Twins development week by week. Stage-by-stage development of the fetus. My observations on the development of twins and twins after birth

Maria Sokolova

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Multiple births are always a serious stress for the expectant mother and a difficult course of pregnancy and childbirth. refers to the state high risk, and its worsening occurs due to the development of two embryos at once. Of course, expecting twins is always happiness for parents, but to the expectant mother It wouldn’t hurt to know about the features of such “double happiness” for nine months.

At the very beginning of pregnancy, it is very important that both the expectant mother and her obstetrician-gynecologist choose special pregnancy management tactics and a special regimen for the expectant mother.

Pregnancy with twins - 10 features

Seven weeks is the most dangerous period for mother and babies. It is at this time that twins are at maximum risk - there is a risk of developing pathologies and miscarriages. It is worth noting that a frozen pregnancy established during diagnosis does not necessarily mean the death of both embryos. Pregnancy with twins, which occurs with complications, requires careful attention to the condition until 12 weeks, when the risk of danger decreases, and the path of intensive development and growth begins for the babies.
During pregnancy with twins, it occurs more often than during normal pregnancy. abnormal presentation and position of the baby in the womb(transverse position, breech presentation etc.), which ultimately leads to such a choice of method of childbirth as C-section.
As for the timing of birth - it is usually during pregnancy with twins start earlier, at 36-37 weeks. The limits of stretching of the uterus are not limitless, so babies are born prematurely. But, as a rule, after the 35th week, twins no longer require medical support, because children are born already mature.
Another feature is earlier lung maturation in twins, which allows them to breathe independently when premature birth. Moreover, fraternal twins adapt better.
Triple test on the list, involves research for the presence of anomalies and defects in development and should not confuse a pregnant woman. His deviations from the norm, increased AFP and HCG is natural during twin pregnancy. Elevated hCG explained by the presence of two placentas or one, but much larger in size, and on top of everything else, also providing for both babies at once. You should only worry if your hCG level is low.
It is not uncommon for such a feature during pregnancy with twins as polyhydramnios in one of the two fetuses. If there is a connecting shunt (vessel) between the placentas, it is possible for blood to be dumped into large quantities one of the fruits. Which, in turn, leads to more frequent urination and growth of the child. This ultimately creates a difference in weight between babies, which should not be a cause for concern, because the second child will have time to gain weight after birth.
Location of babies in the uterus — key factor for the nature of the pregnancy. As a rule, closer to birth, both children are already in longitudinal position. In 50 percent of all cases - head down, "jack" - in 44 percent, breech presentation - in six percent of cases (they are precisely the most difficult for the birth process).
In half of all cases, the birth of two babies begins with premature rupture of water with remaining immaturity of the cervix. The situation is often aggravated by weak labor and excessive tension of the uterus. Taking this fact into account, the expectant mother should receive special medications to improve labor activity.
The period of pushing is also protracted at the birth of twins. Therefore, when natural way During childbirth, all risks should be taken into account in order to avoid fetal hypoxia and infection of mother and babies. To do this, labor is stimulated before the birth of the second baby, and after the birth of the first, both his and the mother’s umbilical cord are tied so that the second baby does not experience oxygen deficiency and nutrients. Prevention is also carried out early detachment placenta to prevent bleeding.
With a baby weighing less than 1800 g there is a risk of birth trauma during natural childbirth. To avoid such risks, it is prescribed C-section.

According to statistics, every 80th expectant mother is told that she is pregnant with twins. This means that two babies are developing in the womb at once, and such a pregnancy is called multiple.

Carrying out pregnancy with twins - not an easy task for a woman, since the load on her body increases significantly. increases the risk of developing health problems for the expectant mother, increases the likelihood of complications such as,. This is why this condition requires increased attention by medical personnel.

Early diagnosis of pregnancy with two fetuses, or twins, is crucial for its further course. Usually a woman does not notice any special signs of pregnancy with twins. early stages. Most often, the situation becomes clearer during.

Only in some cases did women note the following: signs of twin pregnancy:

pronounced heightened sense of smell, persistent aversion to any odors;
noticeable enlargement of the mammary glands;
pigmentation on the chest and face.

IN antenatal clinic, during the initial examination, the doctor can determine a twin pregnancy by the volume of the uterus, which does not correspond to the expected gestational age, and during the next examination - by how quickly it is growing. His assumptions can be confirmed by an analysis that will show values that do not correspond to the current week of pregnancy. That's what it is true signs twin pregnancies in the early stages.

An ultrasound performed in the early stages does not always confirm a twin pregnancy, since during examination one fetus may well hide behind the other and go unnoticed. This method will be informative from the 8th week of gestation, when two will be heard.

Starting from the 20th week, you can determine the symptoms of twin pregnancy not only with the help of an ultrasound, they will be as follows:

palpation of the abdomen can identify four large parts of the fetus - two heads and buttocks different parts uterus;
the height of the uterus and its volume are much greater than those characteristic of a singleton pregnancy;
the woman feels the movements of two fetuses;
When auscultating the abdomen, the doctor hears two heartbeats.

A twin pregnancy test can also indicate that two or more embryos are developing in the uterus. In this case, the second line on the test, indicating pregnancy, will be brighter and clearer.

Main hazards

Multiple pregnancies always carry a high risk of complications for both the mother and the developing fetus.

The most common problems are::

irregular fruit;
increased fatigue, weakness, shortness of breath;
developmental abnormalities of one or both fetuses.

Behavior of the expectant mother

A prerequisite for normal operation multiple pregnancy is a daily routine in which most of the free time will be devoted to rest. Your doctor may advise you to follow bed rest if symptoms of twin pregnancy include increased fatigue and drowsiness.

This rarely happens. More often repeat pregnancy twins are observed as a result of the second successful IVF. In any case, the woman is placed under strict control in the antenatal clinic. From the second trimester, she is recommended to be hospitalized in a hospital in order to monitor how the twin pregnancy progresses week by week.

Pregnancy Calendar

What will the development of twins be like over the weeks of pregnancy? Let's take a closer look.

1-10 week

Signs of twins in the early stages of pregnancy coincide with a singleton pregnancy, but toxicosis appears earlier. By 8 weeks, both fetuses have grown to 3 cm, so they can be seen using ultrasound. After 8 weeks embryonic development ends, by the 10th week the hearts are formed. The weight of each fruit is approximately 5 g.

10-20 week

Pregnancy with twins from 10 to 20 weeks is characterized by the rapid growth of both fetuses, while the uterus rapidly increases in size, and the woman already needs special clothes for expectant mothers. From the 16th week of pregnancy with twins, you can distinguish the sex of the children by ultrasound and calculate the approximate body weight and weight.

The placenta remains the metabolic organ, but fetuses already have rudimentary organs of the digestive and excretory system: they are able to swallow amniotic fluid and remove breakdown products through bladder. A woman can feel the movement of twins during pregnancy from the 16th week, the length of the fetal bodies by this period is at least 17 cm, and the weight is 200 g.

20-30 week

Features of twin pregnancy from week 20 are also characterized by rapid growth of the uterus and accelerated metabolism. The babies begin to move more intensely, causing the expectant mother a lot of inconvenience. The twin pregnancy calendar suggests that by week 25 the growth of the fetus increases to 30 cm, and the weight increases to 700 g. Outwardly, the babies already resemble newborns.

Signs of pregnancy with two fetuses or twins according to the gestational calculator are expressed in the form of increased urination, severe symptoms, and increased fatigue. By 28 weeks, babies become viable; if they are delivered prematurely, they have a high chance of survival. By week 30, the weight of one fetus is about 1000 g, height - 35 cm.

They say that if a woman is pregnant with twins, it is a double blessing from God. Why does it happen that two babies are born at once? Scientists have long explained the essence of this phenomenon. More from school curriculum We know that conception occurs through the fusion of the father's sperm and the mother's egg. As a result, one child is born. Twins are born due to the maturation of two eggs that must be fertilized. Science also knows cases when, at an early stage of its fragmentation, a fertilized egg is divided into two separate organisms with the same genetic material. In this case, identical twins are born. It is difficult to distinguish them, as they are similar to each other, like two peas in a pod.

Twin pregnancy: heredity

Those families who already have twins in their family do not exclude the possibility of having them. This is the most significant factor that increases the chances of multiple pregnancy. This predisposition is mainly traced to female line, although according to male line is also not excluded. The birth of two children at once is more common in those families where mom or dad (or both parents) have twin brothers or sisters. Recurrence of twins occurs mainly after a generation.

Modern medicine has several versions of the birth of twins. But one of the most common is heredity. More precisely, the transmission of the hyperovulation gene through the female line. This phenomenon is explained by the fact that during ovulation several eggs mature. In those families where women have this gene, there is a high probability of giving birth to twins. We often come across photos happy parents with two pairs of twins, similar to each other, like two peas in a pod. This phenomenon is explained by the fact that their mother is 3-4 times more likely to give birth to another such pair. If she is one of a set of twins, then she is 2.5 times more likely to have twins than any other woman. It's all mysterious genetics...

How to determine pregnancy with twins: signs

There is one most reliable way how to find out if you are pregnant with twins - this ultrasonography. Even in the early stages, the doctor will determine the presence of one or two fetuses. If you have not yet gone for an examination, then your body may tell you that you are carrying twins.

There are several signs of multiple pregnancy. The first of them is increased weakness, fatigue and drowsiness. During the first trimester of pregnancy, expectant mothers constantly want to sleep. It doesn't matter that they had a good night's sleep. They take advantage of any moment to put their ear to the pillow and take a nap. As a rule, they sleep longer in the morning and go to bed earlier in the evening. This is explained by the fact that the body works overtime, bearing two fetuses at once. But we must not forget that many pregnant women (with one fetus) experience such a constant desire to sleep.

In the early stages of pregnancy, when testing for the presence of a fertilized egg, mothers carrying twins, as a rule, have more pronounced fatty stripes than mothers carrying one baby. This indicates that twins increase the amount of the hormone HcG (human chorionic gonadotropin), which is found in the urine or blood early after fertilization.

Another sign of multiple pregnancy is severe toxicosis. It can be called double toxicosis. It especially manifests itself in the morning, accompanied by nausea and vomiting. But some women note normal course pregnancy without severe toxicosis. As you can see, it all depends on individual characteristics body.

A sign that you are carrying two babies at once is big size belly - more than when carrying one fetus at the same time. The uterus increases in size, this fact will be confirmed by the results of measuring the height of the uterine fundus.

By listening to the fetal heart rate using the Doppler system (counting heart beats), the doctor will detect double heartbeats in multiple pregnancies. But often the second pulse is not a pulse at all, but extraneous noise or the mother’s pulse. So this test sometimes misleads doctors.

As a rule, women undergo a blood test in the second trimester. If a larger amount of protein is found in it, which is produced by the fetus during its growth, then the pregnancy is multiple. This protein is called alpha fetoprotein. Naturally, two fruits produce more protein for the widow.

Twins pregnancy week by week: fetal development and woman's feeling

During the first trimester of pregnancy, twins live and develop each in their own zygote. Towards the end of the first month, the zygote turns into the endometrium. Already in the second trimester, babies begin to squint and seem to be identified because they have their own fingerprints. The third trimester is the final stage of fetal formation.

In the first trimester of carrying twins (weeks 1-10), the expectant mother's breasts swell and increase in size. hCG level. By the end of the eighth week, the embryos increase in size to 3 centimeters. During this period, they are clearly visible using ultrasound. Symptoms of pregnancy are no different from those of a singleton pregnancy. Only possible early toxicosis or more pronounced. Closer to the ninth week, the embryonic development of the children ends, and by 10-11 weeks, hearts are formed. During this period, children weigh only five grams.

During the 10-20th week of bearing children, the expectant mother’s uterus and, naturally, abdomen are actively growing. The twins also do not lag behind in growth and development. Starting from the 16th week, their gender is easily visible using ultrasound. The movements of future babies inside the womb become more active every day.

The maternal placenta is the main metabolic organ. Gradually, the digestive and excretory system. The twins swallow amniotic fluid, but the decay products are eliminated through urination. During these months, the twins are actively growing, and by the end of the sixteenth week their length is about 17 cm, weight - up to 200 g. By the end of the twentieth week, they gain another 100 grams of weight and grow up to 10 cm. During this period, they can already distinguish well sounds, so mothers are encouraged to talk to them. Mothers usually feel much better, toxicosis recedes.

The period from the 20th to the 30th weeks is characterized by competition between future children in the mother's womb for better position. At the same time, mom feels their shocks well. The uterus grows at an accelerated pace, which leads to stretch marks on the abdomen and thighs. During this period, a woman's metabolism accelerates.

The fruits reach 30 cm by the end of the 25th week and weigh approximately 700 g. The formation of their facial features is also completed. During this period, a woman increasingly feels the urge to urinate, and swelling appears in her legs. She gets tired quickly. The 28th week of the formation of twins signals that the children are already quite viable. And even in case premature birth they will survive. By the 30th week, the baby’s weight is close to a kilogram, height is 35 cm. Doctors say that during this period the fetus is 95% formed.

From the 30th to the 40th week for expectant mothers the most important stage. The fruits are almost fully formed and ready to see the world with their own eyes. It's like they're trying to get out. One gets the impression that the twins are fighting over who will be born first. But mom is already accustomed to their pushes and reacts calmly to them. It is becoming increasingly difficult for her to lie down and sleep, as her huge belly is in the way. Heartburn may also occur. During this period, women need to stock up on special patience. Starting from the 32nd week, false contractions are possible. By the 37th week, the twins are fully formed, their weight ranges from 2.3 to 3.1 kg. During this period, the mother can be hospitalized and prepared for childbirth.

Pregnancy with twins: Ultrasound

Ultrasound examination is the most reliable and effective method definitions of multiple pregnancy. Only starting from 10-12 weeks, with the help of this study it is possible to distinguish between twins.

In the early stages, the doctor can see only one embryo, sometimes two, but the heart rhythm can be heard in only one. There are cases when the second embryo disappears somewhere on its own, as if dissolving, while the first continues to develop. If the development of two embryos up to 12 weeks is detected, then do not rush to share your joy. After the second screening everything will be visible and clear.

Pregnancy with twins in a dream: dream book

Different interpretations interpret the meaning of dreams differently. In order to find out why you had a dream about being pregnant with twins, you should remember well small parts dreams, how you felt in them.

Knowledgeable people say that such a dream portends big profits. Perhaps you will be given real estate or a large sum money. The money may come to you in a different way, but the profit is guaranteed.

If the woman who had such a dream is actually in interesting position, then most likely this dream is prophetic.

If you had a dream unmarried girl, then it portends disappointment in personal life. For a lonely girl, such a dream promises deception and disrepute. You should be more attentive and responsible when choosing your future husband.

If a poor person had a dream about being pregnant with twins, then it foreshadows a miraculous deliverance from debts, some gift of fate and further rich life. If such a dream visited a rich person, that is big risk lose your fortune.

If you dreamed that someone was pregnant with twins, it means that great success awaits that person.

Especially for - Ksenia Manevich

Inna Lvovna KOSYGINA, an obstetrician-gynecologist at maternity hospital #24 in Kirova, talks about how to behave during multiple pregnancy and childbirth.

Twins or as many as three babies How often does such a miracle occur and what influences the fact that not one, but two or more embryos develop in the mother’s womb?
- Today, the birth of twins occurs once every forty, whereas previously - every fifty births, and according to statistics kept in the West, it is believed that two families out of a hundred will experience “double” happiness. In the early 80s, only one pregnant woman in a hundred could count on such joy. This is explained for the following reasons: firstly, today more and more more women delay having children for longer late dates. And with age, the concentration of a hormone such as FSH increases in their blood, which stimulates the maturation of the egg. Thus, several eggs ready for fertilization can mature at once. Secondly, if a woman cannot get pregnant naturally, she goes to reproductive centers, where she undergoes a course of hormonal therapy, which also often involves the maturation of several eggs. There is another very interesting point: twins can be conceived in two ways: either the fertilized egg divides at a very early stage, or two eggs are fertilized at once. In the first case, the twins are called identical, and the probability of having them is approximately 25 out of 100 twins, while the remaining 75 are fraternal twins and sometimes resemble each other no more than ordinary brother and sister.

When can a woman find out that she will have more than one child?
- Not so long ago - about 25 years ago - they could only find out that not one, but several babies would be born, only during childbirth or not earlier than the 20th week of pregnancy. Today's expectant mothers can find out how many children they are expecting as early as 7-10 weeks of pregnancy: listening to heart sounds and ultrasound allow this to be done.

Is managing the pregnancy of a woman who is carrying several babies different from monitoring a pregnant woman with a “usual” number of babies?
- Undoubtedly. As soon as the antenatal clinic doctor determines that the expectant mother is expecting twins, or even triplets, he classifies her as a high-risk pregnant woman. Unlike a woman who is pregnant with one child, a woman pregnant with twins will have to undergo more preventive examinations: after 20 weeks - once every two weeks and every week - after 30 weeks.

What is the difference between being pregnant with multiple children?
- Women pregnant with more than one child have a higher risk of developing morning sickness. early stages, and after the 20th week. The level of hormones in the blood is significantly higher than with normal pregnancy, and therefore mothers with multiple births are more likely to experience morning sickness. In addition, there is a high probability varicose veins veins due to weight gain, and the load on the heart muscle increases three to four times. Much more often than with a singleton pregnancy, expectant mothers of several children suffer from iron deficiency.

Can you give any specific recommendations to women who are carrying not one, but several children inside them?
- Certainly. First, they need to remember additional nutrition. The fact is that when expecting twins, the volume of the expectant mother’s stomach decreases due to compression by the stretched uterus. For this reason, meals should be divided into six small portions, which will include foods that are valuable for the pregnant woman’s body. In addition, the usual dose of the necessary substances is multiplied if you are expecting twins, by two, by three, if you are expecting triplets, and so on. For example, to “meet” the daily requirement for calcium, which in a normal pregnancy is 1,280-1,300 mg per day, which is approximately 200 ml of skim milk or 110 g of salmon with bones from a can, you need to multiply 200 ml of milk or 110 g of fish by two . It turns out that a mother expecting twins needs to eat either 220 g of salmon or drink 400 ml of milk during the day. And a few more tips related to nutrition itself. Since a pregnant woman is deficient in iron, she should not only take medications containing iron prescribed by her doctor, but also replenish her body with iron naturally. Here are the foods that contain it in large quantities: porridge, beef, liver and other offal, sardines, turnips, artichokes, melons, jacket potatoes, spinach, soybeans, molasses, dried vegetables. And for the reason that the blood vessels are overloaded, you should also consume vitamin C every day. To get the required dose of vitamin C per day, you need to eat at least two of following products: 1 grapefruit, 1 glass of grapefruit juice, three medium oranges, one mango, two large tomatoes, 100 g of vegetable juice, one sweet pepper, half a cup of boiled cauliflower. And most likely the doctor will prescribe you folic acid in tablets or vitamin complexes, since it is necessary for normal height fabrics. It should also be taken into account that the expectant mother of twins needs additional rest: attract homework husband and other household members, instead of standing at the stove for hours, buy frozen vegetables and high-quality semi-finished products. As soon as possible (at least 2-3 hours a day), take a reclining position and place your legs on an elevation to relieve tension and pressure on the cervix. It may make sense to go on maternity leave earlier than during a normal pregnancy, or even leave work for a while. Excessive mobility and exercise stress harmful, and perhaps the only safe look sports in this state- this is swimming and then only after consultation with a doctor. For the same reason, be careful with courses on preparation for childbirth: avoid those that actively engage in prenatal gymnastics.

Is it true that multiple pregnancies usually end in premature birth, and is it possible to insure against this?
- Indeed, a double or even triple load on the uterus often leads to the fact that the uterine pharynx begins to open ahead of time and contractions begin. It is for this reason that most twins are born prematurely - somewhere after the 37th week, and only 10% of twins survive until the required 40 weeks. AND the main task The doctor who is caring for such a pregnant woman is to “keep” the babies in the mother’s womb for as long as possible. So, for example, if there is a threat of premature opening of the uterine pharynx, a suture is placed on it or a special soft silicone ring is placed on the cervix. They are removed shortly before birth. If necessary, the woman is sent to a hospital for constant monitoring, and they try to stop premature contractions with medication.

Is the birth of twins or more possible only by caesarean section?
- Not at all, every second twin is born today without surgical intervention. As a rule, surgery is planned if gluteal and transverse presentation fetuses or the uterus is already weak and can no longer “hold” children. In the latter option, a caesarean section is preferable if the children's weight does not exceed 1800 g, since they are very weak and may not withstand a natural birth. The operation also proceeds as planned in case of any diseases of the mother: heart, kidneys, and so on. As for surgical intervention directly during childbirth, it is resorted to in case of unexpected complications, for example, when one fetus prevents the birth of another.

They say that the stronger twin is born first, is that true?
- These are myths. One of the main roles in who is born faster is played by the location of the fetus. Although the second child may indeed have a more difficult time because, for example, after the first child has left the uterus, it becomes more spacious and the second baby may take a position that prevents natural childbirth. And as for the strong and weak, each twin initially “falls short” of the weight of a single newborn on average 1000 g, and the difference in weight between babies from the same womb can range from 100 to 500 g.

A typical gestation (pregnancy) is characterized by the gestation of one fetus, while a multiple pregnancy is characterized by two or more fetuses. According to the number developing embryos we can talk about twins, triplets, etc. The relevance of issues related to polyembryonic pregnancy is explained by the fact that its course is fraught with the development of various complications, prematurity of newborns, premature birth and other features. In addition, perinatal mortality during polyembryonic gestation is about 10%, fetal malformations are recorded twice as often. These and other features are prerequisites for studying the causes of multiple pregnancy and proper management of pregnancy and childbirth.

Causes of multiple pregnancy

Issues related to the emergence of polyembryonicity have not been fully studied. Many factors are involved in its development:

Heredity. A predisposition to multiple births is noted if one of the spouses is a twin or twins and female relatives tend to develop multiple births.
A woman has a high amount of follicle-stimulating hormone in her blood. It stimulates the maturation and development of two or more eggs at once.
Stimulation therapy for infertility.
Performing IVF (in vitro fertilization), during which ovarian hyperstimulation is used.
Malformations of the uterus.
Number of gestations (with each repeated case, the likelihood of polyembryony increases).
Hormonal changes in a woman over 35 years of age. As a result of hormonal accumulation, two or more eggs may ovulate.
Fertilization of eggs of different ovulation periods, when new pregnancy superimposed on an existing one.

Classification

The classification of polyembryony is quite complex and is explained by the many reasons for its occurrence. Determining its type is important for proper management of pregnancy and childbirth. In resolving these issues great importance have zygosity, chorionicity and the number of amniotic cavities. The classification of multiple births is associated with such concepts as:

Monozygotic, or pregnancy with twins, triplets, etc. It develops from a single fertilized egg, the division of which produces similar embryonic structures that develop independently under favorable conditions. As a result, they are born identical twins having the same gender and similar external features, as well as the same blood type, dental structure, etc.
Bizygotic gestation, which develops when two or more eggs mature in both ovaries. Their fertilization leads to the development of dizygotic embryos. They can be variable: same-sex and heterosexual, with different group blood and have other differences. If there are more than two embryos, then there may be options for the development of monozygotic and dizygotic fetuses. The peculiarity of dizygotic embryos is that they have their own membranes - chorionic, placental and amniotic. Each has its own placenta; they are separated from each other by a multilayer membrane septum.

Features of the development of multiple pregnancy

Gestation with two or more fetuses puts a greater burden on a woman’s body and affects the development of embryos. Features of the course of multiple pregnancy are manifested in the following:

Gestation period has been reduced to 35-37 weeks.
Changes occur in the functioning of systems and organs. The volume of circulating blood increases up to 50%, which causes additional stress on cardiovascular system, respiratory organs, urinary system. Toxicosis and gestosis occur (loss of protein in the urine, resulting in the development of a serious complication - eclampsia, which threatens the life of the woman and the fetus).
Polyhydramnios can cause hypofunction of the kidneys.
Isthmic-cervical insufficiency (ICI) is a softening of the cervix that rapidly progresses and requires surgical intervention. Treatment consists of suturing the cervix and inserting a pessary.

There are other risks of polyembryony that threaten the life and health of the woman and fetus:

Development of gestational diabetes.
Impaired blood circulation of the placenta, placenta previa, early abruption.
Threat of miscarriage.
Delay and malformations of fetuses.

Signs of multiple pregnancy and its management

Signs of polyembryonic gestation in the early stages do not differ from normal pregnancy. The woman is experiencing fast fatiguability, shortness of breath, frequent urination. It is quite difficult to recognize multiple pregnancies in the early stages, and women with a history or relatives of multiple pregnancies should be under special control.

The main visual sign of multiple pregnancy in the early stages is fast growth uterus and enlarged pregnant belly.

An ultrasound can diagnose multiple births. Accuracy this method is 99%. Also used to make a diagnosis is to determine the concentration in a woman’s blood. hCG hormone and placental lactogen. Their indicators significantly exceed the norm for a singleton pregnancy.

Features of management

Gestation with multiple fetuses is associated with many risks, even if it is normal. Therefore, its management is mandatory from the moment of diagnosis. A woman must strictly follow the recommendations of specialists:

Visit your obstetrician-gynecologist twice a month before 30 weeks and every week after 30 weeks.
Carry out weight control (recommended weight gain is 20-22 kg).
Take preventive medications prescribed by your doctor.
Undergo an ultrasound scan within the specified time frame.
Visit specialists to monitor the condition of the cervix, organs and systems.
Undergo laboratory blood tests and the necessary control hardware studies (CTG, Dopplerography, echography of the fetoplacental system).

If necessary, the pregnant woman is prescribed additional studies. Her hospitalization in the maternity hospital is necessary from the 36th week, and in some cases even earlier.

Childbirth with multiple births

Childbirth during multiple gestation is a crucial moment for both the mother and doctors. This is explained frequent complications associated with the condition of both the woman in labor and the fetus:

30% of women in labor with multiple births experience early or premature birth amniotic fluid and premature birth.
Due to overstretched uterine muscles, labor contractions become weak and the cervix does not dilate. As a result, the expulsion of the first fetus from the uterus is delayed.
The second fetus often tends to enter the pelvis at the same time as the first, which is fraught with serious complications.

All this leads to protracted labor, there is a threat of infection of the uterus and the development of fetal hypoxia. There are cases of rapid labor with perineal ruptures. During the period of expulsion of fetuses there is a risk of developing severe complication - premature detachment placenta and heavy bleeding. If this happens while the second fetus is in the uterine cavity, it is a threat to its life.

Proper management of multiple births means minimizing the risk of complications.

It is necessary to constantly monitor the cardiac activity of the fetus and the condition of the woman in labor. It is advisable to give birth in the first stage on the left side. In case of weak labor, stimulation and anesthesia are performed.

If necessary, during the expulsion period, obstetric surgical procedures are performed to extract the fetus using instruments. The umbilical cord is tied not only at the fetal site, but also at the maternal site. If this is not done, then the death of the fetus in the uterus is possible. The second child passes into the birth canal 10-15 minutes after the first. If there is a delay, the doctor breaks the amniotic sac to drain the amniotic fluid and the baby comes out of the pelvis on its own.

If the child is in transverse position or the head is not inserted correctly into the pelvis, then the woman is given general anesthesia and the child is mechanically rotated and removed. In complicated cases, delivery is carried out by caesarean section.

Women with polyembryonic pregnancies are provided with increased postpartum leave. They are recommended to use high-quality contraception for three months and plan subsequent pregnancies only after two to three years. Newborns also need special attention and, in accordance with the degree of their maturity and maturity, require a certain amount of nursing.