Multiple pregnancy: signs of twins in the early stages. Multiple pregnancy: signs, in the early stages by weeks, causes, complications

A pregnancy in which a woman carries several fetuses under her heart at once, developing at the same time, is called multiple.

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

Such a pregnancy happens:

single end;
fraternal.

Varieties of this feature

As a rule, fraternal twins are the most common. It occurs when two eggs mature in the ovaries or ovary at once, which meet with the sperm of a man during one sexual intercourse.

The same phenomenon is possible as a result of two acts, but only when the period between them does not exceed a week. Identical twins can have the same genes.

If they have such genes, then they are as similar as possible to each other, but fraternal children will be similar only if they appeared on the same day, but different time. It's no secret that identical twins always have the same sex, but fraternal children are often of different sexes.

twin girls

Possible factors and predispositions

There are many predisposing factors for the appearance of twins:

hereditary factor. If one of the partners in the relationship had twins, the likelihood of multiple pregnancy increases. It passes through one generation;
the woman's age is over 35 years. The fact was studied that the older the girl, the more likely she is to have twins;
stimulation of ovulation. When a woman is diagnosed with infertility, doctors prescribe hormonal drugs that stimulate the maturation of follicles. It is under the influence of these drugs that several follicles can mature simultaneously;
after stopping the combined oral contraceptives weak ovaries begin to become violently activated, as a result of which they synthesize their own hormones. For this reason, the maturation of several eggs at once is possible.

Signs of a dual position

Any woman who finds out about her “interesting position” first of all wants to know who is under her heart: a girl, a boy, or maybe even twins or even triplets?

Consider what signs are characteristic of pregnancy if a woman has twins. To date, signs of twin pregnancy in the early stages are divided into subjective and objective.

gestation of twins

The very first signs of pregnancy with twins are the following.

The onset of toxicosis already in the first days of the delay is the first sign of bearing twins. These include:
mild dizziness;
feeling of nausea;
vomit;
the pregnant woman is very irritable;
nervousness;
drowsiness;
weakness;
there may be increased salivation.

As a rule, a woman pregnant with twins cannot avoid toxicosis, unlike a singleton pregnancy.

Another sign of twins at an early stage is a clearly defined second line on the pregnancy test, which is well manifested already in the first days of the delay. All this is due to advanced level HCG in the urine, unlike the case with one child.
noted fast growth belly of a pregnant woman, which can be seen visually as early as 14 weeks. Naturally, the expectant mother will be able to feel the movements of the babies earlier than those pregnant with one child.
Every week, a pregnant woman has a rapid weight gain in the first trimester. If for a girl expecting one child, during this period of time it is considered the norm to gain about 2 kilograms, then for a woman expecting twins, the weight doubles. More this sign due to the fact that in a pregnant twin, the level of BCC increases, therefore, because of this, an increase in weight is noted.
increased appetite, sharp drops moods. Since in a woman’s body, in any case, “ interesting position There is a hormonal restructuring, therefore, a woman behaves in a completely different way. The body now "requires" 2 times more vitamins and minerals, so the appetite can even be called "brutal".

Objective signs of pregnancy with twins.

When examining a woman by a gynecologist, there is an increase in the uterus, which does not correspond to the gestational age. As a rule, you can notice this already starting from the 9th week of pregnancy.
After passing the tests, namely blood for hCG, very high rates are noted, as well as jumps in the growth of chorionic gonadotropin, in contrast to a singleton pregnancy. Also in the blood, you need to pay attention to the level of iron and the level of AFP (alpha-fetoprotein). When expecting twins, the iron level is usually very low, but the ACE protein level, on the contrary, increases several times.
Another objective sign of twins is listening to the beating of two hearts (Doppler system), as well as probing 2 heads with internal obstetric research(already over later dates). There is still a medical error, therefore, at the slightest suspicion of the existence of twins in a woman, the doctor sends for an ultrasound scan.
Ultrasound is the most reliable way see and determine what kind of pregnancy a woman has, more exact date pregnancies, fetal sizes and all pathologies that exist in two embryos (if any). And also with the help this method it is possible to determine whether a monozygotic or heterozygous pregnancy is observed in a woman.

Twins on ultrasound can be seen and identified as early as 4-5 weeks of pregnancy. As a rule, identical twins are determined later than fraternal twins (not earlier than 12 weeks).

Features of childbirth in multiple pregnancy

Now it's time to talk about childbirth. Women who have multiple pregnancies very rarely make it to due date. So, for example, women who have twins give birth more often at 35-36 weeks.

Double Happiness

If a woman is pregnant with triplets, the term is suitable at 33-34 weeks, but quadruple birth begins already at 30-31 weeks, so every woman with a multiple pregnancy is hospitalized already 2 weeks before the date of the expected birth.

What are the steps a woman in labor needs to take?

Because multiple pregnancies are considered premature, without fail they require resuscitation and special care;
The method of delivery when carrying twins depends on the presentation of the babies, especially one of the first.
Then the number is determined amniotic fluid, as well as possible intrauterine hypoxia of babies.
Doctors monitor the intensity and regularity of contractions. Take into account all extragenital (if any) and gynecological diseases and the woman's age.
A woman is allowed to give birth herself only if the first or both fetuses cephalic presentation, while the condition of the mother and children is satisfactory. Also equally important is the presence of regular activity of incipient labor.
A caesarean section is performed with a breech presentation of the fetus, as well as when a transverse position of one or both fetuses is detected.
Surgical delivery is performed if intrauterine hypoxia one or both fruits.

Not every woman in whose womb twins grow is ready to calmly accept such news. Yes, this is understandable. After all classic version pregnancy is the bearing of one baby, with whom, in the process of growing up, it is not easy for every woman. In a few years, the families are planning the birth of their youngest. And when two crumbs are born at once, it is even more difficult for women. Carrying twins is a double burden on the body, an increased risk of complications. Therefore, it is worth knowing in advance about the symptoms of multiple pregnancy.

Early signs of twins, without ultrasound

Pregnancy with twins turns on itself increased attention obstetrician-gynecologists. Such women and families should be treated more attentively, relieved of prolonged or excessive physical work.

Early detection of multiple pregnancy helps a woman to fully prepare for childbirth. The signs that signal twins in the womb are divided into those shown by ultrasound and the symptoms that the woman herself determines. Among the latter, in particular:

The presence of twins in the family of future parents. It can be passed on genetically and a woman will become happy mom two or three babies at the same time. As practice shows, twins are born in a generation.
Multiple pregnancy can be suspected after a pregnancy test. The control strip on it will be clear, more fat. This is evidence of an increased level of chorionic gonadotropin in the body of the expectant mother.
Drowsiness and lethargy. When carrying twins, a woman very often in the early stages suffers from a decrease in working capacity, increased fatigue, and literally sleeps on the go. This feature is manifested from the first days after successful conception when a woman is still unaware of her new position.
More pronounced signs toxicosis. In the early stages of gestation, almost half of women suffer from toxicosis. With multiple pregnancies, its manifestations can be double.
Changes in the skin of the face. When carrying twins, an excess of hormones produced affects the condition of the skin. May appear acne, redness, obvious dryness.
Accelerated belly growth. Even before twins are detected on an ultrasound, a woman sees that her stomach is growing too quickly. This is due precisely to the fact that two children in the mother's womb are cramped.

Medical tips for twin pregnancy

Obstetrician-gynecologists distinguish such signs of multiple pregnancy:

A horizontal groove that appears as the fruit develops. It indicates the presence of two babies.
Deepening of the fundus of the uterus, felt on palpation. Growing fruits protrude the corners of the reproductive organ. Also, the doctor on palpation can detect two heads and two pelvic ends.
Ultrasound for a period of 8-12 weeks can already show the presence of two or three fetuses. But in this period, the error is not excluded.
Phonoelectrocardiography. This study is done to the expectant mother after the 20th week of the term. It helps doctors to hear the beating of two hearts, their heart tones, which additionally confirms a multiple pregnancy.
When listening to the abdomen by an experienced doctor in the early stages, he will hear the heartbeat in different places.
Alphafetoprotein test. It is carried out in the second trimester of bearing a child. It determines the level of risk of fetal abnormalities. As practice shows, with multiple pregnancy, the result of this test is not only positive, but also very high.

So, there are many signs indicating twins. Therefore, a woman has the opportunity to prepare in advance for double responsibilities and loads. And according to the current standards in obstetrics, such a future mother should attend a antenatal clinic every ten days, in the third trimester - weekly.

But do not be afraid of bearing and giving birth to twins (triplets). The danger of a severe pregnancy is transmitted only by inheritance. But even in this case the level modern medicine allows women to normally endure and give birth to their children.

Especially for- Maryana Surma

They require careful medical supervision, as the risk of complications is higher than with singleton pregnancies.

If in your family there were cases of the birth of two, three or more children at the same time, then you also have a certain probability of becoming a mother of twins. However, every woman has this opportunity, regardless of heredity, especially if the conception occurred through IVF or certain medications were taken in preparation for it.

This is the development of several embryos in the uterus. A woman can carry twins, triplets (3 fetuses), quadruplets (4 fetuses), etc. The growth of multiple pregnancies, frequent in Europe (1 pregnancy out of 89), literally exploded under the influence of artificial insemination.

Stimulation of the ovaries (the appointment of drugs that favor the maturation of eggs in the ovaries) and cases of multiple pregnancy in the family are favorable factors for its development. Such a pregnancy carries more risks than others: the risk of miscarriage, premature birth, eclampsia, low birth weight, etc. increases. In addition, it can be difficult for a woman to bear more than two children in social terms. There is a high risk of problems with caring for them after birth, social and family conflicts caused by the fact that in some cases (4 embryos or more) parents are offered to reduce the number of embryos medically. Multiple pregnancy requires early adapted and enhanced monitoring (this is possible thanks to ultrasound). In most cases, it is suggested to induce labor long before the due date to avoid an accident at birth.

Nowadays, the number of pregnant women expecting twins is constantly increasing. This is due to both the increased average age of pregnant women and the widespread use of artificial insemination. If twins have already been born in the family, the likelihood of multiple pregnancy increases. Twins and fraternal twins are at greater risk of the disease during fetal development. But with its timely detection, many complications can be avoided. Most often, the doctor ascertains multiple pregnancy already at the first or second preventive examination. It is extremely rare that a twin pregnancy is discovered only during childbirth. Therefore, parents of twins usually have enough time to properly prepare for the upcoming double load. And this is very important, because the better organized the beginning of a new family life, the easier it is to adjust. There is great benefit in sharing information with other parents of twins. Contacts with them can be established through forums on the Internet.

Multiple pregnancies are becoming more common

The birth of twins, and even more so of triplets, was rare in the 1970s. Naturally, such phenomena took place, but in families where there were already similar cases. Today, more than 1% of all pregnancies are multiples (twins, triplets). This is a consequence of the increased use of medically assisted reproduction (MPR) technologies. With MPR, one in five pregnancies is multiple.

Accordingly, for you, the level of birth of twins or triplets increases if your family already had similar cases or if you have used MPR (ovulation stimulation).

Symptoms and signs of multiple pregnancy

The diagnosis is established on the first ultrasound, which demonstrates the presence of several gestational membranes in the uterus. In one third of cases, we are talking about "real" twins (monozygous, or identical). In two-thirds of cases, we are talking about "false" (dizygotic, or fraternal) twins. Later, the doctor or midwife will be able to state that the uterus is too large to contain only one fetus.

Overweight

With a second baby in the womb, your weight increases not because of the baby itself, but because of the second placenta (there are two if they are fraternal twins) and double the volume amniotic fluid.

Identical and heterogeneous

When it comes to twins, we often hear the adjectives “real” and “false”, meaning from a biological point of view, completely different things.
Identical, or monozygotic, twins are the result of fertilization by one spermatozoon of one egg. Then the formed egg is divided into two. The fetus can develop in one amniotic sac or in two, the placenta can be one for both children. The two children have the same genetic basis, they are the same sex and look alike like two peas in a pod.
Fraternal, or dizygotic, twins were formed as follows: two eggs were fertilized by two spermatozoa during one menstrual cycle. Each fetus develops in its own amniotic sac, and their placentas are different. The genetic heritage is completely different, hence the different sexes of the children, and they look alike just like brother and sister.

Risks in multiple pregnancies

Often, multiple pregnancies proceed without any problems, complications are rare. True, the time between control examinations is significantly reduced.

The emergence of risks largely depends on the formation of links between membranes and placenta, on the one hand, and twins, on the other.

In the event that both children are attached to the same placenta, their life support can be severely affected.

Even before the 15th week of pregnancy, with the help of ultrasound, you can get a clear picture of the current situation. That is, already in the early stages it is possible to assess the likelihood of risks and understand which of them should be taken into account.

The state of affairs with the placenta is described by the concept of chorionicity. A monochorionic pregnancy means that both babies share the same placenta.

Approximately every third multiple pregnancy is just such a case.

Of these, again, 33% are dichorionic-diamniotic, in which there are two umbilical cords, and the fetal bladders are separated from each other by a thick septum. 65% are monochorionic-diamniotic twins, here the septum is thinner and more transparent. 2% of twins are distinguished by monochorionic-monoamniotic chorionicity, when both the fetal bladder and the placenta are common. Which of these possible situations is realized depends on the moment of cell division.

Dichorionic-diamniotic twin pregnancy. In most cases, just such a favorable relationship develops between both twins and the fetal membranes. The risk of complications is small, therefore, special medical supervision is not required. If the first child has a cephalic presentation, then normal childbirth nothing will interfere.
Monochorionic-diamniotic twin pregnancy. Such twins can only be identical. Since there is a risk of developing feto-fetal transfusion syndrome, starting from the 12th week, it is recommended to conduct follow-up examinations twice a month.
Monochorionic-monoamniotic twin pregnancy. These twins are also always identical. Along with the risk of fusion of twins like Siamese, there is also the danger of intertwining the umbilical cords. This type of pregnancy requires frequent ultrasound examinations. To avoid complications associated with cord entanglement, a caesarean section is recommended.

Controlled Risks

If today the risk of giving life to twins increases, then the chances of giving them good health much more, not least thanks to ultrasound and medical monitoring. Great risk of premature baby, as well as malnutrition (underweight child).

Moreover, in such cases everyday life The mother-to-be is subject to much more stringent restrictions and requires a lot of rest.

In France, various associations are being created to help expectant mothers: for example, the Twins Plus Association, founded in 1979 and known for its socially useful activities since 2003. In Russia, help for mothers of twins is not so developed.

I dialed big weight. Is it possible that I am expecting twins?

Multiple pregnancy or just overweight?

Most likely you just typed excess weight compared with the average possible in the 1st trimester. If you have a naturally fragile constitution, the increase in the weight of the uterus will be noticeable earlier than in a woman of a more dense constitution. The stomach does not get big because you are waiting for two at once. During the examination, your doctor will consider: genetic predisposition, the size of the uterus (not the abdominal cavity), the beating of one or two hearts, more pronounced symptoms (morning sickness, gastrointestinal disorders), etc.

In our company, everyone thinks that giving birth to twins is wonderful, but we have a different opinion! What's happening?

Twin pregnancy and disappointment

Few couples dream of buying two cribs, a double stroller, two high chairs, in a word, two babies! A woman prepares both psychologically and physically for the arrival of a single child, and the news of a twin pregnancy can be a source of disappointment and fear for her. Indeed, taking care of one child is a huge responsibility, which she lacks in abundance, and she does not at all need this responsibility to be doubled. Accept calmly these conflicting emotions at the news of the arrival of two babies and try to avoid feelings of guilt. On the contrary, take advantage of these weeks to get used to the idea that two will appear in your family at once.

Talk to your partner, talk to other twins' parents. If you do not know them, ask your doctor, he will give you the coordinates of associations where you can get acquainted with them. You can also search the Internet. The fact that you are not the first parent to be confused and doubtful will help you to accept the situation and even enjoy it. If at first the efforts to care for two babies should be multiplied by two, then happiness should also be multiplied by two.

Twins do not always end up in the incubator, it all depends on the degree of "full-term" and weight.

Three types of twin pregnancy

If you are expecting twins, the doctor's first task will be to determine by ultrasound, starting in the 1st trimester and as soon as possible, the number of placentas and amniotic sacs. In the presence of two placentas and two amniotic sacs, the pregnancy is defined as "bichorionic biamniotic". If one placenta and two amniotic sacs are identified, it is defined as "monochorial biamniotic". In very rare cases where there is one placenta and one amniotic sac, this is a "monochorionic monoamniotic" pregnancy. All three types of twin pregnancies are different.

Ultrasounds once or even twice a month, starting from the 22nd week of amenorrhea, have a very great importance to monitor the development of both babies. One that receives nutrition in a smaller volume may have malnutrition (low weight) as a diagnosis, the other is prone to cardiovascular diseases A team of specialists, by identifying and taking care of the problem, can help balance the situation, safely "bringing" you directly to childbirth.

If you are expecting three or more babies

The precautionary measures taken when expecting two babies are greatly enhanced when it comes to expecting three or more children. For a future mother, pregnancy is marked by anxiety and anxiety, so she may need the help of a psychologist, starting from the early stages and ending with the moment of childbirth.

If there are more than three fetuses, the risk of complications increases proportionally. There is a small chance that childbirth will occur at an acceptable time, that is, after 34 weeks. Careful medical supervision, childbirth should take place in a maternity hospital with a level not lower than.

Your doctor may suggest that you reduce the number of embryos to two. It is often difficult for parents to make such a decision, but even more - and this is the most common case - - if the pregnancy was the result of infertility treatment (namely, in vitro fertilization). In rare cases, one or more embryos freeze in their development.

Increased medical attention

Expecting twins or triplets means taking very good care of yourself. And your gynecologist and midwife will help you with this, who will monitor your well-being very carefully, since various kinds of complications are possible: premature birth (about 25% of multiple pregnancies end at the 32nd week, that is, at the end of the 7th month), arterial hypertension(the risk doubles or triples), malnutrition (low weight of the child), "donor-recipient" syndrome.

More frequent consultations

Clinical observation is getting closer. In the case of multiple pregnancies, the midwife should visit you at home once a week, starting from the 22nd week of amenorrhea. She must make sure that you get enough rest so as not to provoke cramps in the uterus. She will also check your blood pressure and protein levels in your urine. Use these visits to get the information you need - for example, about the food system. Also, if you are expecting twins or triplets, food portions must be increased (by 10-20%).

Leisure Benefits

Among other things, you should rest as much as possible, thereby reducing the risks. No need to lie down - although sometimes it is necessary - eat during the day during rest periods, avoid long walks and transport trips, starting from the 5th month.

Often the doctor prescribes in the 2nd trimester sick leave in a preventive mode, in order to avoid premature birth, you can also receive help with the housework. However, in some cases, hospitalization is necessary.

Soft delivery

In the case of a twin pregnancy, the term of delivery is 38 weeks, and not 41 weeks, as in a single pregnancy. It is necessary that childbirth be carried out in a maternity hospital, where specialists are able to help in any situation.

After the second time, ultrasounds are performed once a month to monitor the development of the embryos.

What are twins

Why does it become possible development during one pregnancy several fetuses at once? In the first days after conception, a fertilized egg can divide into two or more completely identical parts. In this case, babies are born, who are called monozygotic, or identical, twins. They are always of the same sex, always have the same blood type, and have an amazing resemblance in appearance.

At the same time, depending on the period of development of the zygote, it was divided into two parts, future babies can each have their own placenta and amniotic cavity, different amniotic cavities, but one placenta, as well as common placenta and amniotic cavity.

Another way is also possible. In the ovary of the expectant mother, the simultaneous maturation and release of several different eggs occurs. If each of them on the way to the uterus is fertilized by a spermatozoon, then several embryos will be implanted into the mucosa at once. These babies are called fraternal twins, or heterozygous (dizygous - in the case of twins, trizygous - in the case of triplets, etc.).

These children will be different from each other, as sisters and brothers born from different pregnancies. They may be of the same sex or different, their blood types may be different, and they may have little resemblance in appearance.

After all, unlike identical twins, all these differences are laid down in them at the gene level.

At a later date, the doctor makes an assumption about the presence of two or more fetuses in the uterus based on its rapid increase, which is usually observed in the second trimester of pregnancy.

Some later doctor during an external examination, it can determine the position of several heads or pelvic ends of the fetus, listen to heartbeats at different points of the uterus.

Features of multiple pregnancy

Carrying two or three babies at the same time creates an additional burden on the body of the expectant mother, so from the very beginning of pregnancy she is provided with the most close attention doctors. However, this condition in itself is not a pathology, therefore, if you are expecting several babies at once (and most often twins are expected in multiple pregnancies), following all the doctor's recommendations and regular monitoring will help you spend the next eight to nine months with no less pleasure. than all other mothers.

Due to more intensive growth uterus, which is observed with multiple pregnancy, the risk of abortion is slightly higher than usual. Special attention required by the expectant mother recent months- at this time there is a possibility of premature pouring of water. Most likely, your doctor will recommend you a sparing regimen, restriction physical activity, especially in late pregnancy, and in some cases - bed rest and even hospitalization.

Be careful when doing exercise, give preference to swimming, do not plan long trips and trips.

It should be remembered that childbirth in such cases most often begins a couple of weeks earlier, at 36-38 weeks of gestation, and twins are born with a slightly lower weight than normal newborns. But you should not be afraid of this - nature takes care of these babies and provides them with increased adaptability.

The needs of a pregnant woman nutrients, vitamins inevitably increase, since it must provide everything necessary for two organisms at once. The needs of the expectant mother, who is expecting two or three babies, increase even more. You should carefully consider this problem, as your body can deplete its resources quickly enough, and this will lead to the risk of developing anemia, vitamin deficiency, as well as late toxicosis pregnant. Carefully consider nutrition, including protein products in it, multivitamin preparations And mineral complexes that your doctor recommends.

Under special control your doctor will also be your cardiovascular system and the normal functioning of the kidneys, since these organs are under the greatest stress.

With a normal location of the placenta until the 30th - 32nd week of pregnancy, the size of future babies does not differ from the size of the fetus in a singleton pregnancy. In the following weeks, their total weight gain is approximately equal to that of the fetus at normal pregnancy. At the same time, it is quite natural that the volume of the abdomen and the weight of the expectant mother somewhat exceed these figures for women who are expecting the birth of one child.

Organization of medical care for women with multiple pregnancies

As a rule, multiple pregnancy is detected already during the first ultrasound examination. The most reliable data on the status of the membranes can be obtained between the 9th and 15th weeks of pregnancy. If the twins are fraternal, they may be of different sexes. But even if the born babies are of the same sex, their similarity will not be as great as that of identical twins.

Identical twins receive identical genetic information from their parents, so they are always the same sex. Babies are so similar to each other, at least in infancy and childhood that they can be confused. They often have the same likes and dislikes. However, for pregnancy and childbirth, it is not the division into identical and twins that is important, but how their connections with the placenta and fetal membranes are formed.

Frequency of multiple births

Multiple pregnancies: 2-5% of all pregnancies up to 10 ng.
Monozygotic twins: 3-5/1000.
Dizygotic twins: the frequency is variable, depending on family history, age of the mother, infertility treatment.
The frequency of mono- and dizygotes in multiple pregnancies: 70% dizygotes (necessarily dichorionic / diamniotic). 30% monozygotes (necessarily same-sex, shell ratio: 29% dichorionic/diamniotic, 70% monochorionic/diamniotic, 1% monochorionic/monoamniotic).

Sonographic diagnosis of chorions/zygotes

1st trimester: clearly distinguishable chorionic cavities, sometimes in one anmiotic sac (wide bridge!) - the most favorable moment for diagnosis!

II and II trimesters:

The sex of the fruit.
The location of the placenta (with monochorionic - necessarily unilateral placentation on both sides.
Thick bridge (> 1.6 mm = 4 layers - dichorion).
X-sign in dichorionic twins (triangular protrusion of the placenta in the region of the radiated amniotic membrane during chorionic involution).
T-signs in the case of monochorionic twins (vertically protruding amniotic membrane separating the amniotic sac at the placenta).

Postnatal diagnosis of chorions/zygotes

Gender of children.
Histology of the placenta.
Blood type of children (method reliability 99.9%).
Enzyme-histochemical and tissue-typing analysis (high specificity).
Check similarity/similarity (method reliability 98%).

Prenatal problems in multiple pregnancies

Uncontrollable vomiting of pregnant women (20% of twins, 60% of triplets).
Premature contractions, cervical insufficiency, premature birth.
Premature rupture of amniotic fluid, amniotic infection.
Polyhydramnios (12%).
Preeclampsia (risk is 5 times higher compared to singleton pregnancy).
Intrauterine growth retardation (twins from 35 weeks, triplets from 32 weeks).
Feto-placental insufficiency.
An increased level of malformations ( birth defects heart), especially in monozygotic twins.
Increased risk of chromosomal aberrations.
Risk spontaneous abortions(2 times higher).
Increased risk of hypoxia during vaginal delivery (for the second of twins).
Dyspnea in the mother due to the high position of the diaphragm, gastrointestinal complaints (in the 3rd trimester).
Varicose veins, severe swelling.
"Twin Disappearance Syndrome"(Vanishing Twin Syndrome) - 30% of all initially multiple pregnancies end in the birth of one child (Fetus papyraceus, paper / mummified fetus).
"Dead Fetal Syndrome"(Dead Fetus Syndrome) - intrauterine death of one of the monochorionic twins: possible (20-50%) damage to the survivor due to a hypoxic crisis due to disturbances in the joint circulatory system of the deceased child. The original theory of damage to the surviving child due to the introduction of thromboembolic material through open vascular connections has never been confirmed. Later consequences: violations in the coagulation system of the mother's blood, caused by fetal thromboplastic material - debatable.

Feto-fetal transfusion syndrome (FFTS)

Definition: intrauterine blood transfusion in monochorionic twins through placental vascular anastomoses.

Frequency: 1:1100-10000 (15% of all monochorionic multiple pregnancies), is the cause of death of twins in the perinatal period in 15-17% of cases.

Acute FFT syndrome develops peripartum (growth and amount of amniotic fluid are slightly changed, the donor is anemic, the hematocrit is normal depending on the circumstances, the acceptor is hypervolemic).

Syndrome of chronic TFT (prolonged hemodynamic imbalance) - Triad:

Violation of growth and development> 15%.
Reducing the volume of amniotic fluid.
Hemoglobin change > 5 g/dL.

Donor: IUGR (intrauterine growth / developmental delay), anemia, hypovolemia, hypoglycemia, oligo / anuria, ahydramnia, dropsy due to anemia. Sometimes formed kidney failure with anuria, which regresses postnatally after a few weeks (good prognosis!).

Acceptor: polycythemia, hypervolemia, increased rheological blood viscosity, hyperbilirubinemia, hyperglycemia, polyuria, polyhydramnios, heart failure, often with dropsy, severe postnatal hypertension.

Differential Diagnosis: discordant growth of twins (also with dichorionic twins).

Forecast: the sooner and more suddenly disturbed hemodynamics, the worse. In the absence of treatment, mortality is up to 100%. Morbidity - periventricular leukomalacia.

Therapy:

Drainage (repeated) of the amniotic fluid - a decrease in intra-amniotic pressure, the survival rate is 60-70%.
Fetoscopically guided laser photocoagulation of shunts: overall mortality 53%. Has a significant advantage in terms of morbidity (neurological) in high risk intervention.
Amnioseptostomy [E1].

Multiple pregnancy with acrania and acardia - 1:35,000

Definition: asymmetric malformation of one of the twins, the perfusion of which is carried out at the expense of the other twin through an arterial bypass. Massive puffiness leads to the formation of a "heartless monster" (absent or improperly developed heart, head, upper limbs).

Diagnosis: various forms acrania-acardia, generalized edema (dropsy), with color Doppler sonography - signs of retrograde arterial perfusion of the twin.

Associated anomalies: chromosomal aberrations in 50%.

Mortality: 50% among donor twins.

Therapy [E2]: The principle is to interrupt the retrograde circulation in the umbilical cord of a fetus with acrania-acardia.

Ligation of the umbilical cord.
Laser coagulation of the umbilical cord.
Intravascular installation of fibrin glue.

Pregnancy with Siamese twins -1:50,000

Definition: breaking early embryonic development due to incomplete separation of monochorionic twins.

Types: thoracopagi (70%), craniopagi, pyopagi, ischiopagi.

Diagnosis: lack of separation of body surfaces and fixed mutual position of both twins during ultrasound.

Forecast: depending on the position of the organs and the possibilities of interventional pediatric surgery.

Monitoring of multiple pregnancies

More frequent sonographic studies - especially in monochorionic twins.

Doppler control (every 1-2 weeks from 25 weeks of gestation).

Sonographic control of growth and amount of amniotic fluid (every 2 weeks).

Features of delivery in multiple pregnancy

With multiple pregnancy natural childbirth are possible under the same conditions as with a singleton. Doctors resort to surgery if the uterus and fetuses are too big sizes, and the birth canal of a woman is not prepared for a period of 38 weeks or more.

Overdistension of the uterus - primary and secondary weakness labor activity, atony of the uterus.

Premature detachment of the placenta for the second of the twins - after the birth of the first.

Prolapse of the umbilical cord.

Children's mechanical clutch.

Violation of the separation of the placenta.

Birth management in multiple pregnancies

Indications for vaginal delivery: cephalic presentation of the first of the twins; the difference in weight between twins is less than 500 g.

Desirable terms of delivery 39-40 weeks.

Indications for caesarean section: transverse position, breech presentation the first of twins, the difference in weight between children is more than 500 g; premature birth, more than 2 fetuses, monoamniotic twins (from 32 weeks).

A multiple pregnancy is something for which it is impossible to prepare, since it is impossible to predict it, or vice versa, to calculate its formation. It is worth noting that it is much more difficult to endure such a pregnancy and you will have to try hard not only to save the babies, but also to promote their even development.

early signs of multiple pregnancy

Basically, the signs of pregnancy in the early stages are the same in any case, both when carrying twins and one crumb, however, in the first case, there may be significant deterioration in the condition and the manifestation of new signs.

A twin pregnancy has such primary symptoms as:

Severe toxicosis, and it cannot be avoided in any way, unlike the bearing of one fetus.
The presence of a bright second strip on the test to detect pregnancy, as the level of a hormone called hCG increases significantly.
A rapid increase in the volume of the abdomen of a pregnant woman, which can be recognized literally at week 12, but depending on the physiology, this is possible much earlier.
An earlier manifestation of the movements of babies, since they have much less space for movement, respectively, the shocks will be brighter and earlier.
Rapid weight gain, especially during the first trimester, which occurs in a singleton pregnancy by the middle of the second trimester.
The presence of increased appetite.
Sudden and severe mood swings.

In addition, a woman has a need to eat exotic fruits and unusual foods, as it is required increased amount vitamins and minerals, and, as you know, the body begins to look for them in food, in which there is a strong interest.

The main signs of twins in early pregnancy

Such a diagnosis as multiple pregnancy can be determined independently, but it is better to undergo an examination that will show real result and confirm your guesses. An examination by a doctor allows you to note signs such as an enlarged uterus, which, for example, at 5 weeks of gestation may correspond to 9 weeks of development of an interesting position. Blood is donated for a hormone such as hCG, and if it is noted too high rate, then this becomes another sign.

Be sure to check the blood for the presence of iron levels, as well as alpha-fetoprotein. If there are twins in the uterus, then the level of iron will be reduced, and the ACE protein, on the contrary, will be increased.

Naturally, you can find out that there is not one fetal egg inside, but two by listening to two heartbeats, as well as by probing two heads, but this is done at later stages of pregnancy. To exclude a medical error, it is necessary to undergo an ultrasound scan. It is ultrasound that is an option that will not allow you to make a mistake and will make it possible to identify the exact number of fetuses in the uterus, and also with its help the gestational age is established, and pathologies or their absence are detected.

At what time can twins be determined

The first signs that a woman is pregnant are quite understandable, however, when will it be possible to see the presence of an embryo inside the tummies? Generally, recognize how much fertilized eggs contains the uterus, it is possible by ultrasound already at the 8th week of pregnancy.

If there are several fetuses in the uterus, then several heartbeats can be detected.

It is worth noting that experts do not recommend trusting such a result, and to be more precise, a re-examination is required for a period of 12 weeks, since the probability of death of one fetus is quite high and, according to statistics, only 5 women out of 10 can survive a second child, and this does not depend on the physiology or health of the organism.

Identical twins: when seen on ultrasound

How is pregnancy determined if identical twins are present?

In this case, it is also:

Examination by a doctor;
Pregnancy test;

If the pregnancy contains identical twins, then they can be detected only at week 12 and not earlier. After determining the babies after 3 weeks, a second study is required to confirm the viability of the fetus. Frequent examination by means of an ultrasound machine will not harm babies, as they are now used exclusively modern technologies, but you can clearly track their condition and how they develop.

What are the signs of multiple pregnancy

Ultrasound does not show that twins are in the womb or twins, but you can determine their number. It is worth noting that a singleton pregnancy is significantly different from a multiple pregnancy and the second can be diagnosed in various ways.

Diagnostic procedure:

Naturally, the analysis of complaints about the state of the fair sex is taken into account first. These signs include: delay, nausea, vomiting, malaise, weakness, drowsiness, and swelling of the mammary glands.
The anamnesis of the menstrual function is examined, that is, when the last menstruation was, whether the cycle is regular and how exactly it goes.
Be sure to take into account the results of a pregnancy test done at home.
Blood is tested for the hCG hormone, which during multiple pregnancy should go off scale several times. Eat special tests, which can be done independently, and by how brightly they are colored, an increase or increase will be determined normal level hCG hormone. The test should be done in the morning so that the concentration of the hormone in the urine is maximum.
Held gynecological examination, during which an increase in the volume of the uterus should be detected.

In addition, an ultrasound of the pelvic organs is done. As a rule, ultrasound before 11 weeks is prescribed only if there were previously problems such as miscarriage, fetal fading, ectopic pregnancy or even suspicion of the presence of two eggs. In other cases, a planned study of the body is sufficient.

Twin pregnancy and possible complications

Even geneticists cannot understand the reasons why a twin pregnancy is formed, but they are sure of one thing for sure that it depends on heredity, and it can also be if the fertilization was artificial. The definition of multiple pregnancy does not occur immediately, and most importantly, the formation of disorders and even complications often occurs, and the types of such consequences can be very different. The way the stomach looks does not at all indicate whether there are abnormalities inside the body, and therefore it is required to undergo regular examinations and inform the doctor about all manifestations of pregnancy. There can be many complications, and if the pregnancy is multiple, then hospitalization in the clinic is desirable, which will reduce the risk of harm to the fetus, and even more so the death of one of them.

Toxicosis is both a complication and a kind of normal course of pregnancy. Ideally, it should take place during the first trimester and no more, however, if signs and very bright ones appear in subsequent periods, then this is a signal of a deterioration in the condition.

Preeclampsia is a complication of pregnancy, which can be characterized as a violation of the function of organs important for the life of the fetus. As a rule, such a diagnosis is made after the 20th week, as soon as the second ultrasound is performed and tests are passed. Preeclampsia can be of three forms from mild to severe, and it manifests itself in the form high blood pressure, edema, strong discharge, including bright brown urine.

The occurrence of preeclampsia and eclampsia is quite possible with multiple pregnancies, and this occurs against the background of severe preeclampsia. Symptoms may include increased blood pressure, dizziness, and goosebumps in the eyes. In this case, hospitalization in the clinic under the round-the-clock supervision of doctors is desirable.

With multiple pregnancies, the following problems are possible:

miscarriage;
premature birth;
Threat of fading of both fruits, or one of them.

It is worth noting that in order to exclude such consequences, you need to constantly take tests, undergo an examination and, most importantly, follow all the doctor's recommendations regarding treatment, lifestyle and nutrition. A woman in this position needs a double dose of vitamins, peace of mind and, most importantly, fresh air and the help of loved ones.

To eliminate the threat of premature birth, you need to ensure that there is no uterine tone, which will avoid contractions, placental discharge and similar problems. premature pregnancy it is considered that which ended at a period of 20-37 weeks, and in order to prevent it, in case of a threat, special preparations are required. There is also a post-term pregnancy, and this is one that ended at a period of more than 42 weeks. Intrauterine death of the fetus at a period of 28 weeks occurs due to the mother’s own negligence, as well as due to a medical error, for example, if defects were previously overlooked, and therefore it is worth choosing only qualified specialists and visit the fiery community of expectant mothers.

Problems of multiple pregnancy (video)

Both pregnancy itself and its absence can cause a lot of problems, and therefore you need to treat it with all responsibility in order to avoid the death of the baby, and even more so its underdevelopment. Now there are many drugs that help maintain pregnancy and technologies that allow you to carefully monitor it, and you should not neglect them in any case.