic as soon as possible and strictly follow the recommendations and appointments of specialists.
A doctor may suspect multiple pregnancies already at the first gynecological examination, if the size of the uterus is larger than with the appropriate period of gestation of the baby. With greater certainty, ultrasound can be judged in 5-6 weeks.
In the uterus, then several fetal eggs or embryos are visible. The study is carried out by transvaginal access, that is, using a sensor that is inserted into the vagina.
At such an early stage, it is very important to determine whether the twins belong to an identical or multi-twin. The peculiarity of pregnancy management and the prognosis of possible complications depends on this.
To avoid trouble, the expectant mother should also carefully control her weight. If during singleton pregnancy, physiological weight gain is 10–12 kg, while with multiple pregnancy, it is about 15 kg.
The future mother of twins attends a female consultation more often than during singleton pregnancy. Up to 28 weeks – 2 times a month, at later terms – 1 time in 7-10 days.
Examinations and analyzes will be the same as when carrying one baby, but the interval between them will be less. For example, if ultrasound is recommended to be done 3 times in singleton pregnancy, then in case of multiple pregnancy, depending on circumstances, 5 or more times. In the later stages of the study, it is possible to track the physiological development of future babies, to establish their position and presentation, the structure and amount of placentas, amniotic cavities and the volume of amniotic fluid.
This allows timely identification of complications characteristic of monochorial twins. Depending on the evidence, the doctor also determines in what way the birth will take place – through natural pathways or with a caesarean section.
In multiple pregnancies, the results of double and triple tests, which are judged on the presence of chromosomal diseases and malformations, are not indicative. The level of hormones in any case will be elevated, because a woman bears not one, but several babies.
Doctors in this case focus more on the data obtained in the course of ultrasound.
More often it is necessary to take a blood test for the detection of iron deficiency anemia. Since women carrying several children are more likely to develop gestational diabetes, if necessary, a glucose tolerance test (it is not included in the standard of research for routine antenatal care and is carried out additionally) is prescribed earlier — usually at 22–24 weeks (with singleton pregnancy – on the 24-28th).
Because of the increased risk of preterm birth, a woman after the 22nd week may be given another test – the detection of fetal fibronectin. This substance is a protein that is present in vaginal secretions.
Its detection can be a signal that the body is preparing for childbirth. If the result is negative, then the risk of premature birth in the next 2 weeks is minimal.
If possible, this test should be repeated until the 34th week of pregnancy. True, they do not do it in every laboratory.
The technique is used mainly in perinatal centers and clinics that combine scientific and practical work.
After the 28th week, the so-called non-stress test, or cardiotocography, is often prescribed – a study that measures the heartbeat and physical activity of future twins. The woman quietly lies on her left side for 40–60 minutes, and the external ultrasound sensor on her stomach registers the heart activity of the future babies.
The test examines the reaction of the cardiovascular system of each crumb to its movements. The obtained data helps to understand whether future babies have problems due to the fact that they develop in cramped conditions.
With the help of an additional sensor, uterine contractions are also detected, which can be a sign of impending labor.
The doctor may recommend to undergo more and biophysical profile. In this case, the non-stress test is combined with a detailed ultrasound. The respiratory movements of future crumbs, their physical activity, tone, volume of amniotic fluid and degree of maturity of the placenta are measured in real time.
The study is conducted in the third trimester, since in earlier periods it is impossible to obtain objective data.
After the 30–32th week of pregnancy, the doctor may recommend that such studies be carried out once a week. In multiple pregnancies, childbirth usually occurs earlier – at 36–38 weeks if twins are expected, and at 34–36 weeks if triplets are harvested.
With multiple pregnancies, childbirth usually occurs 2–3 weeks earlier than with singleton. But you should not worry about this, as the twins have an important advantage.
On the welfare of the twins took care of nature itself. The fact is that these babies are more “mature” by the time of delivery and their lungs mature earlier than that of a child with a singleton pregnancy.
So, premature labor for twins and triplets is a much lower risk than other premature babies. You should not worry about the fact that the weight of twins at birth is usually less than usual at 300-400 g. The development of babies, despite this fact, will correspond to the age-old norms.
With what time interval babies will be born depends on how effective the attempts are. But usually, if the twins are dizygotic, the oldest of them is born 20-30 minutes earlier than the younger.
If they are monozygous, the interval between their appearance on the light is no more than 10 minutes.