Multiple pregnancy and women's consultation. An agonizing wait

With multiple pregnancy, much more often than with pregnancy with one fetus, all forms of gestosis develop, the course of which is of considerable severity. The frequency of late preeclampsia can exceed 40%. With multiple pregnancies, there is more often a threat of abortion, anemia, dilatation of the veins of the lower extremities, polyhydramnios, and fetal malformations. The cardiovascular system, liver, kidneys of a woman work with increased stress, so pregnant women complain of fatigue, shortness of breath, frequent urination,.

Up to 50-70% of twin pregnancies do not reach 10 obstetric months. With an increase in the number of fetuses in the uterus, the duration of pregnancy decreases and amounts to multiple pregnancy an average of 37 weeks.

In cases of development of an identical multiple pregnancy, uneven supply of nutrients and oxygen to one of the twins is important, which is due to the peculiarities of the fetal circulation. As a result, one fetus becomes hypotrophic and may even die. The dead fetus is squeezed by another, about amniotic fluid dissolve, the placenta undergoes dystrophy. Such a mummified fetus ("paper fetus") is born together with a living fetus.
accompanied by a large number of complications, which often have more pronounced character than in singleton pregnancies.
The pathological course of pregnancy is due to the high requirements for the mother's body in the presence of multiple pregnancies.

In the presence of multiple pregnancies, a woman belongs to the group of increased and childbirth. Implemented careful observation for its condition, functioning of cardio-vascular system, liver, kidneys, blood system. In the event of deviations from normal course pregnancy, a woman is hospitalized in a maternity hospital.

Women with multiple pregnancies are subject to planned hospitalization for prevention at 18-22 and 31-34 weeks, which are "critical terms" and for prenatal preparation at 36-37 weeks of pregnancy.

The critical periods of a woman with multiple pregnancies are 18-22 and 31-34 weeks (for miscarriage) 18-32 weeks (for anemia); 26-36 weeks (by development late gestosis) 11-22 weeks (for polyhydramnios).

With multiple pregnancy, feto-placental insufficiency develops, leading to fetal hypotrophy, syndrome intrauterine delay development.

In order to prevent these complications, the following measures are taken:

1. Ultrasound is performed in dynamics after 4 weeks to determine the nature of fetal development, type of placentation, the presence of polyhydramnios, congenital malformations, fetal death, etc.

2. Formation of a protective regimen, hospitalization at 18-22 and 30-34 weeks of pregnancy, taking into account critical deadlines for miscarriage.

3. Complete nutrition with a predominance of vitamins, proteins of animal origin (meat, cottage cheese).

4. With an increase in the tone of the uterus, the appearance of periodic cramping pains in the lower abdomen, at critical times due to miscarriage, oral tocolysis with b-agonists is indicated: from 20 weeks of pregnancy, courses of 2-4 weeks with a break of 1-2 weeks. Preparations are used: brinalin 25 mg (1/2 tab. 1-2 times a day), partusisten 5 mg (1/4 tab. 1-2 times a day). For tocolysis, sedatives are used (valerian extract 2 mg in tablets, 1 tab. 3 times a day, liquid motherwort extract 15.0: 2000 ml, 1 tablespoon 3 times a day). Sometimes you can use acupuncture, suturing the cervix with the initial manifestations of isthmicocervical insufficiency (functional or organic form) up to 20 weeks of pregnancy.

5. Long-term (up to 3 months) Starting from 16-20 weeks of pregnancy, oral administration of preparations containing iron (ferroplex 2 tablets 3 times a day, ferro-folic 500 1 tablet in the morning).

6. Improvement of uteroplacental blood circulation in case of detection of signs of intrauterine growth retardation and fetal malnutrition (sigetin is prescribed in tablets of 0.1 g 1 time per day and complamin in tablets of 0.15 g 3 times in Denbigh; trental in tablets of 0, 1 g 3 times a day; cocarboxylase in ampoules of 0.05 g 1 time per day intramuscularly; chimes in tablets of 0.025 g 3 times a day, a solution of rheopolyglucin with glucose - 400 ml intravenously drip 2 times a week oxygen therapy; abdominal decompression).

7. Prevention of SDR fetuses from 28 weeks of pregnancy:

a) dexamethasone 2-4 mg 2 times intramuscularly for 2-3 days or in tablets of 2 mg 4 times a day the first day, then 2 mg 3 times a day the second day the third day 2 mg 2 times a day, for a course of 16 - 24 mg ;
b) Prednisolone 60 mg per day for 2 days Dexazone 4 mg intramuscularly 2 times for 2 days
c) in case of hypertensive syndrome: eufillin 2.4% 10ml, glucose solution 20% 10ml, administered once a day for 3 days
d) ambroxol (lazolvan) 800-1000 mg per day for 5 days intravenously;
e) lactin intramuscularly 2 times within 3 days;
e) nicotinic acid 0.1 mg once a day per os;
g) microdoses of folliculin 2500 IU intramuscularly 2 times a day.

8. Hospitalization of patients upon detection initial signs complications of multiple pregnancy, regardless of the gestational age and prenatal hospitalization at 36 weeks to resolve the issue of the condition of the fetus and choice best method delivery.

So, you are expecting the birth of several babies at once? Congratulations! But what should the expectant mother of several babies prepare for at once? Is it harder than carrying one? What are the possible complications? Can you give birth on your own?

These and many other questions are answered by the doctor of the Toast of Family Medicine Centers, an obstetrician-gynecologist of the highest category, candidate of medical sciences Tatiana ZHORNIK.

At what time can a multiple pregnancy be determined?

Even 30 years ago, when in women's consultations, no one has yet heard that the diagnosis of multiple pregnancy was a matter of chance. The position of babies does not always allow to accurately determine their number by palpation and auscultation. Therefore, often future mother she learned that she had not one, but several babies at once only shortly before the birth, and sometimes directly in the process.

At modern medicine more opportunities for determining multiple pregnancy in the early stages, and hence for a successful course and delivery.

Expert opinion

You can determine how many babies are waiting to be born using ultrasound from 5-6 weeks of pregnancy. If you do not do an ultrasound at an early stage, then you can suspect an extra addition to the family after 13-14 weeks of pregnancy: uterus future mother grows faster. When the doctor begins to listen to the baby's heartbeat, instead of one he will hear two or three hearts. On long term pregnancy, the doctor will be able to touch 3-4 large parts of the body (heads and butts) and many small ones (arms and legs).

How is a multiple pregnancy observed?

When the baby is not alone, then the load on the organisms of the expectant mother increases two (three, four) times. Unfortunately, this is not a myth - the female body is well equipped to bear only one child at a time. Multiple pregnancy is an amazing miracle, a kind of smile of nature. She demands from the expectant mother especially careful attitude to your body, and from doctors - careful monitoring and examination of the pregnant woman.

With multiple pregnancies, the schedule of "appearances" to the doctor will be more intense than with normal pregnancy: 1st and 2nd trimesters - a visit to the doctor every 2 weeks, in the 3rd trimester - weekly.

Expert opinion

After confirming a multiple pregnancy, the woman is taken by a doctor for special control. The expectant mother of twins or triplets will have to visit the doctor more often, the volume of examinations will also increase: once a month, general and biochemical tests will be taken. , Ultrasound of the fetuses will be performed on the 11-13th, 16-18th, 20-22nd week. Starting from 26-28 weeks of pregnancy, along with ultrasound of the fetuses, dopplerography of the vessels of the umbilical cord and uterus is done, again - at the 31-33rd and 36-38th weeks of pregnancy. From 28 weeks of pregnancy, the doctor will recommend that mommy record CTG (cardiotocography) of the fetus to exclude oxygen deficiency and nutrients kids. At 37-38 weeks of pregnancy will determine the date and method of the birth of twins, and also, possibly, suggest prenatal hospitalization.

What are the complications of multiple pregnancy?

“During pregnancy, where it is thin, it breaks there” doctors like to say. Probability of exacerbation chronic diseases during this period is quite high, and if a woman expects several babies at once, then the danger increases.

During a multiple pregnancy, the likelihood of the following conditions increases.

Anemia;

the threat of termination of pregnancy;

preeclampsia;

gestational diabetes;

premature birth;

lagging or developmental features of one or more fetuses;

delivery through .

Expert opinion

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 them is anemia when hemoglobin levels in a woman's blood decrease. In this case, obstetricians recommend to the expectant mother a diet rich in proteins, vitamins, iron (beef, veal, liver, broccoli, buckwheat, apples, etc.) and medications that contain iron.

Every third woman has threatened miscarriage: due to the fact that there is not one, but several babies in the uterus, its walls are overstretched. With their greater weight than during normal pregnancy, growing babies put pressure on the area of the isthmus of the uterus. The cervix may shorten and open, and there is a threat premature birth.

Preeclampsia. Signs of this complication of pregnancy are swelling in the legs, then on the hands and face, the appearance of protein in the urine and an increase in blood pressure. This complication should be treated only in the hospital.

Twins and triplets themselves often lag behind in physical development, this happens in almost half of the cases due to their premature birth. The weight of twins can vary, but 200-300 grams - the difference can be more noticeable; this occurs in twins with one placenta for two, especially if one of the babies has a stronger “appetite”. In this situation between vascular systems twins have special connections - anastomoses and blood flows from one twin to the other. During pregnancy, doctors make sure that both babies receive enough oxygen and nutrients through the blood.

Nutrition rules for the expectant mother of twins

Most important rule: avoid hunger and overeating, Follow the diet recommended by your doctor. During pregnancy, a woman's need for calories increases, especially since several little men grow and develop in your stomach at once.

” If you monitor the calorie content of your diet, then your new daily allowance can be calculated using the following formula: your usual diet + 300 kcal per baby.

In the second half of pregnancy, the need for calories increases, the babies begin to gain weight and they want to eat more. Eat healthy, but try to make sure that the total calorie content of the menu does not exceed 3500 kcal per day if you are expecting twins, and 4500 if you are expecting triplets.

” Gains during multiple pregnancies are always greater than with singletons: the average norm is considered to be an increase while waiting for twins from 16 to 21 kg.

Expert opinion

It often happens that a woman’s body does not have enough strength and “reserves” to feed several babies at once. Expectant mothers can avoid this by taking multivitamins for pregnant and lactating women, which contain vitamins and trace elements in the doses they need. With a decrease in the level of hemoglobin in the blood, in addition to the diet, it is recommended to take iron supplements, but only as directed by a doctor!

At the beginning of pregnancy, do not limit yourself in the choice of food: you can eat almost anything you want, just not very much. Try to eat more often, 5-6 times a day, but in small portions and preferably at the same time, so that there is no feeling of hunger and accompanying nausea, weakness and dizziness. I wish your diet included more dairy products, meats, juices, fruits and vegetables. Do not forget about foods that contain fiber and help the intestines work (wholemeal bread, nuts, vegetables, etc.). At the end of pregnancy, preference should be given to liquid and semi-liquid foods, as the size of the stomach decreases and digestion problems may occur, and snacking on vegetables or vegetable salads, fruits, fermented milk products. It is necessary to completely exclude spicy, fried, smoked, sauces (mayonnaise, ketchup) from your diet, avoid overeating.

Lifestyle during multiple pregnancy

Multiple pregnancy is the time to build for yourself and your future children the most comfortable, convenient, sparing for the body mode of life. Allow yourself to enjoy every pleasant trifle get some rest, take a walk fresh air, meet friends and be sure to observe strict regime sleep - during pregnancy it is very important to get enough sleep.

” By the way, babies feel in utero when the mother is sleeping and when she is awake; they react to hormonal changes in the mother's body and get used to a certain daily routine. It turns out that if the mother slept soundly at night during pregnancy, then the newborns will follow her example.

Expert opinion

In order for the kids to be comfortable and they receive required amount nutrients and oxygen (all this comes through the blood from the mother), try to keep correct image life. Remember that you need to sleep at least 8-10 hours at night, spend more time in the fresh air, for example, walk with your husband before going to bed. Do gymnastics, physical education for expectant mothers at home or in a special group after consulting with your doctor. Try to avoid noisy companies, smoky or stuffy rooms. For the sake of children's health, give up smoking and alcohol.

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. It is worth remembering about the bandage supporting the uterus - it will be easier for you to walk.

Birth before term

Due to the strong stretching of the uterus, twins and triplets are often born ahead of schedule - births at 36-38 weeks are considered the norm for multiple pregnancies. Triplets and quadruplets are often born even earlier. However, nature takes care of the twins: the lungs of twins develop faster, obviously, based on an earlier meeting with the outside world.

” This fact is also taken into account in Russian legislation: in case of multiple pregnancy, a woman has the right to go to maternity leave two weeks earlier than when pregnant with one child. "Multiple" maternity leave starts as early as 28 weeks and lasts 194 days (instead of 140 days of regular maternity leave).

Expert opinion

In 40-50% of cases, the mothers of twins do not leave the water on time, and then you have to start childbirth without waiting for the due date. In 25-50% of cases, twins and triplets are born ahead of schedule for a month or even two. For such a quick acquaintance with the world, the twins are better prepared than other children: for example, their lungs and brain mature 10 days earlier. It is believed that twins are ready to be born already at 37-38 weeks of gestation, and by this time they are not inferior in development to other babies.

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

Endure twin pregnancy - not an easy task for a woman, as 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,. That is why this state requires heightened 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 twin pregnancy in the early stages. Most often, the situation clears up in time.

Only in a few cases did women report the following twin pregnancy signs:

pronounced exacerbation of the sense of smell, persistent dislike for any smells,;
a noticeable increase in the mammary glands;
pigmentation on the chest and face.

In the antenatal clinic, during the initial examination, the doctor can determine the pregnancy with twins by the volume of the uterus, which does not correspond to the expected gestational age, and during the next examination, by how fast it grows. An analysis can confirm his assumptions, which will show values \u200b\u200bthat do not correspond to the current week of pregnancy. That's what it is true signs early pregnancy with twins.

An early ultrasound does not always confirm twin pregnancy, since during the 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 tapped.

Starting from the 20th week, it is possible to determine the symptoms of twin pregnancy not only with the help of ultrasound, they will be as follows:

on palpation of the abdomen, four large parts of the fetus can be identified - two heads and buttocks in different parts uterus;
the height of the uterus and its volume are much larger than those characteristic of a singleton pregnancy;
the woman feels the movements of two fetuses;
on auscultation of the abdomen, the doctor hears two heartbeats.

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

Main dangers

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

The most common problems are::

wrong fruit;
increased fatigue, weakness, shortness of breath;
anomalies in the development of one or both fetuses.

Behavior of the expectant mother

A prerequisite for normal course multiple pregnancy is the regime of the day, in which most of the free time will be devoted to rest. The doctor may advise bed rest if the symptoms of twin pregnancy are manifested by increased fatigue and drowsiness.

This rarely happens. More often repeated 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 hospitalization in a hospital in order to control how the twin pregnancy will proceed by weeks.

Pregnancy Calendar

What will be the development of twins by week of pregnancy? Let's consider in more detail.

1-10 weeks

Signs of twins in early pregnancy coincide with a singleton pregnancy, but toxicosis appears earlier. By 8 weeks, both fetuses grow up to 3 cm, so they can be seen using ultrasound. After 8 weeks embryonic development ends, by the 10th week hearts are formed. Each fruit weighs 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 is rapidly increasing 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 children by ultrasound and calculate the approximate body weight and weight.

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

20-30 week

Features of twin pregnancy from the 20th week are also characterized by the rapid growth of the uterus, the acceleration of metabolism. Babies begin to move more intensively, causing a lot of inconvenience to the expectant mother. The twin pregnancy calendar suggests that by week 25, the growth of the fetus increases to 30 cm, and the weight - up 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 frequent urination, expressed, increased fatigue. By week 28, babies become viable, subject to premature delivery, they have a high chance of surviving. By week 30, the weight of one fetus is about 1000 g, height - 35 cm.

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Pregnancy with twins carries not only joy, but also a huge responsibility, because bearing two babies at once, twins or twins, is a serious burden on the body of a future mother. Today, this situation is not so rare. In about 0.7-1.5% of cases, twin pregnancy is noted. With multiple pregnancy, a woman needs Special attention by medical personnel due to possible complications. Only doctors can take into account the peculiarities of twin pregnancy and proper monitoring of the patient's condition.

What is twin pregnancy

This is the name of one of the varieties of multiple pregnancies (MB), when not one, but two fetuses develop in a woman's fetus. There may be more of them - triplets, quadruplets, etc. When bearing two fetuses, it is very important early diagnosis so that in the future the condition of the woman was under the strict supervision of a doctor. By the number of fertilized eggs, multiple pregnancies can be monozygotic or fraternal. In the first case, the children are called twins, and in the second - twins.

Fraternal twins

This type of twin pregnancy is more common, in about 70% of cases. It occurs when 2 eggs (in the ovary or ovaries) simultaneously mature in a woman’s body, which are then fertilized by different spermatozoa during one or two sexual intercourses, provided that no more than a week has passed between them. In this case, two isolated nuclei are formed. These twins are called dizygotic or fraternal, and in the people - twins. They have only a general resemblance, as between brothers and sisters. Children rarely have the same sex, more often they are born different.

Such twin pregnancy can only be bichorionic biamniotic (otherwise - diamniotic dichorial). It is characterized by:

each baby has its own sac with amniotic fluid (fetal bladder);
each fetus has its own chorion (hereinafter - the placenta);
dizygotic twins have 2 sets of membranes that surround the amniotic sac (the inner layer of the amnion and the outer layer of the chorion).

identical twins

If a fraternal twin pregnancy can only be bichorial biamniotic, then an identical (monozygous) pregnancy has several types depending on the time when the egg was divided. This happens after fertilization. stand out the following types monozygotic MB:

Monozygotic bichorionic biamniotic. Occurs in approximately 1/3 of cases. Separation of the egg occurs during its movement through the tube to the uterus. This is the period during the first three days after fertilization.
Monozygotic monochorionic biamniotic. Occurs when the egg divides from 3 to 8 days after conception. In this case, 2 embryos are formed: each has its own amnion (fetal bladder), but they have a common chorion. This type of connection is typical for every 360 cases. Because of the same placenta for two, such twins are at risk.
Monozygotic monochorionic monoamniotic. Occurs in every 2400 cases. Separation occurs 8-13 days after conception. In this situation, the embryos have a common fetal bladder (amnion) and a common placenta (chorion). Such a twin pregnancy is considered the most unfavorable. Monoamniotic twins are at risk of death due to the possible entanglement of the umbilical cords during the growth of babies.
Siamese twins. Appear when separation occurs later than 13 days after conception. Children can grow together in the coccyx, skull bones, lumbar spine or chest.

Reasons for multiple pregnancy

The main reasons for the birth of twins is the maturation of several eggs at once in one uterus or the division of the zygote into two parts after fertilization. Particular factors in the occurrence of multiple pregnancy are:

genetic predisposition. High degree heredity has influence. When spouses in a relationship had a case of the birth of twins, then the probability of having twins also appears in them.
Age. In the period of premenopause (up to 35 years) not every menstrual cycle ovulation occurs. They alternate with ovulatory when there is a surge of hormones. If ovulation occurs after this, then 2 or more eggs mature.
Hormonal contraception. The abolition of such drugs leads to the activation of the synthesis of their own hormones, which leads to the maturation of several eggs.
In vitro fertilization (IVF). Thanks to modern reproductive technologies, in case of infertility, conception can be stimulated artificially. A woman is implanted with up to 4 eggs, which increases the likelihood of twins.
Birth of twins previous pregnancy. If a woman is pregnant again, then she is more likely to have twins.

twin pregnancy signs

A woman may suspect that she is pregnant with twins already on early stage. test shows positive result the first time. Such an unusual condition is also determined by the following signs:

Toxicosis with twins. It starts earlier and lasts longer, until about 16-17 weeks. The woman's health is more severe. Toxicosis is accompanied by vomiting, increased fatigue.
Rapid weight gain for the expectant mother. Body weight increases much faster from the first weeks, which is why a woman needs to strictly monitor her diet.
Belly with twins. Due to the growth of two babies at once, it begins to increase earlier. The size of the uterus by 12 weeks already almost reaches the navel (with a singleton, it only slightly protrudes above the bosom). Due to the close presentation of the fetuses, the woman feels movement earlier.
Gestosis and anemia. With multiple pregnancy, these conditions are diagnosed in half of the cases. This is due to an increase in the volume of circulating blood and plasma. For the prevention of anemia, iron-containing drugs are prescribed.
Swelling and shortness of breath. Due to the high load on all organs, it is difficult to bear twins without complications. The displacement of the diaphragm disrupts the functioning of the lungs, causes shortness of breath, swelling, and fatigue. Because of heavy load high risk varicose veins veins.

How is twin pregnancy diagnosed?

There are several methods and signs that help identify multiple pregnancy. The doctor can determine it already on gynecological examination, but in addition, several procedures are prescribed for a woman:

Blood analysis. It is necessary to determine the presence chorionic gonadotropin. This hormone is secreted by the placenta.
Ultrasonography. This method more informative only from 8 weeks of gestation. Early ultrasound does not always detect twins, because one fetus can hide behind another.

When examined by a gynecologist in the early stages

During the initial examination, the doctor may note several signs of multiple pregnancy. The gynecologist palpates the soft uterus - in this case, he notes the discrepancy between its size and the delay in menstruation. Other signs that the doctor notes if you suspect multiple pregnancies:

beating of 2 hearts during Doppler diagnostics;
high AFP blood test results;
discrepancy between the size of the head and the volume of the abdomen;
too fast weight gain;
persistent constipation;
severe swelling of the legs;
excessive fatigue of a woman;
severe toxicosis and preeclampsia at an early stage;
high blood pressure.

HCG indicators in a blood test

The analysis of hCG can confirm the doctor's hypothesis. This indicator has specific values for each week. If after analysis it turns out that the level of hCG is too high for certain period pregnancy, this may indicate multiple pregnancies. But this feature is indirect. A high level of hCG is characteristic of some abnormalities in the development of the fetus and ectopic pregnancy. In addition, this method cannot determine how many fetuses are in the uterus, whether they have one fetal bladder and placenta or several.

Ultrasound diagnostics

The first ultrasound is possible for a period of 4-5 weeks literally immediately after the delay of menstruation. It does not guarantee confirmation of multiple pregnancy, because one child can hide behind another, but in most cases it confirms the doctor's assumptions. Further planned ultrasound help the doctor determine how many placentas, the presence of a septum (one or two amnios), the location and heartbeat of the fetus, signs of developmental delay, and fusion between twins.

Development of twins by week of pregnancy

Women who are pregnant with twins are included in the group increased risk therefore they need special supervision from doctors. To do this, you have to visit the antenatal clinic more often: every 14 days up to 28 weeks, and then every 7-10 days. The gynecologist at each examination pays special attention to the weight of the woman. By the time of delivery, the woman in labor should gain no more than 15 kg. Every overweight increases the risk of fetal complications. In each trimester of pregnancy, twins can be distinguished characteristics which are always noted by the doctor.

1-10 weeks

At an early stage, the woman's body begins to react to pregnancy with twins. This is manifested by swelling of the mammary glands, an increase in hCG levels. By week 8, embryos can already be detected on ultrasound - their size reaches 3 cm. The symptoms are the same as those characteristic of multiple pregnancy, but toxicosis manifests itself earlier. By 10-11 weeks, future babies are coming to the end of embryonic development:

their length is about 4.5 cm;
hearts are formed
the weight of the embryos is about 5 g;
the voice-forming apparatus begins to form;
faces are distinguishable, heads are very large.

10-20 week

During this period there is fast growth both fetuses, due to which the uterus greatly increases in size and leaves the pelvic area. This condition requires a woman to wear special clothes for expectant mothers. At week 16, during an ultrasound scan, you can already distinguish the sex of the babies, roughly calculate their weight. Other features of the development of twins at this stage:

babies can clench their hands into fists, they have facial expressions, but they sleep almost all the time;
children have a reaction to sounds;
the rudiments of the organs of the digestive and excretory system appear, the intestines begin to work;
the baby can swallow a certain amount amniotic fluid and remove decay products through the bladder;
from the 16th week, the babies are moving, from the 20th it is already felt very clearly;
the body length of the babies is about 17 cm, and the body weight is 200 g.

20-30 week

At the next stage, women experience a significant acceleration of metabolism, due to the rapidly growing uterus, stretch marks appear. The struggle of babies in the womb for the correct position leads to constant tremors. The woman's back starts to hurt again. The inconvenience brings frequent urination, increased fatigue, lower back pain and severe swelling. Other features of fetal development according to the twin pregnancy calendar:

by week 25, the growth of the fetus is 30 cm, and the weight is about 700 g;

By appearance babies are already more like newborns, ultrasound can detect that one is larger than the other;
by week 28, babies are already viable and have a higher chance of surviving with premature births when compared with premature babies;
by week 30, growth is about 35 cm, and the formation of the body is almost completely completed.

30-40 week

This stage is one of the most important. In the final trimester, a bone skeleton is formed in babies, pancreas develop, and iron and calcium accumulate. The head and body become approximately the same size, so the children look proportional. Because of big belly the woman is uncomfortable sleeping. It is recommended in this case to lie on the left side, it is better to purchase a pillow for pregnant women for this.

A woman during this period should be limited physical activity more time to rest. At 36 weeks, the planned hospitalization of the woman in labor takes place. Babies during this period are considered fully full-term:

the sucking apparatus is formed;
growth reaches 45-50 cm;
weight is about 2.2-3 kg.

Features of bearing twins

The process of carrying twins depends not only on the type of multiple pregnancy, but also on the history of the woman. Many factors are taken into account here - whether the patient is giving birth for the first time or already the second time, in what way the delivery took place last time. Separately, it is worth noting pregnancy after artificial insemination, i.e. IVF when the possibility of multiple pregnancy is high. Each case has its own characteristics of bearing twins.

After caesarean section

If the previous births occurred by caesarean section, then the next ones can have serious complications. There are two possible scenarios here:

With an inferior scar on the uterus, doctors may insist on an artificial termination of pregnancy. Even if twins develop normally, it is still dangerous.
If, after a cesarean section, a woman has a scar on her uterus, then the gestation is prolonged up to 30 weeks. Then comes operative delivery. This is necessary to exclude possible uterine rupture and other negative consequences.

Pregnancy with twins after IVF

In this case, the twins are explained by the fact that from the embryos that the doctor implants in the uterine cavity, two can be introduced into the uterine layer at once, and not one. They are attached and successfully continue development. In rare cases, and only at the request of a woman, specialists artificially remove implanted embryos. In some cases, this may be necessary for health reasons. According to statistics, twins are born in 30% of IVF cases. The high percentage is explained by the fact that in order to increase the chances of becoming pregnant, a woman is implanted with several embryos.

Delivery in multiple pregnancy

The bearing of twins differs in terms and features of the course. In this case, doctors pay special attention to the woman's health, more often inviting them to an appointment. Hospitalized for certain period before the due date. By this time, the babies are fully formed, even though their weight and height are slightly below normal. If necessary, they are immediately sent to intensive care.

When can twins be born

A feature of multiple pregnancy is that women rarely reach the usual period of 38-42 weeks. Patients carrying twins give birth more often at about 36 weeks. For this reason, women are hospitalized at least 14 days before the expected date of delivery. In general, a favorable period for the birth of twins is 36-38 weeks. The peculiarity is that twins have a higher adaptation time than one baby. For this reason, even when born prematurely, they can breathe on their own.

natural childbirth

Delivery tactics are determined taking into account several factors. The doctor takes into account the position and presentation of the fetus, special first baby. Equally important are the regularity and intensity of contractions, the presence of water and intrauterine hypoxia in twins, the age of the woman in labor and possible gynecological diseases. Natural childbirth is resorted to if:

both fetuses are presented with heads;
the condition of the babies and the mother is satisfactory;
labor activity is regular.

Natural childbirth in most cases proceeds normally without any ptology, but sometimes it can be accompanied by some complications:

weak labor activity due to a distended uterus;
premature rupture of amniotic fluid or placental abruption after the birth of the first fetus;
fetal hypoxia;
bleeding;
prolapse of the umbilical cord.

Indications for abdominal delivery

Doctors with multiple pregnancies often do not take risks and resort to abdominal delivery, i.e. caesarean section. Indisputable evidence for planned operation are:

extragenital diseases;
unpreparedness of the birth canal for childbirth after 38 weeks;
age of the primiparous;
pelvic or transverse position first fetus;
complications during pregnancy with twins;
severe gestosis;
excessive stretching of the uterus;
large kids;
polyhydramnios.

Possible risks and complications

Carrying twins is a serious test for a woman. The risk of complications in such patients is higher than in singleton pregnancies. Possible consequences classified according to the time of occurrence. They can be:

intrauterine;
perinatal;
postpartum.

Specific intrauterine complications

reverse arterial perfusion;
the threat of miscarriage;
fusion of children ( Siamese twins);
chromosomal disease in one of the babies;
syndrome of feto-fetal blood transfusion;
congenital "ugliness" of one of the babies;
anembryony - the phenomenon of the death of one of the twins;
antenatal death of one fetus.

Perinatal

Complications with multiple pregnancy can occur during delivery. Mortality rates are high here - about 5 times higher compared to bearing a single fetus. Other serious complications in the perinatal period are:

hypoxia of one or two fetuses;
slow opening of the cervix;
anomaly labor activity;
premature detachment of the placenta (especially for the second baby);
bleeding during separation of the placenta.

Postpartum risks for mother and twins

Because of big risk complications twin pregnancy is considered a borderline state between the norm and pathology. Even after childbirth, mother and babies are at risk. A woman has a high risk of bleeding, inflammation of the uterine cavity (endometritis) or slowing down its contraction (subinvolution). The woman in labor is observed for another 2 hours after delivery. If necessary, reduce the uterus means.

Multiple pregnancy - photo

Video

Multiple pregnancy differs in its course from the bearing of one child. Increased risk of complications for mother and newborn, twin births naturally different from standard. For women with multiple pregnancies, schedules for visiting a gynecologist are being adjusted, and the pregnancy management plan is changing. The chances of getting to the hospital ahead of time increase, so mothers with twins are under special supervision.

Chances of getting pregnant with twins

The mechanism for the formation of twins can be different. There are two main types of twins:

Identical - formed from the fusion of one egg with sperm.
Fraternal - 2 oocytes were fertilized, which matured simultaneously in one or different ovaries.

Scientists note an increase in the number of twins. IN different countries statistics fluctuate at the level of 0.7-1.5% for all births. A link has been established with several predisposing factors:

age over 30-35 years;
a large number of pregnancies;
heredity;
malformations of the uterus;
rebound effect after taking hormonal contraceptives;
infertility treatment;
IVF programs.

Heredity increases the likelihood of having twins if there were twins in the family maternal line. This indicates the features of a woman's ovulation.

The mechanism of twin formation

IVF causes multiple pregnancies due to the practice of transferring multiple embryos to increase the chances of implantation. The risk of complications during pregnancy with the help is high. Therefore, in reproductive technology programs, they try to implant no more than 3 embryos.

It is possible to control the number of fertilized eggs only with IVF. In other cases, it is impossible to predict how many fruits will develop.

Features of the presentation of the fetus and the choice of tactics of childbirth

On the mechanism of the course of childbirth, choice suitable way and the term of delivery affects:

twin type;
place of attachment of the placenta;
malformations;
pregnancy complications.

Twins can have a common amniotic membrane, they are called monoamniotic. With this type, the chance of incorrect position of the fetus increases. Sometimes twins lie with a jack, during labor, the heads of children can catch on their chins, which will not allow them to appear naturally, an emergency operation will be required.

With diamniotic twins, each child has its own fetal bladder, it is separated from the brother or sister by the membrane and its own amniotic fluid. The possibility of complications is reduced.

Attachment of the placenta affects the position of children and the choice of method of delivery - natural childbirth or cesarean. The placenta can be shared by two babies, they are called monochorionic twins. Such fetuses often develop a steal syndrome, one of them becomes a donor, and the second recipient. through the vasculature in common placenta there is a discharge of blood, so the donor has a developmental delay, and the recipient has an overload of the heart and a defect is formed. It is difficult for such children to be born naturally, doctors in the interests of babies do C-section.

The place of attachment of the placenta also determines the tactics of childbirth. With low placentation, the risk of bleeding increases, and with natural childbirth, it is impossible.

The doctor will be able to determine the tactics of conducting a woman in labor on last dates when the position and presentation of the twins becomes stable. Usually, both fetuses are located longitudinally in the uterus, presentation can be:

head-head;
pelvic-pelvic;
head-pelvic;
pelvic-head.

Less often, other variants are noted, sometimes one fetus is located longitudinally, and the second - transversely, or both can lie transversely. In pregnant women with birth defects the development of the uterus, the chances of abnormal presentation increase.

Childbirth through the natural birth canal is carried out in the case when:

both children are located longitudinally with the head to the entrance to the small pelvis;
the first fetus lies head down, and the second - the pelvis (the head of the child has a larger volume than the pelvis, after the birth of the first baby, the birth canal will expand as much as possible, there will be no obstacles for the next one).

Caesarean section shown:

to all women who have both children or the first of them located transversely - it is impossible and dangerous to turn them into a longitudinal one;
to all primiparas whose first fetus is lying (if a second birth is coming and there are no scars on the uterus, then the decision is made taking into account other possible complications).

A second child can be placed across. The doctor's tactics depend on the experience and equipment of the maternity hospital. After the appearance of the first baby, the second baby is turned on the leg under ultrasound control and completed in a natural way. The second option is a caesarean section for the second fetus.

Terms of delivery

Women with multiple pregnancies rarely carry babies before 40 weeks.

What week do twins give birth?

According to the statistics of numerous observations, this is 36-37 weeks of gestation. The more fetuses a woman bears, the higher the risk. With triplets more often at 33 weeks, and with four fetuses - 31 weeks.

The timing of the birth of twins is shifted due to overstretching of the uterus. The mass of two children at 35 weeks can reach 5 kg, in addition, you need to take into account a large amount of amniotic fluid. When carrying one child by the end of pregnancy, its weight rarely exceeds 4 kg, and the number amniotic fluid is 1 liter.

To anticipate possible preterm birth of twins, a woman visits the doctor more often during pregnancy. Until the 28th week, examinations are carried out at a frequency of once every 2 weeks. After receiving a certificate of incapacity for work - every 7-10 days.

Critical periods are defined for preterm birth:

22-24 weeks;
25-27 weeks.

During these periods, a transvaginal ultrasound of the cervix is performed. During the study, you can evaluate its length, condition internal os. With a vaginal examination, this is not possible. The risk of preterm delivery is determined by the length of the cervix in accordance with the gestational period. With a length of up to 32 mm in the period of 22-24 weeks, there is a high probability of delivery before 36 weeks. At 33 weeks pregnant, the cervix should be longer than 27 mm.

In women with a short cervix, they try to prolong the pregnancy until the time when the children are mature enough, which reduces the likelihood of postpartum complications. To reduce the load on the lower segment of the uterus is used. According to indications, special sutures are applied to the neck.

According to clinical protocols, prenatal hospitalization is carried out. With diamniotic twins, they are sent to the hospital at 35-36 weeks. Monochorionic twins are accompanied by high risks of complications, the pregnant woman is hospitalized at 33-34 weeks.

How is a normal birth

At correct position The mother gives birth to fetuses on her own. Childbirth is rarely resorted to. In the first period, careful monitoring of the fetal heartbeat is necessary. It is recommended to refer women for hospitalization in maternity hospitals high level who have good equipment.

The woman in labor must be constantly connected to the CTG device during labor. So you can control the reaction of the cardiovascular system of children to uterine contractions. When opening the neck by 4 cm, contractions can be anesthetized with a solution of Drotaverine, Diclofenac is administered a little later.

In Western countries, mothers are used for comfort. She turns off pain but leaves a feeling of touch. The patient is able to push in period 2, but with less pain.

The position of the woman in labor on the bed prenatal ward is different. To reduce pressure on the inferior vena cava in the first period, the woman lies on her side. Do not use non-traditional methods:

standing;
sitting;
On knees;

They try not to resort to stimulation of contractions with the help of Oxytocin solution. The uterus with multiple pregnancy is overstretched, so the risk of complications increases. In the minimum dosage, the drug may be prescribed to prevent hypotonic bleeding. But in order for Oxytocin to have time to act, a dropper is placed during the transition to the second stage of labor.

How long the birth of twins lasts, it is impossible to guess. After the birth of the first child, the uterus needs time to contract and expel the next baby. Historically, a case has been recorded when several days have passed between the birth of twins. But in modern hospitals, to reduce the risk of complications, they try to reduce this gap. Between the birth of the first and second child, 5-20 minutes pass. The placenta, regardless of the type of twins, separates after the appearance of the second baby.

The total duration in primiparas is 8-10 hours. At the second birth, it is reduced to 5-6 hours. The third and subsequent births can proceed rapidly and end in 3-4 hours.

What complications interfere with normal labor

During pregnancy with twins, the risk of complications increases several times. Some of them appear even during gestation and their severity increases during childbirth. The most common conditions are:

premature birth;
departed prenatal;
prolapse of umbilical cord loops or limbs of one of the fetuses;
anomalies of labor activity or its weakness;
premature detachment of the placenta;
fruit collision;
intranatal blood perfusion;
torsion of the umbilical cords;
in the postpartum period.

Predictions for a successful outcome in preterm delivery depend on the degree of maturity of the fetuses. In newborns with signs of intrauterine growth retardation high risk pneumonia, intracerebral bleeding. Children are placed in the intensive care unit for nursing until they can breathe and eat on their own. In immature newborns, damage to the retina and brain often occurs, so they may develop vision pathology, cerebral palsy and other neurological complications.

Childbirth at 34-35 weeks of gestation is considered premature, but they give a more favorable prognosis.

Indications for a caesarean section

Primary and Secondary generic weakness develops with big size belly. The muscle fibers of the uterus are not able to contract normally, so the contractions gradually fade.
can occur in any of the twins. The reason for the complication is a sharp decrease in the volume of the uterus, which triggers the natural mechanism of separation of the fetal site, and a drop in intrauterine pressure. This is especially dangerous in monochorionic twins, when children receive food from a common fetal place.
Fruit collision - dangerous complication, which occurs once in every 800 multiple births. The condition can occur in monoamniotic twins, in which the first fetus lies pelvis down and the second fetus lies head down. First, the body of the first baby enters the cavity of the small pelvis, followed by both heads clasped by their chins.
, the total weight of the fetus is more than 6 kg often lead to hypotonic bleeding, anomalies in labor.
The syndrome of feto-fetal blood transfusion is diagnosed during the gestation period after 16 weeks. For monochorionic twins with this diagnosis during classical delivery, there is a risk of intranatal blood perfusion. This is a condition in which, after the birth of one child, blood is discharged to the second. The first dies from acute hypovolemia, a severe injury to the gray matter of the brain due to lack of oxygen (hypoxia).
Twins often have short umbilical cords, which, with attempts, can stretch and lead to acute. In monoamniotic twins, the umbilical cords sometimes twist together. This disrupts the blood flow to both children, there is an acute intrauterine hypoxia, which ends with antenatal death. To avoid complications characteristic of monochorionic and monoamniotic twins, the operation is performed in the period of 33-34 weeks.
Siamese twins require a special approach if the pregnancy is not terminated by medical indications V due date or late diagnosed this condition.