Multiple pregnancy - what are the chances and possible complications of such a conception? More frequent consultations. In what cases is a caesarean section prescribed?

The news that a woman will soon become a mother is perhaps the most memorable event in life. The woman's reaction multiple pregnancy does not always cause positive emotions. More often married couple experiencing fear, shock and a sense of the unknown.

The feeling of confusion and discouragement is completely normal reaction twin pregnancy, as parents understand that they have a double responsibility. As a rule, very soon a married couple gets used to this news and looks forward to the birth of babies.

A multiple pregnancy proceeds a little differently than a pregnancy with one baby. This article will reveal all the features of the course of twin pregnancy by week. Thanks to the information received, the pregnant woman will feel more confident and know what to expect.

How to understand the term "multiple pregnancy"?

Multiple pregnancy

Many people, having heard the words "twins" and "twins", do not really understand how they differ from each other. If we recall the school course of human biology, then we know that the formation of the embryo occurs after the fusion of two gametes (male and female germ cells).

If in a woman's menstrual cycle, two eggs matured at once, which were subsequently fertilized by two different spermatozoa, then we are talking about conceiving twins. It is important to understand that fertilization occurs with two different spermatozoa that have a completely different genetic set of chromosomes. Twins can be born of different sexes, have different heights, eye and hair colors, and not be very similar to each other. Such a pregnancy is called dizygotic.

If during the cycle there was a maturation of one egg, fertilized by one sperm, then either one embryo or the conception of identical twins is obtained. Sometimes in a woman's body such hormonal disruptions occur when the egg is divided into two absolutely identical halves. These two female cells are fertilized by the same sperm, resulting in twins. The set of chromosomes in such children is absolutely the same.

These are necessarily same-sex babies, very similar to each other, have a hereditary predisposition to the same diseases, have moles and birthmarks on the same part of the body. Even the characters of identical twins are very similar. This pregnancy is called monozygotic. Obstetrician-gynecologists can easily determine monozygotic and dizygotic pregnancy using ultrasound.

Why do multiple pregnancies happen?

Not everyone is blessed with such happiness.

Despite continuous development obstetrics and gynecology, as sciences, physicians and scientists still cannot specify the exact cause of multiple pregnancy. The following are predisposing factors for conceiving more than one baby.

Heredity. This factor is the most important. Most often, multiple pregnancies are transmitted to women through maternal line, that is, if in the family of a woman there were cases of the birth of twins and twins. Most often, this feature is transmitted through one generation, but exceptions are possible.

Infertility treatment. After treatment of the secondary form of female infertility, there are frequent cases of conception of more than one embryo. This fact is due to the acceptance hormonal drugs that stimulate the maturation of several germ cells at once. If they are all fertilized by sperm, then a multiple pregnancy is obtained.

IVF procedure. The method of artificial insemination in 60% of cases ends with a multiple pregnancy. This factor is due to the transfer of several embryos into the uterus of a woman at once. Several embryos do not take root and die, and 2-3 continue to successfully grow and develop in the uterus. Sometimes doctors carry out reduction (removal) of extra embryos, leaving one or two babies in the uterine cavity.

Despite the constant improvement of scientific methods and the deep knowledge of obstetrician-gynecologists, it is not yet possible to accurately predict the conception of monozygotic twins.

How does a multiple pregnancy proceed?

Having twins is associated with certain risks.

Having studied the pregnancy calendar with multiple pregnancy and bearing one child, a woman will not notice much difference. The development of babies in both cases occurs at almost the same time. A feature of the difference between a multiple pregnancy and a normal pregnancy is the development of complications. Mothers who carry several babies at once face complications more often.

Complications:

Iron deficiency anemia - more common with multiple pregnancies. This is due to the increased need for iron of the mother and children. To prevent such a complication, iron preparations are prescribed for the expectant mother from the very first days of pregnancy;

Toxicosis of the second half of pregnancy (preeclampsia) - often develops in multiple pregnancies. Protein appears in the urine of the expectant mother, and blood pressure indicators reach high levels;

Placenta previa is a common complication of multiple pregnancies. It is characterized by the location of the placenta in such a way that the entrance to the uterus is blocked;

Fetoplacental insufficiency - since the placenta performs "double work", its premature aging and wear occurs, as a result of which children experience oxygen deficiency and nutrients;

Presentation of fetuses - children in the uterus are located in such a way that natural childbirth becomes impossible and the woman is prescribed C-section;

Developmental delay - as a result of insufficient blood supply to the placenta and the supply of nutrients to the fetuses, the development of children often does not correspond to gestational age;

Developmental dissociation - this complication of multiple pregnancy is characterized by a lag in the development of one of the fetuses. This is due to the peculiar deprivation of one of the children of nutrients in favor of the second. If treatment is started in a timely manner, then, as a rule, nothing threatens the life and health of the baby;

The risk of developing anomalies and defects - with multiple pregnancies is much more common than with the bearing of one child;

Risk of preterm birth.

In the first trimester of pregnancy (the first 12 weeks), a fifth of women with multiple pregnancies experience a death phenomenon. gestational sac. In this case, one embryo remains in the uterine cavity and continues to grow and develop, while the second one freezes, stops developing and decreases in size (involutes). Developing fetus such an involution does absolutely no harm.

Ultrasound of two fetal eggs

After the 12th week of pregnancy with multiple pregnancy, the risk of premature birth and amniotic fluid discharge is especially high. A third of all multiple pregnancies end in miscarriage or premature birth.

To prevent miscarriage and premature birth, a woman carrying twins is prescribed medicines throughout her pregnancy that relax the muscles of the uterus. If taking muscle relaxants does not give the expected effect, then the expectant mother is hospitalized in the maternity hospital. A woman is in the hospital either until the birth itself, or until her condition stabilizes and the threat of miscarriage disappears.

Often during pregnancy, a woman complains of violations and abnormalities in the work of the heart and blood vessels. During the period of bearing one baby, the load on the cardiovascular system doubles, and when bearing two fetuses, it triples! Heart failure can lead to negative consequences for babies growing in the womb.

Gynecologists strongly recommend that pregnant women seek medical help in a timely manner for any abnormalities in the work of the heart. A woman must understand that she is responsible not only for her health, but also for the lives of her children, and the slightest delay can lead to sad consequences.

It has already been noted above that with multiple pregnancy, the risk of developing iron deficiency in the blood of the mother increases many times over. When carrying several fetuses at once, the placental tissue has a large mass, in contrast to the placenta of a singleton pregnancy. This leads to an increase placental blood flow and a decrease in hemoglobin levels in the blood.

In women who carry more than one fetus in the womb, in most cases, childbirth begins prematurely. Gynecologists believe that main reason such a complication is the overstretching of the muscle fibers of the uterus. Women bearing twins should especially carefully monitor their well-being and health, and if there are any complaints, you should immediately seek medical help.

Multiple pregnancies are at risk, so gynecologists especially carefully monitor women carrying twins. Such women need to visit the doctor more often, take urine and blood tests more often. Many expectant mothers are outraged by the need for frequent visits, but do not neglect the recommendations of a gynecologist, because the health of babies is much more important than temporary inconvenience.

How is a multiple pregnancy recognized?

The main thing is to find out about multiple pregnancy in time

This question, perhaps, worries many women in whose family there were cases of multiple pregnancies. From the first days of pregnancy, the expectant mother is interested in signs by which you can find out how many fruits she carries under her heart. The most reliable way to determine multiple pregnancy is to visit the office of an obstetrician-gynecologist.

An experienced specialist can accurately diagnose multiple pregnancy, starting from the 4th obstetric week of pregnancy. Already from this period, the woman's uterus is twice as large as during pregnancy with one fetus.

There are women who are trying to independently determine by some signs whether their pregnancy is multiple. It is important to understand that no reliable signs indicating multiple pregnancies. Until the end of the 12th week of pregnancy, you can talk about multiple pregnancy based on the size of the uterus, and already from the 13th week, a woman is prescribed an ultrasound scan. During this study, it is possible to say with accuracy how many fetuses develop in the uterus.

There are cases when, during the first ultrasound, the doctor sees two fetal eggs on the monitor screen, one of which subsequently freezes and only one child is born. It rarely happens that on ultrasound the doctor sees only one fetal egg, and on the next study two fetuses are found. This happens if one fetal egg overlaps the second, but when the embryos grow up a little, they are clearly visible on the monitor screen during an ultrasound scan.

Many women mistakenly believe that multiple pregnancies can be diagnosed if they undergo a blood test for the results of a triple test for hCG, alpha-fetoprotein and estriol. Such a test is done to confirm the fact of pregnancy and early detection of malformations of the embryo, however, such an analysis does not always help determine whether the pregnancy is multiple.

How does a multiple pregnancy proceed? Features of childbirth with multiple pregnancy

It has already been said above that when carrying more than one fetus, the expectant mother is forced to visit the gynecologist's office more often. With a successful pregnancy, a woman, starting from the 13th week, should come to the doctor every 10 days. Starting from the 28th week of pregnancy, the expectant mother should come to the consultation at least once every 7 days.

Obstetricians and gynecologists pay special attention to the weight gain of a pregnant woman. When carrying one fetus, the total increase by the time of birth is usually about 12 kg. If a woman is carrying twins, then by the time of childbirth, weight gain should be no more than 15 kg. The expectant mother should carefully monitor the kilograms and in no case allow a set excess weight. Every extra kilogram gained while carrying twins can greatly complicate the course of pregnancy and the condition of growing babies in the womb.

During the bearing of several fetuses, a woman should be prepared for the fact that at any time it may be necessary to go to the maternity ward for preservation. Obstetrician-gynecologists prefer not to risk the life of children and the health of a woman, therefore, at the slightest deviation in the course of a multiple pregnancy from the norm, the expectant mother is offered hospitalization in the maternity hospital.

Two weeks before the expected date of birth with multiple pregnancy, the woman is sent to the maternity hospital. The woman is invited to immediately take with her all the necessary things for herself and the children, as well as documents. Starting from the 37th week of pregnancy, childbirth can begin at any time, and it would be reasonable if the woman is under medical supervision at this time.

Methods of delivery in multiple pregnancies are still a topic of discussion among doctors. There is no specific method that applies to all women with twins. The method of delivery for multiple pregnancy is selected individually for each pregnant woman, depending on such factors:

How was the pregnancy?

How does a woman feel?

How do babies develop and grow?

Is there placenta or fetus previa?

An agonizing wait

Obstetricians pay great attention to the presentation of the baby who should leave the uterus first. If the fetus is in a breech presentation, then doctors prefer delivery by caesarean section. In natural childbirth, babies can get their heads stuck in the birth canal, often resulting in fetal death.

Often with multiple pregnancy in the process of childbirth, an anomaly of labor activity occurs. This pathology is characterized by weakness birth process, or, conversely, swiftness. Both are bad for mother and children, therefore, to prevent the development of complications, doctors use medical preparations, correcting the intensity of labor activity.

In addition to medical correction, there are other methods of managing childbirth. For example, with weakness of labor activity after the birth of the first fetus, the woman's fetal bladder is pierced, and then the interval between the birth of twins is significantly reduced. If both fetuses show signs of severe oxygen starvation, then the question arises of an emergency caesarean section.

Unlike pregnancy with one child, childbirth with multiple pregnancies always begins earlier than expected by 2-3 weeks. And in this case, wise nature took care of the kids. During the bearing of two children at once, the formation of a sufractant (a substance that helps the lungs of children open after birth) in the fetus occurs earlier than in a singleton pregnancy. This fact suggests that preterm birth in multiple pregnancies is less dangerous for the fetus and the risk of complications than premature birth when carrying one baby.

In addition, scientists noted interesting fact. The adaptation period in monozygotic twins is more difficult than in dizygotic children. Identical babies are more likely to suffer from postpartum jaundice and chronic bronchitis due to prematurity.

The beginning of the birth process with multiple pregnancy is not much different from a normal singleton pregnancy. Most often, a woman leaves amniotic fluid, and their number is much greater than when carrying one child.

Due to polyhydramnios, the muscle fibers of the uterus of a woman are stretched, which subsequently threatens the woman in labor with the primary weakness of labor. To prevent this complication, obstetricians try to open the fetal bladder at the very beginning. initial stage labor activity, when the cervix is ajar a few centimeters.

Due to the fact that childbirth with multiple pregnancies is more often accompanied by the risk of complications, doctors prefer to perform epidural anesthesia even with natural delivery. This is necessary in order to be able to urgently perform a caesarean section if something goes wrong during childbirth, without wasting time on anesthesia.

The postpartum period of a woman with multiple pregnancies is no different from the recovery after the birth of one child. And even breast-feeding both babies is quite possible. A newly-made mother only needs to get used to her new status a little and show patience and dexterity.

Many couples who are expecting twins often worry about the weight of the babies at birth. All concerns about excessively low body weight in twins at birth are just an exaggeration. If a woman's pregnancy proceeded normally, and the children developed according to gestational age, then the birth weight differs by only 400-500 grams from a newborn from a singleton pregnancy. The subsequent development of twins is also no different from a newborn from a singleton pregnancy.

The whole truth about government payments for the birth of twins

All future mothers know that after the birth of a child, the state provides material assistance to certain period time. With multiple pregnancies, women often wonder about the amount of payments at birth.

If two or three children are born in a family at the same time, then lump sum paid for each newborn child. In order to receive material assistance, parents of babies must provide local labor authorities with a certificate stating that at the time of childbirth, the spouses were not officially employed anywhere.

If during pregnancy a woman worked officially, then in order to receive payments for children, she needs to contact the accounting department of her enterprise. The list of documents and certificates required for payments must be clarified at the place of receipt of financial assistance. If the parents are students, then the allowance is paid at the place of study.

Except government payments there are also regional payments for childbirth. Such assistance is provided at a time, and the amount depends on the region of residence. To obtain regional payment benefits must be applied to the local social security authorities.

If a woman gave birth to a child out of wedlock and has the status of a single mother, then in order to receive payments, she must provide documents confirming the absence of a father in children. A woman can receive such a certificate at the registry office, when registering newborns.

Residents of Russia should know that at the birth of the second, third and subsequent babies, the family has the right to receive maternity capital.

Parents must complete all paperwork on time

In case of multiple pregnancy, maternity capital is paid for the second baby. To get this look financial assistance married couple should contact Pension Fund located at the place of registration of his residence. The following list of documents must be submitted to the pension fund:

An application for receiving maternity capital, filled out according to the model;

Original and photocopy of the applicant's passport;

Originals and copies of newborns and existing children;

Certificate of Russian citizenship of the child;

Original and copy of the pension insurance certificate.

Additional benefits for multiple pregnancy are not provided by the state, however, if in a family, except for born twins, there are other children, then the family automatically receives the status of having many children and receives all the benefits that are due in such cases.

Do not worry about excessive bureaucratic red tape with documents. The process of obtaining all certificates and benefits will end very soon, and you will enjoy parenthood. All this will still be, but for now, get used to your position and enjoy every day of pregnancy so that no troubles can overshadow your happiness from waiting for your babies.

Multiple pregnancy- this is a pregnancy in the presence of more than one fetus in the uterine cavity. Despite the increasing incidence of multiple pregnancies in last years, it still correlates with an infrequent (0.7-1.5%) phenomenon, moreover, more often (on average 1 birth out of 80), two babies are born in the final. Multiple pregnancies with three, four and even five fetuses are rarely recorded.

It has been reliably proven that there is a hereditary predisposition to the birth of twins, and not only along direct (from mother or grandmother) lines of inheritance, but also along lateral lines (for example, from an aunt). In such families, a second multiple pregnancy is often recorded.

In addition to heredity, the likelihood of multiple pregnancy increases the use of hormonal drugs for the purpose of contraception or ovulation stimulation for.

To understand the mechanism of the formation of two or more fetuses in the uterus, it is necessary to recall the mechanism for the development of a normal, singleton, pregnancy.

Behind reproductive function in women, the ovaries respond. Every month, successive hormonal and structural changes occur in them, ensuring the maturation of the egg and the possibility of potential conception. Oocytes develop in special formations - follicles. They are laid in the ovaries initially and when a girl overcomes puberty (puberty), they begin to actively “grow up” and become a source of eggs.

The follicle and the ovum located in it mature symmetrically. If we conditionally divide the menstrual cycle in half, then its first half (phase) will correspond to the period of follicle formation, when it begins to actively increase, accumulate fluid and stimulate the growth of the egg by secreting the hormone estrogen. When the egg is fully mature, that is, becomes capable of fertilization, the follicle breaks down and releases it. This moment is called ovulation.

Ovulation is a kind of border between the end of the first and the beginning of the second phase (half) of the cycle. In the second phase, the corpus luteum is formed from the remnants of the follicle - a small hormonal structure that secretes the hormone progesterone. The yellow body in the absence of pregnancy functions for a short time, collapsing shortly before the onset of menstruation. And if a successful conception has taken place, it continues to synthesize progesterone to maintain pregnancy until the placenta takes over this function.

Both are accompanied by the hormonal production of the pituitary gland: in the first phase, it secretes the hormone FSH, which stimulates the growth of the follicle, and in the second phase, LH, the luteinizing hormone responsible for the proper functioning corpus luteum. By analogy with the names of the pituitary hormones, the first phase of the cycle is called follicular, and the second - luteal.

What happens to the egg when it leaves the ovary? To be fertilized, she needs to unite with the male reproductive cell. After leaving the ovary, the egg travels to the fallopian tube. Spermatozoa, having overcome the cervical and then the uterine cavity, also enter the fallopian tube from the vagina, where fertilization occurs. After the fusion of two germ cells, a zygote is formed, thanks to the wave-like movements of the walls of the fallopian tube, it moves towards the uterine cavity, enters it and implants (introduces) into the endometrium.

In the absence of fertilization within two days, the egg dies.

Typically, during one menstrual cycle only one egg has time to “grow up”, and ends with the birth of one fetus. Multiple pregnancy develops:

- subject to the simultaneous fertilization of two or more eggs, that is, when several full-fledged zygotes are formed. In this situation, children are called fraternal (dizygotic) or twins, they have different set genes, can be of different sexes and not similar to each other;

- if a single egg is fertilized, which then divides (usually in two), and a fetus develops from each divided part, such children are called twins. Monozygotic (identical) twins have an identical set of genes, that is, they are always of the same sex and are very similar in appearance.

More often, fraternal twins are born, and in 99% of multiple pregnancies ends with the birth of two children.

The increased incidence of multiple pregnancies is directly related to the widespread use of IVF methods, when several embryos are “planted” into the uterus in order to increase the chances of success (“at least one will survive”), and as a result, two or even three of them survive.

The course and management of a multiple pregnancy differs from the usual one, as the body experiences an increased load. As a rule, multiple pregnancies end earlier, and require careful monitoring.

Multiple pregnancy ends successful childbirth only on the condition that a large number embryos in the uterus. The most multiple pregnancy with a favorable outcome was limited to ten fetuses, and the most multiple pregnancy with a miscarriage in the final was limited to twelve.

Reasons for multiple pregnancy

Multiple pregnancy, despite the low incidence, is not a deviation from the norm, and all children born do not differ from those during a singleton pregnancy.

As a rule, in most cases it occurs only in one ovary, and in one cycle a single egg has time to fully mature. Two or more fetuses (embryos) develop in the following cases:

- When in both ovaries at the same time, that is, during one ovulatory cycle, two mature follicles appear, and after ovulation, two eggs appear in both fallopian tubes, which can be symmetrically fertilized, and then “descend” into the uterine cavity for further development.

By the same mechanism, multi-egg (two - three - and so on) embryos are formed if two (rarely more) follicles that have matured in one cycle are located in one ovary. Then their symmetrical fertilization occurs in one tube.

- If a single follicle with a single egg matures in the ovary, but subsequently the egg divides, and each of its separated parts begins to develop independently. Embryos with this mechanism of development are identical.

Further development of the fetus in the uterine cavity also depends on the number of eggs from which they were formed. If the source of pregnancy was several eggs from different follicles, each developing embryo has an autonomous "place of development" - its own placenta and fetal (chorial and amniotic) membranes. More than 70% of fraternal twins develop according to this mechanism.

In embryos belonging to a single egg, development depends on the moment when this egg is broken into pieces. If it is divided on the first day after fertilization, then each embryo will have its own placenta and membranes, as in the case of a multizygous pregnancy.

When the division period started on the 3rd - 8th day, each embryo forms its own amniotic membrane ("fetal bladder"), but they have one placenta.

Later (up to 13 days) cleavage of the egg leads to the development of embryos in a single amniotic sac with a single placenta.

It is extremely rare that egg division starts after the 13th day after fertilization, as a result, fused embryos develop.

The opinion found among women that multiple pregnancy is the result of consecutive (multi-time) fertilization of an egg by several spermatozoa is absolutely wrong. After conception, the progesterone influence of the corpus luteum excludes full development other follicles, so fertilization of one egg is possible with only one sperm.

In addition to the genetic predisposition, which significantly increases the likelihood of multiple pregnancy, there are several other factors provoking its development:

- Age. As a rule, multiple pregnancy is more often diagnosed in women over the age of 30. Apparently, the natural age-related decrease in the number of ovulatory cycles after thirty years leads to a kind of deposition of hormones, which, in the case of fertilization, play the role of hyperstimulants.

- With prolonged use of hormonal contraceptives. Their contraceptive effect is based on the ovulation suppression mechanism, so when a woman stops taking them, a withdrawal symptom occurs: according to the feedback mechanism, more ovulation-stimulating hormones are synthesized.

- Due to artificial conception, that is, in vitro ("in vitro") fertilization, or IVF. For a woman who wants to become pregnant, several embryos are introduced into the uterine cavity to achieve the greatest probability. More often, only one of them remains in the uterus, but sometimes two survive and develop, less often - more.

- If there is an incorrectly formed uterus (malformation), namely, its doubling. Only the body of the uterus can be doubled if there is one cervical cavity, then it acquires a bicornuate shape. Doubled uterus, cervix and vagina are also found. If each of the doubled genital structures is developed and functions fully, neither complete nor absolute prevents the development of pregnancy. In the case of twins, the embryos are born symmetrically in each of the uterine cavities.

early signs of multiple pregnancy

Multiple pregnancy at the beginning of development does not have any distinctive clinical manifestations, therefore, it requires additional diagnostic laboratory and instrumental studies. Women in the family repeated cases multiple pregnancy, as a rule, do not exclude the presence of such. Also about the possible simultaneous presence of two developing embryos in the uterus warn those who have successfully survived artificial insemination or hormonal stimulation of ovulation.

Clinically early signs multiple pregnancies are similar to those for singleton pregnancies. The very first of them is the absence of another menstruation. At this stage, most women independently resort to express diagnostic methods, and only when they receive a positive test result do they turn to a specialist.

Express - diagnostics is carried out at home and allows you to state pregnancy with a high (97%) accuracy with a minimum (more than 1 day) menstrual delay. It should be explained that the number of days of menstrual delay does not correlate with the "age" of the embryo. Conception, that is, the fusion of two germ cells into a zygote, occurs in the cavity of the fallopian tube, after which the future embryo must enter and infiltrate (implant) into the endometrium, where pregnancy will begin to develop. It usually takes about 2 weeks for the zygote to complete this. After implantation, the secretion of the "pregnancy hormone" (hCG) - human chorionic gonadotropin - begins. It is necessary for correct formation fetus, its preservation in the uterus, as well as to suppress ovulation in order to prevent another conception. Express methods allow you to determine the presence of hCG in the urine, that is, they cannot establish only the fact of pregnancy, but they cannot determine its duration, as well as the number of embryos. Moreover, positive test will be with ectopic localization of the embryo.

The duration of pregnancy is correlated with the concentration of hCG. Since the moment of ovulation, and, consequently, of conception, is calculated with small errors, then for reliable definition pregnancy, it is necessary to measure the level of chorionic gonadotropin in the blood and compare it with the delay period.

The concentration of hCG during multiple pregnancy is higher. It is conventionally believed that once the hormone is synthesized by the placenta, with twins it doubles, and if the doubled (in comparison with the norm) indicators continue to grow along with the gestational age, the probability of having two fetuses is very high. With triplets (and more fetuses), this logic does not apply.

Higher levels of hCG in multiple pregnancies are a relative diagnostic sign, since each multiple pregnancy is not like the others. In addition, quantitatively hCG increases against the background of IVF, even with a singleton pregnancy.

It is also possible to suspect the presence of a multiple pregnancy in the early stages in the process of palpation of the pregnant uterus, when its size does not correspond to the declared delay period. It is in this situation that additional laboratory definition concentration of hCG in the blood.

Thus, the earliest signs of multiple pregnancy - menstrual delay, uterine enlargement on palpation and a positive express test - confirm the presence of the pregnancy itself, but do not specify the number of developing embryos.

The most reliable method is considered to be ultrasound scanning, which is already on early dates(from 5 weeks) "sees" multiple pregnancy. Further management of multiple pregnancies depends on the number of embryos and placentas visualized in the uterine cavity, as well as on their rate of development, so ultrasound monitoring is carried out more often.

The course of multiple pregnancy

Since the bearing of several fetuses at the same time, nevertheless, is not a common situation, it is logical to assume that the uterus, like the entire body of a pregnant woman as a whole, is more adapted to a singleton pregnancy. Therefore, the bearing of two or more fetuses is always accompanied by a greater load and requires the implementation of all the physiological reserves of the mother's body.

The course of multiple pregnancy has several significant features that distinguish it from pregnancy with one fetus, these include:

- Significant increase in circulating blood volume (CBV). As a rule, the presence of another "living organism" in the body of a pregnant woman requires more nutrients and vitamins, which are delivered to the tissues with blood. The volume of circulating blood in a singleton pregnancy increases by 40%, and in a multiple pregnancy - by 50% - 60%, which in turn provokes the appearance of edema and increases blood pressure.

- Anemia. In fact, it can be compared with physiological state, provoked by the increased BCC. Since the volume of circulating blood is replenished by plasma, iron stores and hemoglobin levels, respectively, are not replenished, which means they decrease.

Due to iron deficiency, every second pregnant twin is diagnosed, and if there are more than two fetuses in the uterus, its frequency increases by 100%.

- Gestosis (toxicosis). It is diagnosed in 45% of pregnant women. It is formed much earlier than in a singleton pregnancy, it is more pronounced. This is due to an increase in placental mass (hyperplacental disease).

- Exacerbation of the existing extragenital pathology. Occurs in all women bearing more than one fetus against the background of a significant load on the cardiovascular, respiratory, excretory and other systems. In this case, the observation of the pregnant woman is carried out jointly with related specialists.

- Increased load on adjacent organs. Significantly enlarged uterus presses and displaces adjacent organs (liver, kidneys, diaphragm, bladder, intestines), which cannot work in the previous mode.

- Reducing the duration of pregnancy. There is a direct relationship between the number of developing embryos and the time of onset of labor. In a normal, singleton pregnancy, the signal for the onset of labor is an increase in the size of the uterus to certain, perceived by the body as final, values. When carrying several fetuses, the uterus reaches these sizes much earlier, therefore, labor is induced ahead of time.

With twins, pregnancy often ends at the 37th week (260 days), with triplets - at the 35th (247 days).

— Unequal development of all fruits. The more embryos present in the uterus, the more difficult it is for the body to maintain their symmetrical development. Therefore, one (with twins) or more (with triples or more) fetuses may develop with a lag. This does not mean at all that multiple pregnancy always ends with the birth of only one fully developed child, because differences in development rates can be expressed in different ways. As a rule, most births after twins are completed successfully, but even with a favorable course of pregnancy, the risk of a delay in the development of one of the fetuses remains tenfold increased.

Due to the above reasons, multiple pregnancy significantly worsens a woman's well-being: she often feels pelvic pain, fatigue, shortness of breath, heartburn, defecation disorders (constipation) and urination, which becomes frequent.

It should be noted that multiple pregnancy, although less common than singleton, is not a pathology. Therefore, all accompanying her unpleasant symptoms provoked not by pathology, but by a greater load on the body. With proper management of pregnancy by specialists and strict observance of all recommendations by the expectant mother, multiple pregnancy proceeds calmly and ends with the safe birth of healthy children.

Features of multiple pregnancy

Each multiple pregnancy is unique in its own way, therefore, it always requires an individual plan for monitoring and subsequent births.

It is more convenient to consider the features of the formation of multiple pregnancy on the example of twins. As already mentioned, two embryos can develop from a single fetal egg or from two at once. However, the features of the development of twins do not end there.

With dizygotic twins, each fertilized egg becomes a source of placental formation, and each of the growing fetuses eventually turns out to be isolated from the other by its own fetal (amniotic) and chorionic membranes. Thus, the partition between two fruits consists of four layers. According to such anatomical features, bizygous twins are called biamniotic bichorial. The frequency of such twins (among others) approaches 70%.

If twins develop from a single zygote, the further development of the embryos is ambiguous and is directly related to the timing of the start of division of the fertilized egg.

The unicellular stage of embryo development (zygote) lasts no longer than 30 hours. Then the zygote begins to split up, that is, to divide into cells, and their number in the end is always a multiple - two, four, eight, and so on. The higher the number of cells, the more sizes at the embryo. Such fragmentation does not always begin at the same time.

When the division of a single egg starts in the first three days after conception, the further development of a twin pregnancy is similar to that of twins: two amnions are formed, two placentas, and the fetuses are separated by a four-layer septum. Therefore, twins formed in this way are also called bichorial biamniotic.

Sometimes the egg can begin to split in the interval of 3-8 days. In twins, a common placenta is formed at this time, but different amniotic membranes, and the septum between them has only two layers - monochorionic biamniotic twins.

The development of twins of the monochorionic monoamniotic type is quite rare. When the zygote is crushed in the late (8th - 13th day) period, two embryos have not only common placenta, but also one amniotic sac for two, and there is no partition between them.

It is considered unfavorable to start crushing the egg at a later date, that is, after 13 days. In this situation, both embryos grow together.

Ultrasound scanning allows you to study the anatomical features of multiple pregnancy already in the first trimester. Its course and outcome is determined not by zygosity, but by the number of placentas (choriality). The most unfavorable structural option is monochorionic multiple pregnancy, that is, identical twins.

IN later dates the presence of two or more fetuses is diagnosed during a routine obstetric examination, that is, with external palpation, which determines the presence of several heads and small parts (limbs). In this case, the peculiarity of the location of each child is also more often determined.

The auscultatory method also helps to establish the reliability of a multiple pregnancy, which allows you to listen to the heart sounds of the fetuses in different parts of the uterus. At earlier times, this requires special equipment, and at later times, the doctor listens to the beating of several hearts with a regular stethoscope.

The overall weight gain of pregnant women with multiple pregnancies should be higher than in singleton pregnancies. An increase of 20 or 22 kg is considered optimal. Such an increase in weight, of course, is accompanied by an increased load on the body, because the heart, blood vessels, kidneys and other organs and systems work at the limit of their capabilities.

Multiple pregnancy requires enhanced nutrition. With multiple pregnancy, each of the developing fetuses needs the required amount of calories, oxygen, nutrients and vitamins. The expectant mother herself also needs them. To compensate for these needs, a properly adjusted diet is necessary.

Another feature of multiple pregnancy is considered to be provoked by the depletion of iron stores. If anemia is classified as a negative symptom in a singleton pregnancy, in multiple pregnancy it is considered physiological, but it is always compensated with medication.

For obvious reasons, the observation of a multiple pregnancy is different from that of a single fetus in the uterus. Patients require more careful monitoring, so they should visit the doctor more often. The frequency of monthly visits to the antenatal clinic, as a rule, is determined individually. In addition to the gynecologist, a therapist observes a multiple pregnancy, and in the presence of an extragenital chronic pathology other specialists join the observation.

Pregnant women with multiple pregnancies require restriction physical activity, as well as increasing the amount of time for sleep, including during the day.

Unfortunately, many pregnant women (including those with one fetus) incorrectly correlate their well-being with the course of pregnancy and therefore do not always adequately respond to the recommendations of specialists. Meanwhile, sometimes the unfavorable condition of the fetus in a satisfactory condition of the mother can only be judged by the results of additional studies. In multiple pregnancies, it is especially important to comply with all recommended measures, including agreeing to preventive hospitalizations in a day hospital or pregnancy pathology department.

Childbirth with multiple pregnancy

With adequate tactics for monitoring multiple pregnancies, it proceeds with minimal negative symptoms. However, even the most successful multiple pregnancy before its completion requires prior hospitalization in a maternity hospital. A number of necessary diagnostic measures are carried out in the hospital in order to assess the likelihood of complications and determine the method of delivery.

To elect the right tactics reference upcoming birth, the specialist needs:

- Know the number of fetuses in the uterus and their estimated weight. The uterine muscles are not always able to “push out” more than two fetuses, so operative delivery is often chosen.

Having two large fruits is also sometimes a reason for operative childbirth.

— Assess the equivalence of their development. Unfortunately, sometimes embryos develop asymmetrically, and by the time of birth, not all have the proper level of development. Pronounced signs underdevelopment (hypotrophy) of one or more of the fetuses on the eve of childbirth may mean their non-viability. Sometimes, after birth, a fetus with signs of malnutrition is “nursed” in special conditions until it reaches the required level of development.

- Determine what type of multiple pregnancy it belongs to this pregnancy, that is, set the number of placentas, fetal bladders, and so on.

- Determine the position of each fetus (head, gluteal). Favorable in terms of natural childbirth symmetrical presentation of fetuses is considered. If the first fetus is in the head, and the next one is in the breech presentation, childbirth proceeds safely in a natural way. After the birth of the first baby, the second baby is “turned” under ultrasound control so that it also fits correctly.

The transverse position of one of the fetuses is an absolute reason for operative delivery.

- Assess the individual psychophysical characteristics of the pregnant woman. "Fragile", not distinguished by good physical endurance, women are not always capable of the natural birth of several children at once.

Sometimes multiple pregnancy scares pregnant women, they obviously assume difficult childbirth, they are afraid of them and prefer the surgical route. If the doctor fails to rid the pregnant woman of such fears and set her up correctly, the question of the method of delivery is decided individually.

- Get information from antenatal clinic(it is reflected in the dispensary card) about the course of pregnancy and ongoing medical correction. Severe anemia, high blood pressure, signs of impaired kidney function during the gestation of several fetuses increase the risk of complications in childbirth.

The process of giving birth to several fetuses through the natural birth canal is associated with an increased load on the uterine muscles, therefore, in childbirth, in the event of a weakening of labor activity, the uterus is “helped” with medication.

Adequate pain relief and prevention of bleeding are important steps in the management of natural childbirth in multiple pregnancies.

Operative planned childbirth is resorted to in several cases, namely:

- the presence in the uterine cavity of more than two fetuses;

— transverse arrangement one of the fruits and the pelvic - the very first;

- polyhydramnios;

- a complex form of preeclampsia (stable high blood pressure, high concentration of protein in the urine);

- large fruits;

- the so-called conflict of fruits, when they literally cling to each other's heads;

- hypoxia of one or all fetuses;

The second multiple pregnancy is also more often resolved surgically.

Multiple pregnancy, unfortunately, does not always please the expectant mother. At the urgent request of the woman herself, in the early stages, one of the fetuses can be removed by reduction (aspiration), thus transforming the pregnancy into a singleton. Reduction is also resorted to after artificial insemination. During IVF, several embryos are implanted into the uterus to increase the chance of at least one “taking root”. Sometimes in the end all or a few remain viable, so multiple pregnancy appears.

Complications in multiple pregnancy

Complications of multiple pregnancy can be classified as arising during the development of embryos / fetuses (congenital), and during their birth. Moreover, not all of them are specific, that is, characteristic only for multiple pregnancies.

Specific complications of multiple pregnancy are:

- Fusion of fruits. Such an anatomical defect is possible in the presence of a common cavity without a septum in which embryos develop. The adhesions can be in different departments, starting from the head and ending with the sacral zone. Up to 31% of conjoined twins die already at birth, 34% - in the first day of life. The survival rate of children with such a defect is determined primarily by the type of fusion and the presence of other anomalies.

- Fetofetal transfusion syndrome. If the twins have a common placenta (monochorial), then each of the fetuses communicates with it with individual blood vessels. When development is disturbed, connections (anastomoses) occur between the fruiting vessels of twins, and blood from one fetus begins to be dumped to another. Thus, one of the fetuses becomes a donor and experiences a serious nutritional deficiency and, as a result, may develop incorrectly, and more often (60-100%) die in utero. The recipient fetus may also have developmental abnormalities.

- Intrauterine death of one (with twins) or several fetuses.

- Syndrome of reverse arterial perfusion. It is also inherent in monochorionic twins, when one of the twins does not have a heart, and often a head, and is supplied with blood from a healthy fetus. As a result, both children live at the expense of a single heart, and this provokes polyhydramnios, premature death (41%).

- Asymmetric fruit development. A slight delay in the development of one of the twins is not considered as a complication, but if the delay in maturation is significant, the underdeveloped fetus may die in utero.

- Premature (long before birth) death of one fetus. If it happened early (1st trimester), then the probability of death of another fetus also increases (24%). In later terms, the dead twin becomes a source of intoxication for the living.

These complications, of course, can scare the expectant mother. However, it should be recalled that they are becoming less common, as modern diagnostic techniques allow timely detection of any trouble and take adequate preventive measures.

The generally accepted cause of multiple pregnancy is heredity, especially on the mother's side. This means that twins are more common in families where the mother or father or both parents have twin siblings. The probability of a repetition of twins increases through the generation, that is, if a grandmother gave birth to twins at one time, the granddaughter can follow the same path.

Often multiple pregnancy occurs in women who were prescribed hormonal agents for the treatment of infertility or in preparation for artificial insemination. The fact is that these drugs stimulate the release of an egg in the middle of the cycle, and if the dose of the drug is too large for a woman, not one, but several eggs come out of the ovarian follicle at once. In addition, the birth of twins and triplets depends on the age of the expectant mother: the probability is higher if she is over 35 years old. Over time, the release of an egg (ovulation) in a woman does not occur in every cycle - this is normal. As a result, unrealized hormones that affect ovulation accumulate and are released during the next cycle, stimulating the release of several eggs.

Where do twins and twins come from?

A multiple pregnancy occurs when spermatozoa fertilize several eggs, in which case we are talking about fraternal twins (if 2 eggs are fertilized) or, if two embryos develop in a fertilized egg, we talk about identical twins. Twins are more common than other types of multiple pregnancy, and twins are 2 times more common. A boy and a girl, two boys or two girls are born. These kids can always be distinguished as sisters and brothers. Each of them has its own placenta, from which comes its own chorionic membrane (up to 16 weeks, the chorion is called the placenta), and the amniotic membrane, inside which are the amniotic fluid and the baby.

Twins (identical twins) develop from one fertilized egg, which then divides in a special way. They are always of the same sex, have the same blood type and Rh factor, the same hair and eye color. These children are so similar that even parents cannot always tell them apart.

Identical twins always have a common placenta and, therefore, a common chorionic membrane. As for the amniotic membrane, it can be different for everyone or common. In the latter case, nothing separates the babies, they swim in the amniotic fluid together. If each of them does not have its own shell, then during movement through the birth canal they can “catch” on each other. In this case, doctors will offer the expectant mother to have a caesarean section before the onset of labor.

How is the pregnancy going?

During pregnancy with twins, triplets, the load on the body of the expectant mother increases several times, depending on how many babies she carries. Unfortunately, this means that complications during such a pregnancy are more common.

The most typical of these is anemia, when hemoglobin levels in a woman's blood decrease.

Every third woman has a threat of termination of pregnancy: due to the fact that there is not one, but several babies in the uterus, its walls are overstretched. Growing babies, their placentas with membranes and amniotic fluid, with their greater weight than during normal pregnancy, press on the isthmus of the uterus. Then the cervix opens, and there is a threat of premature birth.

For women expecting the appearance of twins, triplets, the regimen is especially important. As the term of childbirth approaches, the expectant mother needs to lie more (preferably on her side so that the heavy uterus does not squeeze the inferior vena cava), rest three times for 1-2 hours during the day. However, when planning a day, do not forget that outdoor walks are very useful for both mom and kids. It is worth remembering about the bandage supporting the uterus from below - it will be easier for you to walk.

If the expectant mother begins to worry about pain in the lower abdomen and lower back, tension in the uterus, you should not stay at home. It is wiser to contact the maternity hospital as soon as possible, only there it will be possible to stop the onset of premature birth in order to allow the babies to grow up.

Gestosis ( late toxicosis pregnancy). Signs of this complication are swelling in the legs, then on the hands and face, the appearance of protein in the urine and increased blood pressure. It is worth treating preeclampsia only in the hospital, therefore, when the first anxiety symptoms expectant mother needs to see a doctor.

Twins and triplets often lag behind in physical development, this happens in almost half of the cases. In this situation, you need to go to the maternity hospital, where the babies will be “fed” and examined.

How does childbirth develop?

It has been proven that with multiple pregnancies, the “aging” of the placenta occurs earlier, and, apparently, then the babies tend to be born into the world. By this time they are ready to independent living, their organs are quite developed, although these babies are about 2 weeks behind in weight and length.

In most cases, twins, twins and triplets are born ahead of the time set by nature - at the 34-37th week of pregnancy.

If the twin pregnancy is proceeding normally, the expectant mother will be offered to come to the maternity hospital for a period of 36-37 weeks of pregnancy. By this time, with the help of an ultrasound study, the doctor will determine the degree of "aging" of the placenta. Most births occur prematurely at 34 to 37 weeks or even earlier. By this point, the babies in the womb can take different positions: lengthwise (vertically) heads down, lengthwise buttocks down, lengthwise, but one lies head down, and the second buttocks, or vice versa. It happens that one child lies longitudinally, and the second transversely (horizontally) or vice versa, or both babies are located transversely. More often (in 90% of cases), both babies lie longitudinally, and in almost half of the cases, both heads down are the most favorable option.

In some cases, specialists decide to perform a caesarean section. This happens if:

In a woman who becomes a mother for the first time, the baby has taken a pelvic position;

The first child of twins or both babies lie transversely;

Triplets, quadruplets, and so on are expected.

The birth of babies through the natural birth canal requires attention from doctors. Due to the fact that the uterus is overstretched, childbirth usually proceeds slowly, water is poured out earlier than expected, generic activity may weaken, and the expectant mother may get tired.

The first to pave the way is the baby whose presenting part, head or ass, is lower by the beginning of childbirth. It is on him that the greatest load falls. After the birth and separation from the mother of the first baby, the doctor determines the position of the second, listens to his heartbeat. During this time, the uterus contracts and wraps around the second child. Then the doctor conducts a vaginal examination, opens the bubble of the second child (by the way, the woman does not feel this), and the birth process is left to its natural course.

Multiple pregnancy is a condition in which a woman's body develops more than one fetus at the same time. There is also a separate classification according to the number of fruits. For example, if two babies grow up, then they talk about pregnancy with twins, if three - then triplets.

twins childbirth process
in ultrasonic fluid
what does the snapshot look like
features in the position that should happen

This unusual feature is observed quite rarely, and today multiple pregnancy occurs in 1% of expectant mothers. This value varies depending on the specific country, but does not exceed one and a half percent of the total number of expectant mothers.

Varieties of this feature

Consider curious classification multiple pregnancy on the example of twins.

According to the mechanism of appearance, they distinguish:

dizygotic, or "dual";
monozygotic, or "identical".

Fraternal twins are commonly referred to as fraternal twins, while identical twins are referred to as twins.

It is curious that it is prolific, but interesting pregnancy observed less and less, as the number of children simultaneously growing inside the mother increases. So, among all such pregnancies, the value of 70% of the total number was assigned to twins. At the same time, the gender of the twins is always the same, and in appearance there is an obvious similarity. This similarity is explained by the absolutely identical set of genes in two babies.

healthy twins

Unlike twins, twins are often of different sexes, and their similarities are not so noticeable and remain at the level of ordinary blood relatives. The explanation for this is a set of genes that for this case different.

A multiple pregnancy with fraternal twins occurs as a result of the simultaneous fertilization of two mother's eggs at once. At the same time, curiously, the second egg can be fertilized later than the first, and this period can be up to one week.

From a physiological point of view, the signs of such a multiple pregnancy in the case of fraternal twins include the presence of a separate placenta and fetal bladder in each fetus. If we talk about identical twins, everything is a little more complicated, and two fetuses meet both in the same fetal bladder and in different ones.

Self-feeding

How many fruits can be at a time

The most multiple mass pregnancy is observed in our country and abroad:

the world's most prolific big pregnancy to date, of those that have been recorded, is the tithe of a Brazilian woman who gave birth to ten babies in 1946. However, the birth was unsuccessful, and 8 girls, as well as 2 boys, died before reaching the age of one;
also, according to unconfirmed reports, the birth of tens was observed in China a little earlier - in 1926;
For Russia maximum number simultaneously growing fruits is also limited to ten. A happy mother from Kursk was able to repeat the records set by other countries.

Such a large number of fruits is a rather rare phenomenon, and not entirely safe for children, since the resources of the female body are not enough for the normal bearing of a large number of fruits at the same time.

According to current data, during pregnancy with more than six fetuses at the same time, some children develop developmental retardation, which continues to exist after birth.

Reasons for the interesting situation

The causes of multiple pregnancy may be the following.

by the most exact way detection of multiple gestation is a conventional ultrasound, which gives data close to 100% in reliability, because an ultrasound is a kind of photograph in which a multiple pregnancy that has arisen is visible to the naked eye.
HCG in a multiple pregnancy is another way to detect the development of multiple fetuses at the same time. The data of venous blood are taken as a basis, however, the accuracy of this method is significantly inferior to ultrasound.

Yes, ultrasound can give a 100% result, but then where do other ways to detect this unusual phenomenon come from? The answer is simple - the doctors of the past also tried to the best of their ability to predict the number of fetuses in the expectant mother, and succeeded a little here.

The signs of a multiple pregnancy are:

an enlarged uterus, which is unusual for one baby;
low position of the head or pelvis of the fetus;
too big belly;
the concentration of hCG during a multiple pregnancy is twice the norm;
listening to two heartbeats instead of one, if you listen to the tummy;
severe toxicosis;
fast fatiguability;
high blood pressure.

Also, the signs of multiple pregnancy may not be single, and be a combination of several features from the list at once.

Happy expectant mother

Staged development of the fetus

As already mentioned, such gestation is a rare phenomenon, therefore it may proceed a little differently than the classic " interesting position". Multiple pregnancy by weeks of fetal development is as follows:

1-4 weeks;

The most inconspicuous period, which is no different; differs from ordinary gestation and is characterized by delays. Much more interesting processes, which are now flowing inside the young mother, which we familiarized ourselves with earlier.

5 week;

It is also not much different from carrying one baby. The only thing worth mentioning is that the process of formation of two placentas is accompanied by more vigorous activity organism, and signs of multiple pregnancy can be observed on the test for determining this position, which will have brighter stripes. This sign is rather subjective, and it is not suitable as a sure way to determine the number of fruits.

6 week;

With twins, there is a significant likelihood of early manifestation of toxicosis, which usually does not bother expectant mothers this week. In addition, the intensity this disease in the case of twins, it will be stronger, but again, for a future mother who is carrying her first child, it is impossible to determine twins in this way.

7 week;

Additional features are not observed, and pregnancy proceeds in the already familiar rhythm.

8 week;

When examined by a gynecologist, it will be noticeable accelerated growth of the uterus, which will be a wake-up call for an ultrasound check - how many children do you actually have, if this has not happened before, of course. Toxicosis is now especially strong, and for expectant mothers of twins it can last an unnaturally long time, up to 16 weeks, which is not typical for the usual situation.

9-10 weeks;

The size of the uterus is increased to the size of a 14-week-old, subject to one baby, and this becomes the reason for diagnosing at least twins, without even resorting to ultrasound.

11 week;

It proceeds without any surprises associated with multiple gestation.

12 week;

There are no additional symptoms of multiple pregnancy, and almost always at this stage, the presence of twins or triplets is successfully established. Often, at this point, more than one ultrasound has already been performed, and you have even managed to admire this little miracle.

13 week;

There may be pain, but they are in no way connected with the proximity of childbirth, since there is no pressure in the lower abdomen. Most often, discomfort appears in the so-called iliac region.

14 week;

The abdomen is enlarged - now it is approximately 3 centimeters larger than with a singleton pregnancy.

15 - 20 weeks;

An increase in the tummy continues to be observed, a high hCG level. Walking becomes difficult, pain in the back and lower back is possible. A dark line may form on the tummy, which will disappear after childbirth and should be looked after to prevent wrinkling.

21 - 25 weeks;

It is worth listening to your condition, and consult a doctor if:

I have a stomachache;
the temperature rises;
discharge from the genital tract appears;
swelling or headaches occur.

All this will help protect the twins from possible complications associated with the multiple occurrence of an “interesting position”.

26 - 30 weeks;

Shortness of breath appears, since the size of the uterus does not allow the lungs to sufficiently expand. After the thirtieth week, usually the babies are no longer in danger, and you can completely calm down.

31-36 weeks.

Possible discomfort in the region of the ribs associated with an impressive tummy. It's time to switch to constant monitoring by a doctor, and everything will end with the birth of the long-awaited twins.

Proper maternity leave

The good news for young mothers expecting twins will be the opportunity to go on maternity leave with multiple pregnancies earlier than usual - already at 28 weeks, while the rest go on vacation only at 30.

Miraculous twins

During childbirth, it often happens that everything goes naturally, without any special complications. This happens if the fruits are located longitudinally. However, unfortunately, cases of complications during childbirth are not uncommon, the fault of which is precisely the presence of more than one fetus. For these reasons, hospitalization of expectant mothers of two or more children begins before the due date, three to four weeks, and not at the time of birth, as is usually the case.

This period of time is used by doctors to decide whether a natural birth is possible, or whether a caesarean section will have to be done. At the same time, if any of the fetuses is located transversely, a planned caesarean section will be performed with 100% probability. In the event that there is no reason for this, labor can begin naturally, but doctors are usually ready for an emergency caesarean at any time.

Multiple pregnancy creates increased stress on the body of a pregnant woman. Therefore, these patients require special supervision and attention to the development of babies and the well-being of the expectant mother.

Kinds

Polyzygous multiple pregnancy(dual, not identical) occurs as a result of ovulation and the fertilization of several eggs.

In this case, the fruits have about half of the common genetic traits, but differ in the set of chromosomes. They look like ordinary brothers or sisters.

By the way, the processes of ovulation and fertilization occur in different ways:

simultaneous fertilization- happens with ovulation of several eggs from both or one ovary;
one-time fertilization- happens when a pair of eggs ovulate in one follicle;
fertilization of multiple eggs that matured in one cycle, semen from different males;
egg conception with an existing pregnancy.

Polyzygous twins develop in separate watery, hairy membranes and their own placentas.

Monozygotic multiple pregnancy occurs against the background of the splitting of a fertilized egg or during the conception of a multinucleated egg.

As a result two or more identical, same-sex, genetically identical fetuses are formed. Such children are born with the same facial features, get sick at the same time, have similar learning abilities.

By the way, the psychology of identical twins is considered a very interesting phenomenon. Scientists have proven that they have a connection on an emotional level.

Another classification of this type:

if a fertilized cell divides into two within three days after conception, then each fetus will have its own placenta and amniotic fluid;
if embryonic splitting occurred from 4 to 8 days after conception, then the embryos will develop in general children's place, with a common chorionic membrane, but with separate amniotic cavities;
due to embryonic separation on days 9-12, amniotic, chorionic cavities and placenta are formed;
later division of the fetal egg is extremely rare and leads to the formation of fused embryos.

Both twins and triplets are polyzygous and monozygotic. The latter may have a single fruit and an identical pair. More fruits expands the number of variations. For example, a quadruple may consist of non-identical or vice versa all identical fetuses, one triplet and a single fetus, or two twins.

Possible reasons

Unfortunately, there is still no exact explanation for why multiple pregnancy occurs. It is assumed that during the formation of monozygotic twins, the splitting of the fertilized cell occurs due to a lack of oxygen in the blood of the pregnant woman, a violation of the acidity or toxicity of the environment.

Also plays an important role genetic predisposition to multiple egg maturation. Multiple conception can also be affected by the stimulation of superovulation by certain medicines, which improve the production of several follicles in the ovaries or affect the maturation of 2 or more eggs in one follicle.

The cause of multiple pregnancy can be ethnicity. Indeed, in different ethnic groups, the frequency of the birth of fraternal twins is significantly different. Most high performance similar fertility recorded in African countries and the lowest in Asia. In America and Europe, these figures are average. And monozygotic twins in the world are born with the same frequency - 3.5 out of 1000.

Cases have been recorded when several children grew in the womb at the same time as a result of an anomaly in the development of the structure of the uterus (shape), with and after prolonged use oral contraceptives(more than half a year).

The probability of having twins also increases if it occurs after 35 years.

Main features

Having learned about pregnancy, it is difficult to resist and not ask who is in the stomach. But besides gender, some parents are primarily interested in the number of children that develop in the womb.

There are a few ways to find out if you have multiple pregnancies.

One of the earliest signs of a multiple pregnancy is bold and distinct second line on the test to determine pregnancy.

This sign was established thanks to a special survey conducted among mothers of twins. Since multiple pregnancy greatly increases the level of the HcG hormone, it can be determined already for a period of 10 days.

Heredity- if in your family or among the relatives of the future dad there have already been cases of multiple pregnancy, then the likelihood that you will continue such family tradition, increases exponentially.

The presence of several children in the womb is most often first reported to a pregnant gynecologist. Even at the first examination, at an early stage, the doctor can calculate approximate date conception and note the excess size of the uterus.

A longitudinal depression on the anterior wall of the uterus may indicate the development of a multiple pregnancy. It is formed as a result of the adjacent fruits to each other.

Horizontal furrow- Occurs on the anterior wall of the uterus transverse position fruits.

Deepening of the uterine fundus- associated with protrusion of the corners of the uterus by several fetuses.

Obstetric examination by palpation determines 3-4 large parts of the fetus (2 heads and 2 pelvic ends).

Sensation of fetal movement different places and simultaneous probing of body parts of the crumbs in various parts of the abdomen.

Listening to a distinct heartbeat in different places of the uterus. If a zone is found where heart tones are not heard or they have an unequal frequency, then this is a confirmation of the fact of multiple pregnancy.

Phonoelectrocardiography- carried out from the 20th week of pregnancy to register the heart sounds of children and determine the presence of two or more fetuses.

Abnormal AFP test result, which is done in the 2nd trimester to identify abnormalities in the development of the baby.

External signs: severe toxicosis, vomiting,