The development of two fertilized eggs in the uterus. Questions about multiple pregnancy

At 12 weeks, an ultrasound scan showed that twins, monochorionic, the 1st - ktr 64, the 2nd ktr 69. At 20 weeks, the difference in weight in the fetuses is 100 g 361/262. Doctors are afraid of the possible development of SFFT (Feto-Fetal Transfusion Syndrome). What is the percentage difference between them and will it really lead to the death of both fetuses?

With monochorionic twins, the risk of developing feto-fetal transfusion syndrome is very high. Therefore, as a rule, there is a difference in the indicators of fruit fetometry, their condition and adaptive capabilities. Observation during pregnancy allows for a timely assessment of the condition of the fetus, without waiting for a critical condition.

One gestational sac was placed on ultrasound at 3 weeks. HCG showed 5-6 weeks. On ultrasound at 13 weeks they said 100% girl on the back wall, and at 17 weeks they said that one fetus was a boy on the anterior wall. I have monozygotic twin brothers. Could it be that two uzists in a hurry found different kids, and the second one was not looked for or noticed.?!

In terms of 13 and 17 weeks, the diagnosis of singleton / multiple pregnancy is not difficult. Highly specialized ultrasound specialists of our center will be able to answer your questions.

Dee Dee twins 24 weeks pregnant. On ultrasound, one fetus is developed in terms of time and size for 24 weeks and 1 day, and the second for 22 weeks and 3 days. Is this delay normal?

Unfortunately, it is impossible to answer your question without information about the size of both fetuses in the period of 11 - 14 weeks, screening data of the first trimester and information about the state of the placenta, umbilical cord, the amount of amniotic fluid and Doppler results of your babies. Or send the question again, specifying all the necessary data. Or make an appointment by calling the Unified Call Center: 8-495-636-29-46

18-19 weeks of pregnancy, did an ultrasound: monoamnitic monochorionic undissociated twins. Do I have heterosexual children or same sex children? How to understand it? What is it in general and whether it can threaten me with something?

Monoamniatic monochorionic twins means that babies not only have one placenta for two, but also one amniotic cavity for two. In this case, the gender of the babies should be the same. Non-dissociated twins means that the babies have not separated, “grown together” with each other (the so-called “Siamese twins”). In this case, the prognosis for the life and health of babies may be unfavorable. To clarify this serious diagnosis, it is advisable to conduct an expert ultrasound, and then consult a geneticist.

At the first ultrasound for a period of 7 weeks, the pregnancy is monochorionic biamniotic, and in the maternity hospital at 11 weeks - bichorial biamniotic. In connection with the doctor's concern about the reduction of the cervix, she did an ultrasound at 15 weeks and again put a monochorionic pregnancy. At the same time, the doctor was completely convinced that they were twins. At 19 weeks they said that you can’t see how many placentas. How to find out twins or all the same twins? And whether it is possible or probable it on the subsequent US? The kids are same-sex, neither my family nor my husband had twins.

The most accurate chorionicity (how many placentas) is determined in the first trimester, when it is possible to assess the thickness of the amniotic septum and the presence of chorionic tissue between the membranes of the amniotic cavities. With an increase in the gestational age, these signs lose their significance and the determination of chorionicity when both placentas are located along the same wall becomes difficult. An indirect indicator of monochorionic twins is the same sex in both babies, but this option is also possible if there are two placentas. It will be possible to finally resolve the issue of twins after childbirth.

We are planning a pregnancy. In October, the ovarian cyst was removed. After laparoscopy, the doctor prescribed treatment: 3 injections of Zoladex, 3 months of drinking Byzanne and Claira. In my husband's line, his grandmother was from twins, my husband has twin cousins, in my line there are no twins. After taking these drugs and taking into account the heredity of the husband, do we increase the chances of a multiple pregnancy?

If more than three months pass from the moment you stop taking the drugs to conception, then the effect of an increased risk of multiple pregnancy will come to naught. As for heredity, the probability of multiple pregnancy is increased, but slightly compared to the population.

The first day of the last menstruation was April 27, my periods were always irregular, I was diagnosed with polycystic disease. Conception could occur on May 10, 11, 17, June 2 and 13. Considering the first day of the last menstruation, it should have been 9 weeks pregnant on June 29, but the embryo was not visible. HCG - 22000 (corresponding to 9 weeks of pregnancy), said an embryonic pregnancy, suggested a purge or pills. Is there a possibility of multiple pregnancy? My father is a twin and I have twins from my grandmother. Could there just be a short period at which the embryo is not visible? Is hCG high because multiple pregnancy is developing?

To clarify the situation, it is necessary to undergo a study in dynamics.

At 12 weeks of pregnancy, according to ultrasound: dichorionic diamniotic twins, at 21 weeks: monochorionic diamniotic twins, at 24 weeks: monochorionic, sex is the same. During the consultation, we decided that we should believe the first ultrasound. How to be?

To determine the chorionicity with twins, early ultrasound is the most informative, so it is better to focus on ultrasound at 12 weeks.

6-7 weeks of pregnancy according to ultrasound, according to the last menstruation - 9-10 weeks. Cycle 34-36 days, ovulation was late, on May 10 by ultrasound: fetal egg 18 mm, 1 embryo: CTE 4.7, heart rate 93 beats / min., yolk sac 3.1 mm, 2 embryo: CTE 3.4, heartbeat is not recorded, yolk sac 2.8 mm, corpus luteum in the right ovary 15 mm. Can the second embryo be delayed in development, or does this mean that the second embryo is frozen? And is it not a small heart rate in the first embryo?

The heart rate of the first fetus is within the normal range. The CTE of the second fetus (3.4 mm) corresponds to a period of less than 5 weeks. At this time, the fetal heartbeat may not yet be determined. The size of the embryos can vary significantly already in the early stages of pregnancy, so it is quite possible that the second embryo still needs to grow. To assess the growth rate of the embryos and the presence of a heartbeat in both babies, it is advisable to repeat the ultrasound in 2-3 weeks.

7 weeks of pregnancy, a multiple pregnancy is called into question. On November 22, there was a spontaneous abortion, the period for menstruation was 8-9 weeks, according to ultrasound a few hours before the miscarriage, the fetal egg was 4-5 weeks in size. interruption, but the doctor dissuaded, I want to keep the pregnancy. What is the probability that frozen and spontaneous abortion will not happen again?

The causes of missed pregnancy are different - genetic, antiphospholipid syndrome, luteal phase deficiency, viral infections. It is necessary to examine and adjust the intake of drugs depending on the results obtained.

7 (obstetric) weeks of pregnancy, according to ultrasound: two fetal eggs, but one has an embryo and a heartbeat is heard, and the other is empty. Can the second egg be late with the development of the embryo, or is it already certain that it will resolve?

Sometimes two fetal eggs are laid, in one of which the embryo develops, and in the second fetal egg the embryo is not laid. At screening time I at 11-14 weeks, it will be possible to accurately determine the number of embryos and how they develop.

One fetus and two bladders, are they twins or twins? What is this?

Sometimes two fetal eggs are laid, in one of which the embryo develops, and in the second fetal egg the embryo is not laid. Based on your information, you are having a singleton pregnancy. The second "empty" fetal egg does not affect the development of the fetus.

The second pregnancy, 22 weeks, monochorionic diamniotic twins, the first was 5 years ago, she gave birth on time, the son is fine. At 21 weeks, one fetus froze. The gynecologist sent for an interruption, I refused, because I hope to endure the second one until a viable term, at the moment the child is healthy, all indicators correspond to the term. What are our chances? What are the risks for the living baby and for me? I am 27 years old.

With diamniotic twins, there is a chance to carry a second child. But careful monitoring in dynamics is necessary, including ultrasound and Doppler. For you, the risks are similar to the usual twins.

13 weeks of gestation, monochorionic diamniotic twins, one pathology of MVPR with CHD omphalocele. What happens in such cases? Is it possible to save a second healthy baby?

Theoretically, yes. But if a fetus with congenital malformations dies in utero, then this can negatively affect the formation of the second fetus and there may be secondary changes in it, including quite serious ones.

5-6 weeks of pregnancy, ultrasound identified one fetal egg GS-21.3 mm in size, and it contains two yolk sacs 4.2 mm and 4.4 mm. Does this indicate twins?

Ultrasound is needed in dynamics in 1-2 weeks, when it will be possible to determine the number of embryos and their heartbeat.

My first pregnancy came at the age of 19, twins, two girls. I had a spontaneous miscarriage at 17 weeks. The second pregnancy came in 1.5-2 months, one fetus, she gave birth at the age of 20, a boy. I didn’t have twins in my family, my husband had a grandmother from twins, his mother and her sisters and brothers didn’t have twins, her children don’t have sisters and brothers either. What is the probability that I will have twins?

The probability is increased, but it is impossible to say in numbers.

At 7 weeks of pregnancy, according to ultrasound: two embryos in one fetal egg, fetal KTR 9 mm, monochorionic biamniotic twins. According to the ultrasound at 9 weeks, another doctor did not see the second fetus. The KTR of the fetus during the ultrasound varied from 26 to 28 mm. Can the second hide behind the first? And why did the KTR change?

When measuring CTE, an error within 2 mm is acceptable, we recommend screening ultrasound for a period of 11-12 weeks to clarify the situation.

6 weeks pregnant. According to ultrasound: there are two fetal eggs in the uterine cavity, in one of which there is a developing embryo with a heartbeat, in the second - the embryo is not visualized. Is there a possibility of fertilization of two eggs with a difference of several days? Why does the development of the second embryo lag behind the first? Does this mean a halt in the development of the second egg?

Most likely, we are talking about a non-developing fetal egg. The death of the second fetal egg will not affect the bearing of the remaining baby.

4 weeks pregnant, a week ago we found two fetal eggs in a private clinic. Has made US in other place, one fetal egg 7.7 mm, another - do not see. What could it be? Has it disappeared? Is this a doctor's mistake or a different quality of the equipment? There were no allotments.

It is not uncommon for one of the fetal eggs to die in early pregnancy and resolve.

First pregnancy, 7 weeks. According to ultrasound at 4.4 weeks: signs of a two-egg uterine pregnancy in one fetal egg and anembryony in the second. Now what to do with the second frozen egg? Should it be removed or will it come out on its own? What will happen to a normally developing fetal egg now? I am 27 years old.

There is no cause for concern. The dead fetal egg will resolve without harm to the remaining one. We recommend that you repeat the ultrasound to clarify the situation.

I have a twin pregnancy. Is biochemical screening informative?

The first day of the last menstruation is December 2, the average cycle length is 28 days. The first ultrasound on January 4: a 3 mm fetal egg was determined in the uterine cavity, the corpus luteum was not identified. On January 5, the result of the analysis for hCG is 4471.0 mIU / ml. At the 11th week of the obstetric term, I found out that I had twins. Is it possible not to see twins at 4 weeks of obstetric period? Is it possible to conceive two babies at such different times?

For a very short period of time (as in this case), it is quite possible not to see the second fetal egg. And if we are talking about identical twins, then they can only be seen when the embryos are well visualized.

At the first ultrasound, the doctor did not see the fetal egg, set a period of no more than two weeks, the hCG result on the same day was twice as high. Two weeks later, she came to register with another doctor, without an ultrasound, the doctor examined, set a period of 8 weeks. At 12 weeks, they wrote at the screening that there was one fetal egg and one fetus. Could you not see the second baby on the ultrasound or is it impossible?

12 weeks of pregnancy, on ultrasound they said that one embryo froze at 9-10 weeks, and the second one is developing well. What is the probability of carrying a child? Will there be infections from the dead fetus?

The chances of having a baby are pretty good. With a frozen fetus at this gestational age, it can resolve without harming the second fetus.

Did IVF. Last period April 10th, puncture April 28th, transfer April 30th. The result of hCG on May 14 is 403. At what time can a multiple pregnancy be detected? When to do an ultrasound? The doctor recommended June 11, and the doctor who performed IVF recommended May 25.

Is it possible with a multiple pregnancy to have an ectopic development of one fetus and a fading of the second at the same time? although it was clear from the condition of the pregnant woman, as well as the size of her uterus, that the fetus had died?

It is possible to have a uterine and ectopic pregnancy at the same time. An ectopic pregnancy will develop until the rupture of the fetus. It is important to prevent this, but to carry out surgical treatment preventively with minimal health consequences.

I had identical twins at 6 weeks. One is 5.7mm, the other is 6.2mm. The first has a heartbeat of 154 beats / min, the second - 156 beats / min. Now I am 11 weeks old. Could one of them "disappear" by this point?

In some cases, in the early stages, one of the twins may stop developing, which can lead to its "disappearance".

By my count, I'm three weeks and three days pregnant. Menstruation was from 21 to 26 September. I know that I got pregnant on October 9th. Everything was planned. I started drinking vitamins with folic acid in early September. On October 31, I passed an analysis of hCG - 19795. On the same day, I did an ultrasound scan, which showed 5 weeks and six days. Can an ultrasound doctor make a mistake and not see a multiple pregnancy, but put a longer period?

In the conclusion of the ultrasound, the obstetric gestational age is indicated, from the first day of the last menstruation. You consider from conception, the true term. It is of no use to anyone but you. All terms (decree, childbirth, etc.) are considered in obstetric weeks. Details about the calculation of gestational age are written in the articles on our website.

My paternal grandmother had twins and my maternal grandmother's husband had twins twice, I have two sons and am currently 4 weeks pregnant, can I have twins?

Based on pedigree, you are twice as likely to be born as compared to population frequency. Everything will be visible on the ultrasound.

I went for an ultrasound at 16 weeks pregnant, everything was fine. But when I came for an ultrasound at 24 weeks, they told me that I had uterine fibroids, although I didn’t have it. Could uterine fibroids have formed in 2 months?

Most likely, uterine fibroids were, but small in size. During pregnancy, fibroids rapidly increase in size.

multiple pregnancy- this is such a pregnancy in which not one, but several (two, three or more) fetuses simultaneously develop in the woman's uterus. Usually, the name of a multiple pregnancy is given depending on the number of fetuses: for example, if there are two children, then they talk about pregnancy with twins, if three, then triplets, etc.

Currently, the frequency of multiple pregnancy is from 0.7 to 1.5% in various European countries and the USA. The widespread and relatively frequent use of assisted reproductive technologies (IVF) has led to an increase in the incidence of multiple pregnancies.

Depending on the mechanism of the appearance of twins, dizygotic (twin) and monozygotic (identical) multiple pregnancies are distinguished. The children of fraternal twins are called twins, and the children of identical twins are called twins or twins. Among all multiple pregnancies, the frequency of twins is about 70%. Twins are always of the same sex and are like two drops of water similar to each other, because they develop from the same fetal egg and have exactly the same set of genes. Twins can be of different sexes and are similar only as siblings, since they develop from different eggs, and, therefore, have a different set of genes.

A twin pregnancy develops as a result of the fertilization of two eggs at the same time, which are implanted in different parts of the uterus. Quite often, the formation of fraternal twins occurs as a result of two different sexual intercourses, carried out with a small interval between each other - no more than a week. However, fraternal twins can also be conceived during one sexual intercourse, but on condition that the maturation and release of two eggs from the same or different ovaries occurred simultaneously. With fraternal twins, each fetus necessarily has its own placenta and its own fetal bladder. The position of the fetuses, when each of them has its own placenta and fetal bladder, is called bichorionic biamniotic twins. That is, in the uterus there are simultaneously two placentas (bichorionic twins) and two fetal bladders (biamniotic twins), in each of which the child grows and develops.

Identical twins develop from one fetal egg, which after fertilization is divided into two cells, each of which gives rise to a separate organism. With identical twins, the number of placentas and fetal bladders depends on the period of separation of a single fertilized egg. If separation occurs during the first three days after fertilization, while the fetal egg is in the fallopian tube and has not attached to the wall of the uterus, then two placentas and two separate fetal sacs will form. In this case, there will be two fetuses in the uterus in two separate fetal bladders, each feeding on its own placenta. Such twins are called bichorionic (two placentas) biamniotic (two amniotic sacs).

If the fetal egg divides 3-8 days after fertilization, that is, at the stage of attachment to the uterine wall, then two fetuses are formed, two fetal bladders, but one placenta for two. In this case, each twin will be in its own sac, but they will eat from one placenta, from which two umbilical cords will depart. This variant of twins is called monochorionic (one placenta) biamniotic (two amniotic sacs).

If the fertilized egg is divided on the 8th - 13th day after fertilization, then two fetuses will form, but one placenta and one fetal bladder. In this case, both fetuses will be in one for two fetal bladder, and eat from one placenta. Such twins are called monochorionic (one placenta) monoamniotic (one amniotic sac).

If the fetal egg divides later than 13 days after fertilization, then as a result of this, Siamese twins develop, which are fused with different parts of the body.

From the point of view of safety and normal development of the fetus, bichorionic biamniotic twins, both monozygotic and dizygotic, are the best option. Monochorionic biamniotic twins develop worse and the risk of pregnancy complications is higher. And the most unfavorable option for twins are monochorionic monoamniotic.

Probability of multiple pregnancy

The probability of multiple pregnancy with an absolutely natural conception is no more than 1.5 - 2%. Moreover, in 99% of multiple pregnancies are represented by twins, and triplets and a large number of fetuses only in 1% of cases. With natural conception, the likelihood of multiple pregnancy increases in women over 35 years old or at any age in the spring season against the background of a significant lengthening of daylight hours. In addition, in women in whose family twins or twins have already been born, the likelihood of multiple pregnancy is higher than in other representatives of the weaker sex.

However, if pregnancy occurs under the influence of drugs or assisted reproductive technologies, then the likelihood of twins or triplets is significantly higher than with natural conception. So, when using drugs to stimulate ovulation (for example, Clomiphene, Clostilbegit, etc.), the probability of multiple pregnancy increases to 6 - 8%. If drugs containing gonadotropin were used to improve the chances of conception, then the probability of twins is already 25 - 35%. If a woman becomes pregnant with the help of assisted reproductive technologies (IVF), then the probability of a multiple pregnancy in this situation is from 35 to 40%.

Multiple pregnancy with IVF

If a woman becomes pregnant with the help of IVF (in vitro fertilization), then the probability of multiple pregnancy is, according to various researchers, from 35% to 55%. In this case, a woman may have twins, triplets or quadruplets. The mechanism of multiple pregnancy during IVF is very simple - four embryos are placed in the uterus at the same time, hoping that at least one of them will take root. However, not one, but two, three or all four embryos can take root, that is, be implanted in the wall of the uterus, as a result of which a multiple pregnancy is formed in a woman.

If during the ultrasound after IVF a multiple pregnancy (triplets or quadruplets) was detected, then the woman is offered to “remove” the extra embryos, leaving only one or two. If twins are found, then the embryos are not offered to be removed. In this case, the decision is made by the woman herself. If she decides to keep all three or four embryos that have survived, then she will have quadruplets or triplets. The further development of a multiple pregnancy that has developed as a result of IVF is no different from the natural one.

Reduction in multiple pregnancy

The removal of an "extra" embryo in a multiple pregnancy is called reduction. This procedure is offered to women who have more than two fetuses in the uterus. Moreover, at present, reduction is offered not only to women who become pregnant with triplets or quadruples as a result of IVF, but also who conceived more than two fetuses at the same time in a natural way. The purpose of the reduction is to reduce the risk of obstetric and perinatal complications associated with multiple pregnancies. With reduction, two fetuses are usually left, since there is a risk of spontaneous death of one of them in the future.

The reduction procedure for multiple pregnancy is carried out only with the consent of the woman and on the recommendation of a gynecologist. At the same time, the woman herself decides how many fruits to reduce, and how much to leave. Reduction is not carried out against the background of the threat of abortion and in acute inflammatory diseases of any organs and systems, since against such an unfavorable background, the procedure can lead to the loss of all fetuses. Reduction can be carried out up to 10 weeks of pregnancy. If this is done at a later stage of pregnancy, then the remnants of the fetal tissues will irritate the uterus and provoke complications.

Currently, the reduction is carried out by the following methods:

• Transcervical. A flexible and soft catheter connected to a vacuum aspirator is inserted into the cervical canal. Under ultrasound guidance, the catheter is advanced to the embryo to be reduced. After the tip of the catheter reaches the fetal membranes of the reduced embryo, a vacuum aspirator is turned on, which tears it off the uterine wall and sucks it into the container. In principle, transcervical reduction is inherently an incomplete vacuum abortion, during which not all fetuses are removed. The method is quite traumatic, so it is rarely used now;
• Transvaginal. It is performed under anesthesia in the operating room, similar to the process of taking oocytes for IVF. The biopsy adapter is inserted into the vagina and, under ultrasound control, a puncture needle is used to pierce the embryo to be reduced. Then the needle is removed. This method is currently the most commonly used;
• Transabdominal. It is performed in the operating room under anesthesia in a similar manner to the amniocentesis procedure. A puncture is made on the abdominal wall, through which a needle is inserted into the uterus under ultrasound control. The embryo to be reduced is pierced with this needle, after which the instrument is removed.

Any reduction method is technically difficult and dangerous, since in 23-35% of cases pregnancy loss occurs as a complication. Therefore, many women prefer to face the burden of bearing several fetuses than to lose the entire pregnancy. In principle, the current level of obstetric care makes it possible to create conditions for carrying multiple pregnancies, as a result of which quite healthy children are born.

The most multiple pregnancy

Currently, the most multiple pregnancy recorded and confirmed was a tenth, when ten fetuses appeared in the woman's uterus at the same time. As a result of this pregnancy, a resident of Brazil in 1946 gave birth to two boys and eight girls. But, unfortunately, all the children died before reaching six months of age. There are also references to the birth of the tenth in 1924 in Spain and in 1936 in China.

To date, the most multiple pregnancy that can successfully result in the birth of healthy children without deviations is the gear. If there are more than six fetuses, then some of them suffer from developmental delay, which persists throughout their lives.

Multiple pregnancy - due dates

As a rule, a multiple pregnancy, regardless of the method of its development (IVF or natural conception), ends before the 40-week period, as the woman begins preterm labor due to excessive stretching of the uterus. As a result, babies are born prematurely. Moreover, the greater the number of fetuses, the earlier and more often preterm birth develops. With twins, as a rule, childbirth begins at 36 - 37 weeks, with triplets - at 33 - 34 weeks, and with quadruple - at 31 weeks.

Multiple pregnancy - causes

Currently, the following possible causative factors that can lead to multiple pregnancy in a woman have been identified:

• genetic predisposition. It has been proven that women whose grandmothers or mothers gave birth to twins or twins are 6 to 8 times more likely to have multiple pregnancies compared to other women. Moreover, most often multiple pregnancy is transmitted through the generation, that is, from grandmother to granddaughter;
• The age of the woman. In women over 35, under the influence of hormonal premenopausal changes, in each menstrual cycle, not one, but several eggs can mature, so the likelihood of multiple pregnancy in adulthood is higher than in young or young. The probability of multiple pregnancy is especially high in women over 35 years of age who have previously given birth;
• The effects of drugs. Any hormonal agents used to treat infertility, ovulation stimulation or menstrual disorders (for example, oral contraceptives, Clomiphene, etc.) can lead to the maturation of several eggs at the same time in one cycle, resulting in multiple pregnancy;
• A large number of births in the past. It has been proven that multiple pregnancy mainly develops in re-pregnant women, and its probability is higher, the more births a woman had in the past;
• In vitro fertilization. In this case, several eggs are taken from a woman, fertilized with male sperm in a test tube, and the resulting embryos are placed in the uterus. At the same time, four embryos are introduced into the uterus at once so that at least one can be implanted and begin to develop. However, two, three, and all four implanted embryos can take root in the uterus, as a result of which a multiple pregnancy develops. In practice, most often as a result of IVF, twins appear, and triplets or quadruplets are rare.

Signs of multiple pregnancy

Currently, the most informative method for diagnosing multiple pregnancies is ultrasound, but the clinical signs on which doctors of the past were based still play a role. These clinical signs of multiple pregnancy allow a doctor or woman to suspect the presence of several fetuses in the uterus and, on the basis of this, conduct a targeted ultrasound study that will confirm or refute the assumption with 100% accuracy.

So, the signs of multiple pregnancy are the following data:

• Too large size of the uterus, not corresponding to the period;
• The low location of the head or pelvis of the fetus above the entrance to the pelvis, in combination with the high standing of the uterine fundus, which does not correspond to the period;
• Mismatch between the size of the fetal head and the volume of the abdomen;
• Large volume of the abdomen;
• Excessive weight gain;
• Listening to two heartbeats;
• The concentration of hCG and lactogen is two times higher than normal;
• Rapid fatigue of a pregnant woman;
• Early and severe toxicosis or preeclampsia;
• Stubborn constipation;
• Severe swelling of the legs;
• Increased blood pressure.

If a combination of several of these signs is detected, the doctor may suspect a multiple pregnancy, however, to confirm this assumption, it is necessary to perform an ultrasound scan.

How to determine multiple pregnancy - effective diagnostic methods

Currently, multiple pregnancy is detected with 100% accuracy during conventional ultrasound. Also, the determination of the concentration of hCG in venous blood has a relatively high accuracy, but this laboratory method is inferior to ultrasound. That is why ultrasound is the method of choice for diagnosing multiple pregnancies.

Ultrasound diagnosis of multiple pregnancy

Ultrasound diagnostics of multiple pregnancy is possible in the early stages of gestation - from 4 to 5 weeks, that is, literally immediately after the delay of menstruation. During the ultrasound, the doctor sees several embryos in the uterine cavity, which is undeniable evidence of multiple pregnancy.

The number of placentas (chorionicity) and amniotic sacs (amniotic) is decisive for the choice of pregnancy management tactics and the calculation of the risk of complications, and not the number of fetal or monozygotic fetuses. Pregnancy proceeds most favorably with bichorionic biamniotic twins, when each fetus has its own placenta and fetal bladder. The least favorable and with the maximum possible number of complications is a monochorionic monoamniotic pregnancy, when two fetuses are in the same fetal bladder and feed from the same placenta. Therefore, during the ultrasound, the doctor counts not only the number of fetuses, but also determines how many placentas and fetal bladders they have.

In multiple pregnancy, ultrasound plays a huge role in detecting various malformations or fetal growth retardation, since biochemical screening tests (determining the concentration of hCG, AFP, etc.) are not informative. Therefore, the detection of malformations by ultrasound in multiple pregnancies must be carried out in the early stages of gestation (from 10 to 12 weeks), while assessing the condition of each fetus separately.

HCG in the diagnosis of multiple pregnancy

HCG in the diagnosis of multiple pregnancy is a relatively informative method, but inaccurate. Diagnosis of multiple pregnancy is based on the excess of hCG levels of normal concentrations for each specific gestational age. This means that if the concentration of hCG in a woman's blood is higher than normal for a given period of pregnancy, then she has not one, but several fetuses. That is, with the help of hCG, multiple pregnancy can be detected, but it is impossible to understand how many fetuses are in a woman’s uterus, whether they are in the same fetal bladder or in different ones, they have two placentas or one is impossible.

Development of multiple pregnancy

The process of developing a multiple pregnancy creates a very high load on the mother's body, since the cardiovascular, respiratory, urinary systems, as well as the liver, spleen, bone marrow and other organs continuously work in an enhanced mode for quite a long period of time (40 weeks) to provide one, but two or more growing organisms with everything you need. Therefore, the incidence in women carrying a multiple pregnancy increases by 3-7 times compared with a singleton. Moreover, the more fetuses in a woman's uterus, the higher the risk of complications from various organs and systems of the mother.

If a woman suffered from any chronic diseases before the onset of a multiple pregnancy, then they will definitely become aggravated, since the body is under very strong stress. In addition, with multiple pregnancies, half of the women develop preeclampsia. All pregnant women in the second and third trimesters develop edema and arterial hypertension, which are a normal reaction of the body to the needs of the fetus. A fairly standard complication of multiple pregnancy is anemia, which must be prevented by taking iron supplements throughout the entire period of childbearing.

For normal growth and development of several fetuses, a pregnant woman must eat fully and intensively, since her need for vitamins, trace elements, proteins, fats and carbohydrates is very high. The daily calorie intake of a woman carrying twins should be at least 4500 kcal. Moreover, these calories should be gained from nutrient-rich foods, and not from chocolate and flour products. If a woman during a multiple pregnancy eats poorly, this leads to the depletion of her body, the development of severe chronic pathologies and numerous complications. During a multiple pregnancy, a woman normally gains 20-22 kg in weight, with 10 kg in her first half.

In multiple pregnancies, one fetus is usually larger than the other. If the difference in body weight and height between the fetuses does not exceed 20%, then this is considered the norm. But if the weight and growth of one fetus exceeds the second by more than 20%, they speak of a delay in the development of the second, too small child. Delayed development of one of the fetuses in multiple pregnancies is observed 10 times more often than in singleton pregnancies. Moreover, the probability of developmental delay is highest in monochorionic pregnancy and minimal in bichorionic biamniotic.

Multiple pregnancies usually end in preterm delivery because the uterus is stretched too much. With twins, births usually occur at 36-37 weeks, with triplets - at 33-34 weeks, and with quadruples - at 31 weeks. Due to the development of several fetuses in the uterus, they are born with a smaller weight and body length compared to those born from a singleton pregnancy. In all other aspects, the development of a multiple pregnancy is exactly the same as that of a singleton.

Multiple pregnancy - complications

With multiple pregnancy, the following complications can develop:

• miscarriage in early pregnancy;
• premature birth;
• Intrauterine death of one or both fetuses;
• Severe preeclampsia;
• Bleeding in the postpartum period;
• Hypoxia of one or both fetuses;
• Collision of fruits (clutch of two fruits with heads, as a result of which they simultaneously find themselves at the entrance to the small pelvis);
• Syndrome of fetofetal blood transfusion (FFG);
• Reverse arterial perfusion;
• Congenital malformations of one of the fetuses;
• Delayed development of one of the fetuses;
• Fusion of fetuses with the formation of Siamese twins.

The most severe complication of multiple pregnancies is the fetofetal hemotransfusion syndrome (FFTS), which occurs with monochorionic twins (with one placenta for two). SFFH is a violation of blood flow in the placenta, as a result of which blood from one fetus is redistributed to another. That is, one fetus receives an insufficient amount of blood, and the other - an excess. In SFFG, both fetuses suffer from inadequate blood flow.

Another specific complication of multiple pregnancies is fetal fusion. Such fused children are called Siamese twins. The fusion is formed in those parts of the body with which the fruits are most tightly in contact. Most often, fusion occurs in the chest (thoracopagi), the abdomen at the umbilicus (omphalopagus), the bones of the skull (craniopagi), the coccyx (pygopagi), or the sacrum (ischiopagi).

In addition to those listed, with multiple pregnancy, exactly the same complications can develop as with a singleton.

Childbirth with multiple pregnancy

If the multiple pregnancy proceeded normally, the fruits have a longitudinal arrangement, then natural delivery is possible. In multiple pregnancies, complications in childbirth develop more often than in singleton pregnancies, which leads to a higher frequency of emergency caesarean sections. A woman with a multiple pregnancy should be hospitalized in a maternity hospital 3-4 weeks before the expected date of birth, and not wait for the start of labor at home. A stay in the maternity hospital is necessary for examination and assessment of the obstetric situation, on the basis of which the doctor will decide on the possibility of natural childbirth or on the need for a planned caesarean section.

The generally accepted tactics of delivery in multiple pregnancy is the following:
1. If the pregnancy proceeded with complications, one of the fetuses is in a transverse position or both are in a breech presentation, the woman has a scar on the uterus, then a planned caesarean section is performed.
2. If a woman has approached childbirth in a satisfactory condition, the fetuses are in a longitudinal position, then it is recommended to give birth through natural routes. With the development of complications, an emergency caesarean section is performed.

Currently, with multiple pregnancies, as a rule, a planned caesarean section is performed.

Multiple pregnancy: causes, varieties, diagnosis, childbirth - video

When they give sick leave (maternity leave) with multiple pregnancy
pregnancy

With a multiple pregnancy, a woman will be able to receive a sick leave (maternity leave) two weeks earlier than with a single pregnancy, that is, within 28 weeks. All other rules for issuing sick leave and cash benefits are exactly the same as for a singleton pregnancy.

In some African tribes, multiple pregnancy was considered a curse, and in some cases the second child was even killed. Among the American Indians, on the contrary, it was believed that twins born alive have divine superpowers. At the same time, the very fact of such a birth was furnished with special rituals, and the children and their parents were given badges of honor. Europe also contributed to the cultivation of superstitions around multiple pregnancy: in the Middle Ages, there was a view of multiple pregnancy as evidence of adultery, since the second child was assumed to have a second father.

Causes and types of multiple pregnancies

We will analyze them using the example of twins, as the most common type of multiple pregnancy. It is now established that the causes of multiple pregnancy can be two different processes.

The first (and most understandable) is the fertilization of two eggs by two different sperm. In this case, two independent embryos (or zygotes) are formed. Such a pregnancy is called bizygous. Among multiple pregnancies such 2/3, that is, the majority.

The mechanisms for the formation of bizygotic twins, in turn, can also be of two types. The first is the so-called multiple ovulation, when two eggs mature in one cycle, which are then fertilized by two sperm. The cause of multiple ovulation may be the peculiarities of the formation of hormones. It is this mechanism that is used to obtain several eggs during in vitro fertilization: with "in vitro conception" to increase the likelihood of success with the help of medications, they ensure that several follicles - vesicles with eggs - mature in the ovary during one cycle.

However, another mechanism is also possible, when, for reasons that are not entirely clear, after the fertilization of the first egg, the maturation of the next follicle is not inhibited and ovulation and fertilization occur in the next cycle. Thus, with an interval of approximately 28 days, two fertilized eggs sequentially enter the uterus. Such children are born together, but the period of stay in the womb (and, consequently, the weight and degree of maturity) of the second child will be 4 weeks less. Indirect evidence of the possibility of such a mechanism in humans are some results of ultrasound studies, when a doctor who discovered a singleton pregnancy at an early stage notes the appearance of a second fetal egg in the uterine cavity after 4-5 weeks. It should be noted that there is still no rigorous evidence for the existence of this mechanism. It is clear that bizygotic twins can be both same-sex and different-sex.

The remaining one third of the total number of twins develops from one egg and is called monozygotic. These twins are still a mystery to obstetricians and, more often than not, create the greatest problems during pregnancy. The mystery lies in the fact that at a certain period of development, the zygote, for unknown reasons, is divided into two viable halves. At the same time, from a formal point of view, one of the future embryos is a clone of the other.

Separation of an egg with the formation of monozygotic twins can occur between 2 and 15 days after fertilization of the egg. If the division of the egg occurred on the 2-3rd day, then each of the halves of the zygote has the full potential for independent intrauterine development. That is, two embryos are formed, each of which has a separate chorion (the precursor of the placenta) and its own separate amniotic cavity (fetal bladder). Such twins will be called monozygotic (from one zygote), bichorial (with two placentas) and biamniotic (with two amniotic sacs). If the division of the zygote occurred from the 4th to the 7th day after fertilization, then the mass of cells from which the chorion will develop later, and then the placenta, has already separated from the main group of cells that form the body of the embryo. Thus, the separation process will only affect this last group. The result is twins with one common placenta and two amniotic cavities. This type of twins is called monochorionic biamniotic (one placenta, two amniotic sacs).

If the separation occurred in the interval of 8-12 days, then only the separation of the embryos occurs. In this case, they share not only the placenta, but also the amniotic cavity. Such twins are called monochorionic monoamniotic (one placenta, one fetal bladder).

Separation for a period of 13-15 days after fertilization can no longer be completed completely and leads to malformations. In this case, the twins can be fused with any part of their bodies. An example of such an incomplete separation is the famous Siamese twins. In a sense, even an early separation, when the separation of the bodies of the embryos is completely completed, cannot be considered as a completely normal process, since the incidence of malformations in one or both monochorionic twins is several times higher than in the case of a singleton pregnancy or bizygotic twins.

It is quite obvious that since monozygotic twins originated from the same egg, their gender, blood type and chromosome set should be the same. However, it happens that in monozygotic twins, one of the fetuses is born with a malformation, while the other does not. Obviously, the cause of this cannot be a genetic (chromosomal) pathology. In this case, the only reason can be only a defect in the backfill - i.e. the influence of external, in relation to the embryo, factors on the development of the internal organs of the embryo in the first trimester. These factors may include physical (ionizing radiation), chemical or infectious (viruses, bacteria).

Diagnostics and monitoring

Modern ultrasound technology makes it possible to detect multiple pregnancies at the earliest stages of development. Usually, already at the 5-6th week, two fetal eggs are clearly visible, a little later the bodies of the embryos become visible and the contractions of their hearts are clearly recorded. At a later stage of pregnancy, it becomes possible to determine the number of placentas, the presence of partitions between the amniotic sacs, and the dynamics of fetal growth. These data are very important for determining the synchronism of fruit growth. Since monozygotic twins have an increased likelihood of malformations, special attention is paid to the search for this pathology.

Twins have an increased incidence of spontaneous abortions (spontaneous abortions). Probably, such spontaneous abortions of one of the bizygotic fetuses can explain the facts when, at an early stage of pregnancy, a woman experiences short-term bleeding, after which the pregnancy continues and ends relatively normally as a singleton.

Features of the course of pregnancy

Numerous ultrasound studies of twins show that in the case of their normal development, the growth dynamics of each of the fetuses up to 30-32 weeks of pregnancy corresponds to the growth of the fetus in a normal singleton pregnancy. Of course, much depends on the place where the placenta is located in each of the fetuses. The most favorable place for attachment of the placenta is the bottom, anterior and posterior walls of the uterus. The lower the placenta is, the fewer the so-called spiral arteries of the uterus, supplying blood to the villi of the placenta, and the worse its nutrition. This is not an accidental dependence, but a completely justified biological mechanism that makes low placentation unprofitable in order to reduce the likelihood of central placenta previa (the so-called condition when the placenta completely covers the internal os of the cervical canal uterus and makes it impossible for the child to be born naturally). If placentation has occurred low enough, then the process of placental growth goes in the direction of better nutrition, and it seems to be shifting upwards. This explains the “lifting” of the placenta at a low location in the case of a singleton pregnancy.

It is clear that if the placenta of one of the fetuses turned out to be low enough, then the likelihood of developing placental insufficiency in it increases, one of the manifestations of which may be preeclampsia.

After 32 weeks of pregnancy, the rate of increase in the length and weight of twins decreases. By 37-38 weeks, the weight of each of these fetuses is less than the standard weight of the fetus from a singleton pregnancy. Studies show that the weekly weight gain of each twin after 32 weeks is consistent with the weekly weight gain of a twin fetus at the same time. Thus, it can be assumed that at the end of the third trimester, the main limiter to the growth of fetuses from twins is the ability of the mother's body to deliver oxygen and nutrients to the uterus. Obviously, in this situation, the body of a mother carrying a multiple pregnancy experiences a significant additional load. By the end of pregnancy, the total increase in mother's body weight in the case of twins is 30% more than in a singleton pregnancy. In addition, the volume of circulating blood increases (by 10-15%), but there is no corresponding increase in the number of red blood cells. Therefore, in pregnant women with twins, anemia is more often observed - a decrease in the number of red blood cells. To prevent the development of this condition, women with multiple pregnancies should eat more protein and be sure to take iron supplements.

During the development of a multiple pregnancy, the internal volume of the uterus increases at a faster rate than in the case of a singleton pregnancy. The uterus reaches the volume characteristic of the period of full-term pregnancy earlier. Own regulatory mechanisms of the uterus at this point increase its contractile activity, preparing for the upcoming birth. Therefore, with multiple pregnancy, childbirth often begins prematurely. But this is not a cause for concern.

Interestingly, the incidence of multiple pregnancies is not the same in different countries and on different continents. It is possible that this is in some way connected with the ethnicity of the population of these countries. Thus, in Japan, the lowest incidence of twins is observed - 0.6% (i.e. 6 per 1000 newborns), in Europe and the USA it ranges from 1.0% to 1.5%, and in Africa this figure is the highest. Thus, in Nigeria this figure reaches 4.5% (45 per 1000). Such differences relate exclusively to bizygotic twins. Monozygotic twins are observed with amazing consistency in all parts of the world. Their frequency is 0.4% (4 per 1000). It was found that the likelihood of bizygotic twins is inherited - mainly through the maternal line. Perhaps this is due to the inherited increased synthesis of folliculin, a hormone that affects the number of eggs that mature in the ovary.

Complications of pregnancy in monochorionic twins

The term "monochorial twins" suggests that the separation of the placenta between the two fetuses did not occur and they receive oxygenated blood from the same placenta. In this situation, it can be assumed that some of the vessels belonging to the vascular placental system of one fetus are connected to the same vessels of another fetus. Such vascular connections are called anastomoses. Indeed, a careful study of the placenta showed that in 98% of cases in monochorionic twins, the placentas are connected by vessels. However, in only 28% of cases, blood is pumped through these connections from one fetus to another. The reasons for this bleeding are still not fully understood. In this situation, the fetus from which the blood is pumped acts as a donor, and the other as a recipient.

In the event of such a complication, called the feto-fetal transfusion syndrome (FFTS), the discharge of blood from one fetus to another leads to bleeding of the donor and, conversely, to an overload of the recipient's circulatory system. If not stopped, feto-fetal transfusion can quickly lead to the death of the donor, and then the recipient. Unfortunately, there are no effective methods for the prevention and treatment of transfusion syndrome. The only way to prevent the development of feto-fetal transfusion syndrome today is therapy aimed at improving placental circulation.

Summarizing the currently known information on multiple pregnancy, we can draw the following conclusions:

• Multiple pregnancy makes special, increased demands on the mother's body. Of course, doctors do not consider it as a pathology, but they believe that such a pregnancy (especially with monochorionic twins) requires more attention from medical personnel.
• The likelihood of developing placental insufficiency and preeclampsia in multiple pregnancy is greater than in singleton. Therefore, all measures aimed at preventing the development of these conditions are carried out from the beginning of the second trimester. Particular attention is paid to the full-fledged protein nutrition of the expectant mother: taking iron preparations, vitamins.
• Delivery of a woman with twins is desirable to be carried out in a high-level maternity hospital (perinatal center), which has a powerful qualified resuscitation of newborns. It is clear that the frequency of operative delivery (caesarean sections) in multiple pregnancies is much higher than in singleton pregnancies. However, the method of delivery depends on many factors: on how the pregnancy occurred - spontaneously or with the help of IVF, on the nature of the twins (bichorial or monochorionic), on the nature of the location of the fetus, on the health of the expectant mother and other factors. In each case, the tactics of childbirth is developed individually.

With the simultaneous birth of two or more children at once, many myths and legends have long been associated with almost all peoples. And this did not happen by chance. After all, multiple pregnancy (twins) was often accompanied by various complications already in the process of its development, as well as postpartum problems. Currently, modern medicine is making every effort to protect embryos as much as possible and save their lives. However, whatever the case with two or more embryos, he will need attention not only from the expectant mother, but also from doctors.

Why do 2 fertilized eggs develop in the uterus?

One of the most common types of multiple pregnancy is the conception and birth of twins. It develops as a result of one of two possible processes:

1) simultaneous entry of different spermatozoa into two eggs and their fertilization.
2) the development of two zygotes from the same egg.

In the first case, the result of a separate fertilization is two completely independent zygotes, and the type of such pregnancy is called "bizygotic". This type includes about 65% of all multiple cases.

In the case of a separate development of embryos, twins, according to characteristic features, can be called as follows:

• Monozygotic (developing from the same zygote).
• Bichoral (has two placentas).
• Biamniotic (has two fetal bladders at once).

Characteristics of a bizygote

Bizygotic twins are divided into 2 types:

• Multiple ovulation (when fertilization occurs within the same ovulation cycle) is due to some features of hormonal production. This feature is used for "test tube conception", or in vitro fertilization. The reason for this ovulation is called the increased production of folliculin due to the stimulating hormone (FSH).
• Sequential fertilization of two eggs (without inhibition of the second process). The interval between eggs entering the uterus will be about 28 days.

Despite the difference in weight and degree of maturity, the birth of such children will occur at the same time. On ultrasound, 2 fetal eggs will become noticeable 28-35 days after the first (singleton) pregnancy is detected. As for the sex of future children, bizygotic twins can be of any gender, or of opposite sex.

The degree of probability of the formation of a bizygote is due to hereditary factors, most often this is transmitted to patients through the mother.

Characteristics and types of monozygote

The second case - the simultaneous development of two zygotes, or monozygotic twins - is still a mystery to specialists. A monozygote, which has 2 fetal eggs, brings the greatest difficulties in the course of such a pregnancy. For reasons that have not yet been studied, the zygote, reaching a certain period, forms two separate halves, quite suitable for life. One of these embryos will be like a mirror image (cloned copy) of the second.

Separation of the egg and the formation of monozygotic twins usually occurs from 2 to 16 days after the fertilization process has occurred. At the same time, there are some features due to the day of separation:

• On day 2-3 - each half will have a full potential to develop inside the womb on its own. 2 fetal eggs will be formed in the uterus, each of them will have its own chorion and amniotic cavity (the sac).
• On day 4-7, the cell mass for the development of the chorion and placenta will be separated from the cells that serve as the basis for the formation of the embryonic body. The division will affect only the detached part of the cells. The twins will have a common placenta but two separate amniotic cavities and will be called monochorionic (one placenta but 2 different bladders).
• On days 8-12 - the separation process will affect only the embryos. At the same time, they will have both the placenta and the fetal bladder in common, and it will be called monochorionic monoamniotic.
• On the 13th-15th day, the separation will be incomplete, therefore, defects will be observed in the further development process. Embryos can grow together in any part of the body (for example, "Siamese twins").

Even cases where embryonic separation occurs in the early stages cannot be considered normal processes. The frequency with which various malformations can appear will be much higher than in the case of a single fetus.

In embryos from monozygotic twins, not only the sex, but also the blood group, as well as the set of chromosomes can be different. The reason for this may be:

• Pathology at the genetic level (chromosomal).
• Bookmark defects (due to external factors that influenced the first trimester - radiation, viruses, etc.).

To minimize the risks of developing malformations and other defects that may affect the development of embryos, not only constant monitoring by qualified specialists will be required, but also timely examination.

Features of the diagnosis and monitoring of multiple pregnancy

To date, ultrasound diagnostics (ultrasound) makes it possible to identify several fetuses already at the beginning of their development. In this case, one of two types of examination is used:

• TA-scanning (transabdominal) - through the anterior wall of the peritoneum.
• TV (transvaginal) - the scanner is inserted through the vagina.

In total, three examinations are carried out, at different times:

• at 10-14 weeks;
• for 20-24 weeks;
• at 30-34 weeks.

Transvaginal ultrasound examination reveals a fetal egg 2 mm (maximum - 4 mm). This occurs in the case of a delay in menstruation for a period of 3 to 6 days, that is, much earlier than in the case of a TA scan.

As practice shows, 2 fetal eggs become clearly visible by the fifth or sixth week. After that, embryonic bodies are gradually formed, and their heartbeats can be recorded. Over time, when the gestational age becomes more significant, it is possible to establish the exact number of placentas, the absence or presence of partitions separating the fetal bladders, and also to indicate the dynamics of the development of all fetuses. All these data help the doctor to determine the synchrony of fetal growth. At the same time, the most careful attention is always paid to the search for pathological abnormalities.

If the development of both fetuses proceeds normally, until the period of 30-32 weeks they will have similar features with the development of one fetus (with the usual type of pregnancy). H6 placental location of each of the fetuses will be of little importance. The most favorable are the bottom, as well as the anterior and posterior uterine walls. The lower the placenta is located, the worse the quality of its nutrition will be. This is a biological feature in order to avoid central presentation, when the placenta will block the channel, excluding the possibility of a natural exit of the fetus during delivery.

After a period of 32 weeks, the rate of fruit development is slightly reduced. On the mother's body, however, there will be significant burdens. In addition to an increase in maternal body weight (about 30%), there is an increase in the volume of blood circulating inside the body (about 10%), with the same level of red blood cells. This explains the manifestation of anemia.

Due to the accelerated increase in the volume of the uterus, the term of delivery in the case of multiple pregnancies often occurs earlier than expected.

General requirements for the course of multiple pregnancy

Compared with the development of a single fetus, the type of multiple pregnancy requires special attention. Its characteristic differences will be as follows:

• increased level of requirements for the mother's body;
• special care throughout the gestation period (especially with the monochorionic type) of the surrounding medical staff;
• due to the increased risk of developing placental insufficiency or the development of preeclampsia, special preventive measures are needed, which begin as early as the second trimester;
• the need for a complete protein menu, the appointment of drugs that include iron, the intake of vitamin groups;
• selection of a perinatal center (for delivery) of only the highest category - it is likely that qualified resuscitation of newborns will be required.

Caesarean section, as a type of operative delivery, is used much more often for a multiple-fetal case than for situations with a single fetus.

Under the concept of multiple pregnancy, modern medicine assumes a situation where several future babies (from two or more) develop simultaneously in the womb of the mother instead of one fetus. The name of such a pregnancy is different, and depends on how many fetuses the expectant mother develops. If a woman is carrying twins, then this development of pregnancy is called twins, if more, then, respectively, triplets and in ascending order.

Multiple pregnancies are considered quite rare phenomena, which as a percentage is expressed in terms of 0.7 to 1.5% in European countries and the Americas. This number gradually begins to grow with the emergence of new reproductive options that increase the likelihood of multiple pregnancies. Two healthy babies can appear from two types of pregnancy, which differ in the mechanism of conception.

Pregnancy may be:

• Bizygotic (dizygotic);
• Identical (monozygous).

In the first case, the children are considered twins, and in the second method, twins. In 70% of cases, such a pregnancy takes place in a twin form. In the case of a monozygotic pregnancy, the babies will be completely identical in appearance, as they develop from a single egg and, accordingly, have the same genes. At the same time, twins differ both in gender and in many external features, since a dizygotic pregnancy gives babies a different composition of chromosomes. The development of a twin pregnancy is facilitated by the simultaneous fertilization of two eggs, which are attached in different parts of the uterus.

Very often, this conception occurs during several sexual intercourses during one period of ovulation. Although there are cases when two eggs are fertilized during one sexual contact. The condition for such fertilization is the presence of eggs from both ovaries.

Twin pregnancy - twins

A twin pregnancy involves its own placental membrane and a separate amniotic sac for each fetus. From a medical point of view, the situation when each fetus has its own bladder and individual placenta is referred to as bichorionic biamniotic twins.

Twins

In other words, 2 placentas (biharial) are simultaneously located in the uterus, along with two fetal bladders (biamnic), and each child grows each in its own placenta. During an identical pregnancy, both embryos begin to develop from one egg, which at a certain moment divides into two independent cells and in each of them a new life of the unborn child develops.

It is impossible to name the exact number of placentas and fetal bladders during such a pregnancy: this individual factor depends on the time when the separation of the fertilized egg occurred. If such a separation occurred within 72 hours after conception, during which the fertilized egg does not yet have time to attach to the wall of the uterus, then two fetal bladders with two placentas are formed.

From a medical point of view, such a pregnancy is also called bichorionic biamniotic (two placentas and two amniotic sacs). In the case when the separation of the egg occurred at a later period, but not longer than 8 days (at the stage when the egg has already attached to the uterus), then in this case two embryos are formed with two fetal bladders, but the surrounding placenta is the same for two. Then there are future twins separated from each other by fetal bladders, but they receive nutrition from a common placenta. In accordance with the facts, such a development of pregnancy is called monochorionic (single placental) biamniotic (with two bubbles).

The latter situation is associated with the division of the egg in the period from 8 to 13 days - the female body will be able to form two fetuses, but with a common placenta and with a single fetal bladder. Nutrition will come from one placenta - for each baby it will come through a separate umbilical cord for each embryo.

Such a pregnancy is called monochorionic (single placenta) monoamniotic (single amniotic sac). The separation of the fetal egg, which occurs after 2 weeks from the moment of fertilization, leads to the development of Siamese twins - that is, babies with fused body parts.

For the body of the expectant mother, the safest types of double pregnancy are considered twins and identical bichorionic biamniotic twins. During the development of monochorionic biamniotic pregnancy, there is a possibility of pregnancy complications and delayed embryo development. Potential mothers with a monochorionic monoamniotic course of fetal development are most at risk.

During natural fertilization, the possibility of developing a multiple pregnancy equates to a maximum of 2%. Among these two percent, the majority of pregnant women (99%) have twins, and only one percent of conceptions occur with triplets and a large number of children. The development of fetal pregnancy is accompanied by several factors:

• The woman is over 35 years old;
• Conception during the lengthening of daylight hours (spring);
• Mothers who have previously had a similar pregnancy;
• Conception with the help of additional reproductive technology solutions.

The use of such modern drugs as "Klostilbegit" or "Clomiphene", increase the likelihood of developing a multiple pregnancy course up to 8%.

At the same time, we note that in the case when funds containing gonadotropin were used to improve the reproductive form, the chance of conceiving twins increases by 25-35%. The maximum probability of multiple pregnancy is given by the use of reproductive technologies (IVF). In patients using this system, the probability of multiple conception increases up to 40%.

The use of in vitro fertilization from different sources increases the likelihood of multiple conception from 35% to 55%. The number of developing embryos in this case can be from two to four. IVF technology operates according to the following principle: four embryos are placed in the uterus and how many of them will eventually take root, how many children the woman will subsequently give birth to.

As practice shows, any number of attached embryos can take root at the same time: that is, it can be one child, or maybe all four attached fetuses. Accordingly, a woman, in this case, is faced with a multiple pregnancy.

Subsequent ultrasounds will show the number of surviving embryos, and after that, the expectant mother will be asked to make a choice to preserve all the engrafted fetuses or go for an operation to remove excess embryos. In the event that only half of the embryos have taken root, it is recommended to leave both. But, of course, the last word remains with the future mother. A pregnant woman can also leave three or all four implanted embryos, if she so desires, and in the end she will become a mother for three or four babies.

The next stages of fetal development in women using the IVF system for conception are no different from conceptions that occurred naturally. The operation, during which an extra embryo is removed from the uterus, is called “Reduction”.

Nowadays, reduction is proposed not only for mothers who have artificially conceived three or more embryos, but also for persons who have three or more fetuses after natural conception. This is carried out in order to reduce the likelihood of complications during pregnancy, childbirth and postpartum development, which may develop under the influence of multiple pregnancies.

During the operation, doctors always leave two fetuses, in case one of the embryos dies or miscarriages occur. In any case, the reduction procedure is carried out completely at the request of the pregnant woman. It is up to her to decide how many embryos to leave for further development, and how many to remove. In what cases is reduction contraindicated:

• If the gestation period is more than 10 weeks;
• The presence of acute infections and inflammatory diseases;
• With the threat of miscarriage.

At a later date, reduction is unacceptable, since the remnants of fetal tissues, which cannot always be completely removed, can provoke irritation of the walls of the uterus and cause miscarriage. Modern medicine offers several types of reduction.

Transcervical method

Performed under ultrasound guidance. For it, a soft and fairly flexible catheter is used, which is inserted into the uterus (having previously connected to a vacuum aspirator). The catheter is slowly advanced towards the embryo to be removed. When the tube touches the fetal bladder, a vacuum aspirator is launched, sucking the embryo, together with the fetal bladder surrounding it, into a special container.

We can say that this type of reduction is similar to the method of incomplete vacuum abortion. However, this method is not the safest for the uterus and therefore its use is rare.

Transvaginal method

Anesthesia is used during the operation. The procedure is also performed using ultrasound. Using a biopsy adapter, the embryo is pierced with a puncture needle, which is immediately removed after the procedure. This method is common in many clinics.

Transabdominal method

During the operation, general anesthesia and ultrasound control are used. The technique is similar to the amniocentesis procedure. With the help of a puncture made on the abdominal wall, a needle is inserted, which subsequently pierces the embryo, and the needle is removed.

No matter how modern the reduction methods used are, any of them carries a potential danger. Up to 35% of pregnant women who used the reduction operation had complications or suffered a miscarriage later. That is why most expectant mothers prefer the difficulties of bearing multiple pregnancies than the likelihood of losing the unborn child after surgery.

Note that obstetrics has stepped far forward and today it is much easier and safer to carry two or more babies than, say, 15 years ago.

The currently known record of multiple pregnancy was recorded in 1946 - a resident of Brazil carried 8 girls and 2 boys. But the joy of motherhood did not last long. All the children died before they lived even six months. In addition to her, a Spaniard in 1924 and a Chinese woman in 1936 became the owners of bearing 10 children.

To date, the maximum number of children that can be safely carried is six fetuses. With a larger number, there is a delay in growth and development, which does not disappear over time.

As the practice of recent years shows, multiple pregnancy, regardless of the method of conception (natural or artificial), occurs much earlier than usual and ends at 40 weeks of pregnancy. Already during this period, women give birth due to too much stretching of the uterus.

Naturally, such children are born prematurely. The onset of preterm birth directly depends on the number of children born: the more babies are expected, the earlier the birth will begin.

The average time to end a pregnancy with multiple pregnancy is as follows:

• Twins are born at 36-37 weeks;
• Triplets are born at 33-34 weeks;
• Four babies are usually born at 31 weeks.

Age

One of the possible causes of multiple pregnancy is the age of the future mother. After 35 years, the female body begins hormonal changes and gradually prepares for pre-climatic changes. As a result, the number of simultaneously maturing eggs from one can change into several pieces. And this can happen in every cycle. The likelihood of multiple pregnancies also increases in those who have already given birth before.

gynetics

Next reason: genetic predisposition. According to statistics, the ability to have multiple pregnancies is expressed in one generation. With a genetic predisposition, the probability of multiple pregnancy increases up to 8 times.

Hormonal

The use of reproductive drugs. All hormonal drugs aimed at increasing the likelihood of becoming pregnant or curing infertility, as well as drugs used to restore the menstrual cycle, increase the likelihood of maturation of several eggs ready for fertilization at once.

Frequent childbirth

Frequent childbirth. Frequent childbirth can be one of the reasons for the development of several embryos at the same time.

Artificial insemination

In vitro fertilization. Borrowed mature eggs are artificially fertilized with the help of male sperm in a pre-treated test tube. Fertilized cells attach to the uterus. This method involves the attachment of 4 embryos at once, as a result of which a multiple pregnancy is very often obtained.

Such a large number of embryos are planted for the reason that any of them or several of them may not take root and die. It also happens that all attached embryos begin normal development. But this is more rare than commonplace. Most often one, two or three fertilized eggs take root.

Ultrasound diagnostics is considered the best modern method for determining multiple pregnancy. But besides it, there are a number of signs by which doctors monitored pregnancy in the old days. These signs are still relevant today. It is they who will help the expectant mother and the doctor in time to determine the likelihood of carrying a multiple pregnancy and then make the most accurate ultrasound, showing or refuting the theory in detail.

• The size of the uterus does not correspond to the terms of pregnancy (increased size);
• Inconsistency in the location of the pelvis or head of the unborn child at the entrance to the pelvic region. At the same time, the high standing of the day of the uterus is also taken into account;
• The volume of the abdomen does not correspond to the size of the fetus;
• Too big belly at an early stage;
• Rapid weight gain;
• The equipment listens to 2 heartbeats;
• The level of hCG and lactogen exceeds the standard values ​​several times;
• Enhanced toxicosis already in the early stages;
• High physical fatigue;
• Frequent constipation;
• Swelling of the legs;
• High blood pressure.

If a pregnant woman has several of the listed signs at once, then the probability of developing a multiple pregnancy is high. But to confirm the diagnosis, it is imperative to undergo an ultrasound scan - only it can accurately diagnose the type of pregnancy.

Another way to confirm such a pregnancy is to take a blood test for hCG - but if you have a choice, it is better to use the ultrasound diagnostic method, as it is more accurate.

Ultrasound - diagnosis of multiple pregnancy

Ultrasound can be performed as early as a month after conception. On the monitor, the doctor can see, if available, several developing embryos. The method of managing a multiple pregnancy depends, first of all, on the number of placentas and fetal bladders formed. Monozygotic or twin pregnancy does not affect the choice of tactics for monitoring pregnancy.

The best is the development of bichorionic twins, in which each fetus has its own placenta and fetal bladder. The most difficult in terms of maintaining gestation and the successful development of the unborn child is the monochorionic monoamniotic variation of pregnancy, in which several embryos are connected by one common placenta and a common fetal bladder (nutrition in this case comes from a single source and is delimited by separate umbilical cords).

During the ultrasound diagnostics, the specialist will immediately see all the necessary points in the development of the embryos, as well as the total number of placentas and fetal bladders. Ultrasound diagnosis is extremely important in multiple pregnancy. It is it that will show a violation of the development of the fetus and possible congenital malformations. Biochemical blood tests cannot reveal such disorders. In this regard, an ultrasound examination must be carried out as early as 10-12 weeks of pregnancy - during this period, the quality of the development of each fetus is already visible.

HCG tests are more of an additional way to confirm the course of pregnancy than the main source of information. HCG rises several times higher than the normal pregnancy rate if several fetuses develop in the uterus at once.

Development of multiple pregnancy

Any pregnancy is a test for the female body. Multiple pregnancy several times increases the already difficult load. Almost all organs and life support systems are tested.

The greatest load falls on:

• the cardiovascular system;
• urinary system;
• Respiratory system.

The bone marrow, spleen and liver begin to work in an enhanced mode, without giving any rest and fasting days. And all this happens within 40 weeks. After all, the body no longer supports one life, but two or more growing organisms in the womb. With each new day, the embryos require more space and nutrition. Therefore, it is not surprising that expectant mothers who are faced with multiple pregnancies are more likely than others to suffer from various infections and diseases.

The probability of catching the same flu or cold increases by 3-7 times compared to pregnant women who carry one child under their hearts. The more embryos the expectant mother bears, the higher the likelihood of catching any infection or catching a cold out of the blue.

If before the onset of pregnancy a woman had problems with any chronic disease, then its consequences will definitely return to her, but in an even more severe form. The same applies to infectious diseases. All this is due to too much stress that the female body faces throughout pregnancy.

Preeclampsia

Almost half of pregnant women face such a problem as preeclampsia. Not a single pregnant woman with a multiple pregnancy has escaped leg edema and high blood pressure in the second and third trimester for a long time. And this is considered absolutely normal, as developing fruits require more and more nutrition and special conditions.

Anemia

Such a disease as anemia is also widespread among expectant mothers with multiple pregnancies. Therefore, it is imperative to carry out prevention through fortified nutrition and the intake of special dietary supplements containing iron. For the full development of future babies, their mother must eat intensively and fully.

Weight gain during multiple pregnancy

After all, her need for daily calorie intake is several times higher and reaches 4500 kilocalories per day. At the same time, it is not recommended to use chocolate and a large amount of flour products to replenish nutrients. It should be healthy food with a large set of nutrients. Poor nutrition leads to depletion of the body, which in turn increases the likelihood of developing severe pathologies in a chronic form, and also creates the likelihood of complications in the process of gestation.

With a multiple pregnancy, a woman gains on average about 22 kilograms, with half of this weight added at the very beginning of pregnancy. Statistics show that with the development of multiple pregnancy, one fetus is always larger than the second.

The ratio in the difference in weight and height can reach 20%. If this one is shown more, then there is a possibility of a delay in the development of the second fetus. This phenomenon also occurs with a singleton pregnancy, but with a multiple pregnancy, the probability of developmental delay is 10 times higher. The greatest risk is observed in women with a monochorionic course of pregnancy, while owners of a bichorionic biamniotic course are less likely to experience this problem.

Due to the large load on the uterus, multiple pregnancy usually ends earlier than a normal pregnancy. Those who carry twins usually give birth at 36-37 weeks, mothers of three babies at 33-34 weeks. If 4 babies are born at the same time, then the timing of childbirth is shifted to 31 weeks. Multiple pregnancy does not allow babies to gain the necessary body weight. Therefore, children are born with less weight and relatively short stature. Otherwise, multiple pregnancy is no different from pregnancy with one child.

Multiple pregnancy may be accompanied by the following complications:

• miscarriage in the first trimester of pregnancy;
• premature birth;
• Death of one or more embryos during development;
• preeclampsia;
• Prolonged bleeding after childbirth;
• hypoxia;
• A collision of fetuses due to which both children are simultaneously ready to leave;
• Fetofetal blood transfusion;
• Congenital malformations of one or more fetuses;
• The birth of Siamese twins.

Other options for complications are the same as with a singleton pregnancy. If the fetuses are located vertically, as expected, then during childbirth there are no problems with exiting the uterus. But often doctors have to do a caesarean section. due to complications that occurred during gestation.

For those who are faced with a multiple pregnancy, it is important to be hospitalized in the maternity ward about a month before the expected date of birth of the children. Being under the supervision of specialists and having passed all the necessary examinations, the doctor leading you will decide on the method of giving birth to babies: will it be a natural birth or a caesarean section.

A typical decision tree looks like this:

a caesarean section occurs if there is a complication during pregnancy, or one of the babies is incorrectly positioned. A cesarean section is also resorted to in situations where both fetuses are simultaneously in the pelvic area and in the presence of scars on the uterus.

If the fetus is in the correct position, and the woman feels satisfactory, then natural childbirth is still recommended. If they have problems, the doctor may perform an unplanned caesarean section.

Nowadays, doctors are increasingly using a planned caesarean section.

When sick leave

With a multiple pregnancy, the expectant mother can go to the hospital already at 28 weeks, in contrast to the 30-week period of a singleton pregnancy. In all other respects, the period of validity of the sick leave does not differ.

Most often, women vividly experience multiple pregnancy and, as a result, speak positively about it despite all the difficulties they face in the process of bearing. Speaking of difficulties, I mostly remember fatigue, a big belly and swelling. According to those who have already given birth to several babies, the greatest difficulties begin from the fifth month of pregnancy. They attribute this to a large weight gain and, as a result, an increased load on the musculoskeletal system.

In addition, most young mothers talk about the importance of moral preparation for the difficult physical consequences of bearing. Many were constantly tormented by the feeling of hunger, despite plentiful and nutritious food. Childbirth in most women occurred at 36-38 weeks and, mainly, by caesarean section. Those few mothers who have given birth naturally agree that there is nothing particularly difficult in such childbirth and positively perceive their experience.

Remember, being a mother is not only a great happiness for any woman, but also a great responsibility. If you're having multiple pregnancies, don't panic. Talk to your doctor, discuss the situation with loved ones. It is up to you to decide whether to keep a multiple pregnancy. If you are not ready for this, doctors will come to your aid. But if you want to take a chance and give birth to two or even more babies at a time, then know that you will succeed.