Multiple pregnancy - Causes, symptoms and treatment. MF.

Multiple pregnancy is called a pregnancy, in which two or more fetuses develop simultaneously in the womb. If the fruit is two, they are called twins. If three - triplets and so on. Babies who were born as a result of multiple pregnancies are called twins.

Gemini can be monozygotic( monozygotic) or dissimilar( dizygotic).What is the difference between them? If, after fertilization, a single egg is divided, then identical twins are obtained. They are similar to each other as "two drops of water", because they have the same set of genes. Kids will be of the same sex.

Varicose twins are formed if two or more oocytes are fertilized immediately. Tethered twins have a different set of genes, because they were formed from different oocytes. Therefore, they are similar to each other, like a brother and sister, born in the same family, that is, the similarity is minimal. Dysygotic twins can be of different sexes, unlike identical twins. According to statistics, raznoyaytsevye twin are born more often than odnoyaytsevye.

Recently, the incidence of multiple pregnancies has been increasing and is approximately 2% of the total number of pregnancies. At the same time in 99% of cases twins are born and only in 1% of cases of triplets and more fruits.

What is the cause of multiple pregnancies?

The first factor that no one doubts is heredity. Twins are more likely to be born in families in which the parents of fathers or mothers already had twin births or triplets.

The second factor is the age of the mother. It is noted that in women who become pregnant in the late reproductive age( for 35 years), there is more frequent pregnancy. The fact is that with age, fertility( the ability to conceive) in a woman is reduced and ovulation occurs not every month. Unrealized hormones that promote ovulation and the release of the egg accumulate, and during the next menstrual cycle are released and with a "big boost" than it should, stimulate maturation and the release of just 2 or more eggs.

Finally, the main reason for the growth of multiple pregnancies is associated with the widespread popularization of the "conception of children in vitro" technology, that is, IVF( in vitro fertilization).A woman who wants to become pregnant is placed in the womb at once several embryos, in the hope of "survival" of at least one embryo. But in the end, after a grafting, a woman can easily forget both twins and triplets and even fours!

These are the main reasons for the development of multiple pregnancies. Other factors that increase the chances of multiple pregnancies include national characteristics, the abolition of hormonal contraceptives after long-term use, repeated delivery.

Features of Multiple Pregnancy

The course of multiple pregnancies differs in many respects from that of singleton. Pregnant women with twins often complain of rapid fatigue, dysuria, dyspnea, constipation. Such women often have severe toxicosis with prolonged nausea and vomiting in the first months of pregnancy. In the second and third trimester of pregnancy, the pregnant woman is rapidly gaining weight. The uterus reaches a very large size, exerting a strong pressure on the abdominal organs. At the end of pregnancy, there are pronounced swelling of the legs, blood pressure rises, and protein in the urine may appear.

The duration of a multiple pregnancy also differs from a single-fetal pregnancy. The more fruits, the earlier birth occurs. Thus, the duration of pregnancy with a double on average is 260 days, that is 37 weeks of pregnancy;at a triple 247 days, that is 35 weeks of pregnancy.

Diagnosis of multiple pregnancy

To prevent complications during pregnancy and childbirth, a woman should immediately register with a gynecologist in a women's consultation after she suspects a pregnancy. Starting from the 5th-6th week of pregnancy, that is, immediately after the first days of menstruation, the doctor will be able to diagnose a multiple pregnancy.

Confirm the presence of multiple pregnancy is possible only after ultrasound. In the uterus of a pregnant woman several embryos are visualized at once. Due to the high informativeness of ultrasound, it is possible not only to reveal a multiple pregnancy, but also to precisely locate the fetuses, the volume of amniotic fluid, the presence of developmental defects in fruits and so on.

In addition to ultrasound, all other diagnostic methods are not always reliable. So, it is known that in multiple pregnancy the level of human chorionic gonadotropin( hCG) in the blood is higher than in single pregnancy. But nevertheless, based on one level of hCG, it is impossible to diagnose a multiple pregnancy.

With a gynecological examination, a gynecologist may also suspect a multiple pregnancy due to the large size of the uterus that does not match the gestation period. However, this sign is also relative, since the uterus can be greatly increased for other reasons, for example, if the pregnant woman has uterine fibroids.

Thus, ultrasound is the main and most reliable method for diagnosing multiple pregnancies in early pregnancy. In late pregnancy, ultrasound is done especially often, based on the position of the fetuses in the uterus, will determine the tactics of giving birth.

During pregnancy, all women with multiple pregnancies are under the enhanced supervision of an obstetrician-gynecologist. The doctor of the woman's consultation in the first trimester of pregnancy must prescribe folic acid and iron preparations( Sorbifer, Maltofer) for the prevention and treatment of anemia, which often happens in multiple pregnancies.

If there is a threat of premature birth, appoint adrenomimetics( Ginipral, Salbutamol) to prolong the pregnancy.

Childbirth with multiple pregnancies

Even if the pregnancy is completely normal, early hospitalization is indicated in the maternity hospital approximately 3-4 weeks before the expected date of delivery.

The most urgent issue is the choice of the method of delivery in multiple pregnancies. If the pregnant woman feels well, all the tests are normal and both fetuses are in the head preposition, then it is preferable to lead through the natural birth canal. In case the first fetus is in the head presentation, and the second in the pelvic-birth can also be led naturally. After the birth of the first fetus, under the control of ultrasound, the outer turn of the second fetus is made in the head presentation.

During careful labor, cardiomonitoring of the heart activity of both fetuses is carried out through the natural birth canal. When there is a weakness in labor activity, the hormone Oxytocin is injected intravenously for active contraction of the uterus. To anesthetize labor, epidural anesthesia is used. After the birth, Oxytocin continues to drip for the prevention of postpartum hemorrhage. For the general strengthening effect in the postpartum period, intravenously injected glucose solution for 2 hours.

When one of the fruits is in the transverse position, a caesarean section is shown. In addition to the transverse position of the fetus, indications for cesarean section in multiple pregnancy are: the presence of polyhydramnios, complicated forms of gestosis( stable increase in blood pressure, protein in the urine), large fruits, the presence of more than two fruits, hypoxia of one of the fetuses or both, pelvic presentation of the first fetus, a collision of fruit( when the head of the first fetus clings to the head of the second fetus at the entrance of the small pelvis, which makes it impossible to pass the fruit).

A woman should have more rest during pregnancy. The same rule applies to multiple pregnancy. Starting from the 29-30 weeks of pregnancy, a woman should be more in bed, as excessive activity can lead to premature birth.

Nutrition throughout the pregnancy should be caloric and balanced. On average, the weight gain for multiple pregnancy can be up to 20 kg. In the presence of edema, especially at the end of pregnancy, fluid intake should be limited to 1.5 liters per day.

Complications of multiple pregnancies:

- miscarriages in early pregnancy;
- premature delivery;
- Fetal / Fetal Hypoxia; Fruit Collapse;
- antenna fetal / fetal death;
- severe forms of gestosis;
- postpartum hemorrhage.

Prevention of complications of multiple pregnancies implies careful observation of the pregnant woman in the antenatal clinic throughout pregnancy, timely hospitalization before delivery.

Consultation of obstetrician-gynecologist.

1. Is it possible to give birth to yourself in the presence of twins?
It is possible, if there are no contraindications.

2. I have twins, but I do not want to give birth to two, can I "clean" one fruit?
It is possible to reduce( aspiration) one of the fruits in the early stages.

3. In what dose is it better to drink folic acid in multiple pregnancies?
1 mg per day.

4. How to conceive twins?
Most often, twins are born after IVF( in 50% of cases), sometimes immediately after the abolition of contraceptive tablets.

5. I already had twins. How to avoid pregnancy twins a second time?
There are no such methods.

6. Is it true that in birth a strong fetus is born first, then weak?
It's not true, at first a fetus is born, which is located closer to the exit from the small pelvis and this does not mean that it is the strongest.

7. On what term of pregnancy can I go to a decree with a double?
At the 28th week of pregnancy.

Obstetrician-gynecologist, Ph. D.Christina Frambos