In which week can you determine the number of fruits? Twins: from conception to birth. Indications for surgical delivery

04.10.2023

Hello, dear subscribers! Some mothers know for sure that they are pregnant with two or more babies from the very beginning. Perhaps they have strong intuition, or, most likely, they are under the supervision of a reproductive specialist. In today's article I will list the main symptoms of multiple pregnancy in the early stages.

Looking back, many of the symptoms were obvious to me - terrible toxicosis, extreme fatigue (all I wanted to do was lie on the couch). After the news that we were having twins, my husband and I experienced a storm of emotions: from horror to happiness. But the probability of multiple pregnancy is so low (1 case in 80).

In most women, multiple pregnancies are discovered only after an ultrasound. However, is there a way to tell if you are carrying more than one child? Yes, you can understand this before visiting the doctor. Early signs of multiple pregnancy include:

Severe toxicosis

Intolerance to certain foods and smells accompanies many women at the beginning of their journey. But multiple births increase symptoms of illness, such as nausea and vomiting, which can occur throughout the day.

Fatigue

Excessive fatigue is a common complaint among women carrying twins, both early and throughout pregnancy. Their bodies undergo powerful hormonal changes, which is why they have so little energy left to carry out everyday activities.

Constant hunger

Growing a baby is hard work for the body, especially if there are two of them. You no longer eat for two, but for three. Mothers often do not know about twins in the early stages. They don't eat enough and feel constantly hungry.

Old clothes don't fit

Weight gain can vary depending on a woman's height, her build, and how much she weighed before. During a singleton pregnancy, the mother gains an average of 1-2 kg. If more, then this indicates multiple births or excessive consumption of unhealthy foods. If you have a clearly large belly at 8-10 weeks, then this indicates the presence of several babies.

Hormones are out of control

Because the body produces hormones in higher quantities, mood swings during a twin pregnancy may be worse than during PMS. Therefore, going from tears to joy, from melancholy to action and back in five minutes is not uncommon.

Elevated levels of human chorionic gonadotropin

This hormone grows at a rapid pace, reaching a maximum at about 10 weeks. Due to the fact that it is higher in multiple pregnancies, a positive test appears earlier than usual, and it will look like two fat stripes.

Extreme Heartburn and Overactive Bladder

These symptoms are more pronounced because two children take up more space than one. In addition, children grow faster, and the uterus during multiple pregnancies puts even more pressure on the stomach and bladder.

A few heart beats

Hearing your baby's heart beat for the first time is one of the most memorable experiences. Using sound waves, a Doppler detector amplifies the fetal heart sounds. Unfortunately, this is not the most effective way in the early stages.
A clear heartbeat is usually recorded towards the end of the first trimester. And even what seems like the heartbeat of the second baby can be an ordinary echo of the beating of the mother’s heart. Or the babies may be located so close to each other in the uterus, especially identical ones, that their rhythms do not differ and merge into one sound.

High alpha-fetoprotein test results

An AFP test, also known as the triple screen, is usually performed in the second trimester. It eliminates the risk of congenital fetal defects. With twins, the titers of this marker are at an increased level.

In addition to physical symptoms, many mothers report an unexplained feeling or suspicion. Unusual cases often occur. One expectant mother of twins discovered that all the eggs she bought for holiday baking contained double yolks. A couple of days later, an ultrasound showed that she was expecting twins!

The surest way to diagnose twins

It is believed that it is possible to accurately see several embryos only with the help of ultrasound. At what stage is a multiple pregnancy determined? A specialist can see this fact in 5-6 weeks. But, as a rule, it is diagnosed during the first screening at 12 weeks.

Although there are cases where the ultrasound did not detect twins (there are simply too many noses to accurately determine who is who). Sometimes when twins are detected very early (before 10 weeks), only one child is found later. So called .

By the way, the largest multiple pregnancy in the modern world happened to 33-year-old Nadia Suliman in 2009. She became pregnant through IVF and gave birth to eight healthy children. Interestingly, she already had six children. The book of records also recorded ten children born at the same time, but none of them survived.

Now you know how to identify a multiple pregnancy, and this news will not take you by surprise like it did me.

They require close medical supervision because the risk of complications is higher than with a singleton pregnancy.

If in your family there have been 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 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 increase in multiple pregnancies, common in Europe (1 pregnancy in 89), has literally exploded under the influence of artificial insemination.

Ovarian stimulation (prescription of drugs that promote the maturation of eggs in the ovaries) and cases of multiple pregnancies 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 babies, etc. increases. In addition, it may be difficult for a woman to bear more than two children socially. There is a high risk of problems with caring for them after birth, social and family conflicts caused by the fact that parents in some cases (4 or more embryos) are offered to reduce the number of embryos by medical means. Multiple pregnancy requires early adapted and enhanced monitoring (this is possible thanks to ultrasound). In most cases, it is suggested to induce labor well before the due date to avoid an accident at birth.

These days, 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 a family has already had twins, the likelihood of a multiple pregnancy increases. Twins and twins are at greater risk of the disease during fetal development. But with timely detection, many complications can be avoided. Most often, the doctor detects 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, since the better the beginning of a new family life is organized, the easier it will be. Sharing information with other parents of twins can be very beneficial. Contacts with them can be established through forums on the Internet.

Multiple pregnancies are becoming increasingly common

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

Accordingly, your rate of having twins or triplets increases if you already have similar cases in your family or if you used MPR (ovulation stimulation).

Symptoms and signs of multiple pregnancy

The diagnosis is made by the first ultrasound, which demonstrates the presence of several gestational membranes in the uterus. In one third of cases we are talking about “true” twins (monozygotic, 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 determine that the uterus is too large to contain only one fetus.

Overweight

When you have 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 the double volume of amniotic fluid.

Identical and fraternal

When it comes to twins, we often hear the adjectives “true” and “false”, which mean completely different things from a biological point of view.
Identical, or monozygotic, twins are the result of fertilization by one sperm of one egg. The resulting egg is then divided into two. The fetus can develop in one amniotic sac or in two, and there can be one placenta for both children. Two children have the same genetic basis, they are of the same sex and are like two peas in a pod.
Fraternal, or dizygotic, twins were formed as follows: two eggs were fertilized by two sperm 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 just like brother and sister.

Risks of multiple pregnancies

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

The occurrence of risks largely depends on the formation of connections between the fetal membranes and the placenta, on the one hand, and the twins, on the other.

If both children are attached to the same placenta, their life support may be greatly affected.

Even before the 15th week of pregnancy, ultrasound can provide a clear picture of the current situation. That is, already in the early stages it is possible to assess the likelihood of risks occurring 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 two umbilical cords are present, and the membranes 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 they share both the amniotic sac and the placenta. Which of these possible situations occurs 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 membranes. The risk of complications is low, so special medical supervision is not required. If the first child has a cephalic presentation, then nothing will interfere with a normal birth.
Monochorionic-diamniotic twin pregnancy. Such twins can only be identical. Since there is a risk of feto-fetal transfusion syndrome, starting from the 12th week, it is recommended to carry out control examinations twice a month.
Monochorionic-monoamniotic twin pregnancy. These twins are also always identical. Along with the risk of conjoined twins, there is also the danger of intertwined umbilical cords. This type of pregnancy requires frequent ultrasound examinations. To avoid complications associated with umbilical cord entanglement, cesarean section is recommended.

Controllable risks

If these days the risk of giving life to twins increases, then the chances of giving them good health are much greater, not least thanks to ultrasound and medical monitoring. There is a high risk of having a premature baby, as well as malnutrition (a child with low weight).

In addition, in such cases, the expectant mother's daily life is subject to much stricter restrictions and she requires a lot of rest.

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

I gained a lot of weight. Is it possible that I am expecting twins?

Multiple pregnancy or just excess weight?

Most likely, you simply gained excess weight compared to the average possible in the 1st trimester. If you have a naturally fragile constitution, an increase in the weight of the uterus will be noticeable earlier than in a woman with a denser build. Your belly doesn't get big because you're expecting two at once. During the examination, your doctor will take into account: genetic predisposition, size of the uterus (not the abdominal cavity), the beating of one or two hearts, more severe symptoms (morning sickness, gastrointestinal disorders), etc.

Everyone in our company thinks that having twins is wonderful, but we have a different opinion! What's happening?

Twin pregnancy and disappointments

Rare couples dream of buying two cribs, a double stroller, two high chairs, in a word, two children! A woman is preparing both psychologically and physically for the birth 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 has more than enough of, and she does not need this responsibility to double. Accept these conflicting emotions calmly at the news of the arrival of two babies and try to avoid feelings of guilt. On the contrary, take these weeks to get used to the idea of having two people in your family at once.

Talk to your partner, talk to the other twins' parents. If you don’t know any of them, ask your doctor, he will give you the coordinates of associations where you can meet them. You can also search on the Internet. The fact that you are not the first parent to be confused and doubtful will help you 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 pregnancies

If you are expecting twins, the doctor's first task will be to determine the number of placentas and amniotic sacs using ultrasound, starting in the 1st trimester and as soon as possible. If there are 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 “monochorionic biamniotic.” In very rare cases, when 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, are very important for monitoring the development of both babies. The one who receives less nutrition may be diagnosed with malnutrition (low weight), the other is prone to cardiovascular diseases. A team of specialists, having identified and monitored the problem, can help balance the situation, safely “bringing” you directly to childbirth .

If you are expecting three or more babies

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

If there are more than three fetuses, the risk of complications increases proportionally. There is a small chance that birth will occur at an acceptable time, that is, after 34 weeks. Careful medical supervision is necessary, and childbirth must take place in a maternity hospital of at least the same level.

Your doctor may suggest that you reduce the number of embryos to two. It is often difficult for parents to make such a decision, especially - 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 very carefully monitor your well-being, 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 becomes more careful. In case of multiple pregnancy, the midwife should visit you at home once a week, starting from the 22nd week of amenorrhea. She should make sure that you get enough rest so as not to provoke cramping in the uterus. She will also check your blood pressure and protein levels in your urine. Use these visits to obtain the information you need - for example, about the food system. Also, if you are expecting twins or triplets, food portions need to be increased (by 10-20%).

Benefits of relaxation

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

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

Soft birth

In the case of a twin pregnancy, the due date is 38 weeks, and not 41 weeks, as in a singleton pregnancy. It is necessary that the birth takes place 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 embryos.

What types of twins are there?

Why does it become possible for several fetuses to develop during one pregnancy? In the first days after conception, a fertilized egg may split 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 gender, always have the same blood type and an amazing resemblance in appearance.

At the same time, depending on at what stage 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 is fertilized by a sperm on the way to the uterus, then several embryos will be implanted into the mucous membrane at once. Such babies are called fraternal twins, or heterozygous (dizygotic in the case of twins, trizygotic in the case of triplets, etc.).

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

After all, unlike identical twins, all these differences are inherent in them at the genetic level.

At a later stage, 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.

A little later, during an external examination, the doctor can determine the position of several heads or pelvic ends of the fetuses and listen to heartbeats at different points of the uterus.

Features of multiple pregnancy

Carrying two or three babies at the same time creates additional stress on the expectant mother’s body, so she receives the closest attention from doctors from the very beginning of pregnancy. However, this condition in itself is not a pathology, therefore, if you are expecting several babies at once (and most often with multiple pregnancies, twins are expected), 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 the more intensive growth of the uterus, which is observed with multiple pregnancy, the risk of miscarriage is slightly higher than usual. The expectant mother requires special attention in the last months - at this time there is a possibility of premature rupture of water. Most likely, your doctor will recommend a gentle regimen, limited physical activity, especially in late pregnancy, and in some cases, bed rest and even hospitalization.

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

It should be remembered that labor in such cases most often begins a couple of weeks earlier, at 36-38 weeks of pregnancy, and twins are born with a slightly lower weight than ordinary newborns. But you should not be afraid of this - nature takes care of such babies and provides them with an increased ability to adapt.

A pregnant woman's needs for nutrients and vitamins inevitably increase, since she must provide everything necessary to two organisms at once. The needs of an expectant mother expecting two or three babies increase even more. You should pay close attention to this problem, since your body can deplete its resources quite quickly, and this will lead to the risk of developing anemia, vitamin deficiency, as well as late toxicosis of pregnancy. Carefully consider your diet, including protein foods, multivitamins and mineral complexes that your doctor will recommend to you.

Your doctor will be under special supervision of both your cardiovascular system and the normal functioning of your kidneys, since these organs are subject to 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 fetuses in a singleton pregnancy. In the following weeks, their total weight gain is approximately equal to that of the fetus during a normal pregnancy. At the same time, it is quite natural that the volume of the abdomen and the weight of the expectant mother are slightly higher than these indicators in women expecting the birth of one child.

Organization of medical care for women with multiple pregnancies

As a rule, multiple pregnancies are detected already during the first ultrasound examination. The most reliable data on the state of the membranes can be obtained between the 9th and 15th weeks of pregnancy. If twins are fraternal, they can also be of opposite sexes. But even if the babies born 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, what is important is not the division into identical and fraternal twins, 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: frequency is variable, depending on family history, maternal age, infertility treatment.
Frequency of mono- and dizygotes in multiple pregnancies: 70% dizygotes (necessarily dichorionic/diamniotic). 30% monozygotes (necessarily same-sex, membrane ratio: 29% dichorionic/diamniotic, 70% monochorionic/diamniotic, 1% monochorionic/monoamniotic).

Sonographic diagnosis of chorions/zygotes

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

II and II trimesters:

Gender of the fruit.
Location of the placenta (if monochorionic, unilateral placentation is required on both sides.
Thick bridge (> 1.6 mm = 4 layers - dichorion).
X-sign in dichorionic twins (triangular protrusion of the placenta in the area of the radial amniotic membrane during chorion involution).
T-signs in the case of monochorionic twins (vertically protruding amniotic membrane separating the membranes on the placenta).

Postnatal diagnosis of chorions/zygotes

Gender of children.
Histology of the placenta.
Children's blood type (method reliability 99.9%).
Enzyme histochemical and tissue typing analysis (high specificity).
Verify similarity/similarity (method reliability 98%).

Prenatal problems in multiple pregnancies

Uncontrollable vomiting of pregnancy (20% of twins, 60% of triplets).
Premature contractions, cervical insufficiency, premature birth.
Premature rupture of amniotic fluid, amniotic infection.
Polyhydramnios (12%).
Preeclampsia (the risk is 5 times higher compared to a single pregnancy).
Intrauterine growth restriction (twins from 35 weeks, triplets from 32 weeks).
Feto-placental insufficiency.
Increased incidence of malformations (congenital heart defects), especially in monozygotic twins.
Increased risk of chromosomal aberrations.
The risk of spontaneous abortion (2 times higher).
Increased risk of hypoxia during vaginal birth (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.
"Disappearing Twin Syndrome"(Vanishing Twin Syndrome) - 30% of all initially multiple pregnancies end in the birth of one child (Fetus papyraceus, paper/mummified fetus).
"Dead Fetus 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 injury to the surviving child due to entry of thromboembolic material through open vascular connections has never been confirmed. Late consequences: disorders in the mother’s blood coagulation system caused by fetal thromboplastic material are debatable.

Feto-fetal transfusion syndrome (FTTS)

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).

Chronic FFT syndrome (long-term hemodynamic imbalance) - Triad:

Impaired growth and development > 15%.
Reducing the volume of amniotic fluid.
Change in hemoglobin content > 5 g/dl.

Donor: IUGR (intrauterine growth/development retardation), anemia, hypovolemia, hypoglycemia, oligo/anuria, ahydramnia, dropsy due to anemia. Sometimes renal failure develops with anuria, which reverses 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 in dichorionic twins).

Forecast: the earlier and more suddenly hemodynamics are disrupted, the worse. Without treatment, mortality is up to 100%. The incidence is periventricular leukomalacia.

Therapy:

Drainage (repeated) of amniotic fluid - reduction of intra-amniotic pressure, survival rate 60-70%.
Fetoscopic guided laser coagulation of shunts: overall mortality 53%. It has a significant advantage regarding the level of morbidity (neurological) with a high risk of intervention.
Amnioseptostomy [E1].

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

Definition: an asymmetrical malformation of one of the twins, which is perfused at the expense of the other twin through an arterial shunt. Massive swelling leads to the formation of a “heartless monster” (the heart, head, and upper limbs are absent or improperly developed).

Diagnosis: various forms of acrania-acardia, generalized edema (edema), 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.

Umbilical cord ligation.
Laser coagulation of the umbilical cord.
Intravascular installation of fibrin glue.

Pregnancy with conjoined twins -1:50,000

Definition: a disorder of early embryonic development due to incomplete divergence of monochorionic twins.

Types: thoracopagus (70%), craniopagus, pyopagus, ischiopagus.

Diagnosis: absence of separation of body surfaces and fixed relative position of both twins during ultrasound.

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

Monitoring multiple pregnancies

More frequent sonographic examinations - especially in monochorionic twins.

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

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

Features of delivery during multiple pregnancy

During a multiple pregnancy, natural childbirth is possible under the same conditions as during a singleton pregnancy. Doctors resort to surgery if the uterus and fetuses are too large and the woman’s birth canal is not prepared at 38 weeks or more.

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

Premature placental abruption for the second of twins - after the birth of the first.

Loss of umbilical cord loops.

Mechanical clutch of children.

Violation of placenta separation.

Management of childbirth during multiple pregnancy

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

The desired delivery time is 39-40 weeks.

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

Multiple pregnancy is something for which it is impossible to prepare, since it is impossible to predict it, or, conversely, to calculate its formation. It is worth noting that carrying such a pregnancy is much more difficult and you will have to try a lot not only to save the babies, but also to promote their uniform development.

Signs of multiple pregnancy in the early stages

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

Twin pregnancy has primary symptoms such as:

Severe toxicosis, and there is no way to avoid it, unlike carrying one fetus.
The presence of a bright second line on a test to detect pregnancy, as the level of a hormone called hCG increases significantly.
A rapid increase in the volume of a pregnant woman’s abdomen, which can be recognized literally at the 12th week, but depending on the physiology, this is possible much earlier.
Earlier manifestation of baby movements, since they have much less space to move, accordingly, the tremors will be brighter and earlier.
Rapid weight gain, especially during the first trimester, which in a singleton pregnancy occurs by the middle of the second trimester.
Having an increased appetite.
The presence of sudden and serious mood swings.

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

The main signs of twins in early pregnancy

You can determine a diagnosis such as multiple pregnancy yourself, but it is better to undergo an examination that will show the real result and confirm your guesses. An examination by a doctor allows you to note such signs as an enlarged uterus, which, for example, at the 5th week of pregnancy may correspond to the 9th week of development of an interesting position. Blood is donated for a hormone such as hCG, and if the level is too high, then this becomes another sign.

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

Naturally, you can find out that there is not one fertilized egg inside, but two, by listening to two heartbeats, as well as by palpating the two heads, but this is done in later stages of pregnancy. To exclude medical error, you should definitely undergo an ultrasound. Ultrasound is an option that will not allow mistakes 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 identified.

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A multiple pregnancy is a pregnancy in which a woman carries more than one fetus. During natural conception, it occurs in the proportion of 1 case per 80 births. When using reproductive technologies, whether it is stimulation of superovulation or the IVF method, the chances that the expectant mother will carry twins, triplets or quadruplets increase sharply.

The recorded record for multiple pregnancies is the birth of ten twins. However, not all of them survived. The largest number of twins that have been born and survived are octuplets. However, carrying multiple fetuses at the same time increases the risks of premature birth, early pregnancy loss, and neurological problems in children after birth.

How does a multiple pregnancy happen?

Multiple pregnancy photo (twins)

Several babies can appear for two reasons: either the mother had several mature eggs fertilized at the same time, or the zygote of one egg separated several hours after fertilization.

In the first case, the twins will be called fraternal; the embryos are implanted in different segments of the uterine body. Normally, one egg should mature in each menstrual cycle. But hormonal disruption or stimulation of superovulation can lead to the formation of several dominant follicles at once, which enlarge and produce several eggs ready for fertilization.

By the way, within 1 – 2 months after stopping a course of oral contraceptives, a rebound effect may occur, when the woman’s body also produces several eggs in one cycle.

In the second case, when a division of one female cell has occurred, the twins will be called identical. The division of a zygote can be either spontaneous (which happens very rarely) or hereditary (which happens much more often). It is typical for identical twins that an ultrasound scan in such a multiple pregnancy in the early stages may not show that there are several embryos.

Having twins or triplets is a test not only for the morale of future parents, but also for their family budget. Therefore, the sooner the number of embryos is established, the more opportunities the couple will have to prepare for further waste. In addition, it is important to monitor the signs of multiple pregnancy in the early stages after stimulation of superovulation, so that at 10–12 weeks it is possible to carry out selective reduction if there are too many embryos in the uterus.

Among the first symptoms of the presence of several embryos are the following:

The level of hCG in a blood test does not correspond to the parameters observed in the presence of one child - the levels of this hormone are much higher.
Toxicosis begins earlier than pregnancy is detected by ultrasound, that is, before 21 days from conception.
During a bimanual examination, the gynecologist states that the enlargement of the uterus occurs more intensely, and the size of the reproductive organ is larger than during pregnancy with one fetus at one time or another.

As the period increases, ultrasound can determine the number of fertilized eggs, and then, in the second trimester, the number of embryos in one fetal egg (if the twins are identical).

Methods for accurately diagnosing multiple pregnancies

In addition to the symptoms, there are ways to accurately diagnose a multiple pregnancy - this is assessing the dynamics of hCG and assessing the results of an ultrasound examination. Moreover, the doctor must take both results into account, especially if the woman only passed a test to determine the level of the pregnancy hormone.

HCG during multiple pregnancy reaches 31,500 mU/ml at 4 weeks, 82,300 mU/ml at 6 weeks and 291,000 mU/ml at 11 weeks. This is several times more than the hormone level during pregnancy of one fetus. If a woman is carrying more than two embryos, the rates may be even higher.

But a high level of hCG is not always the first accurate sign of multiple pregnancy. Sometimes it may indicate chromosomal abnormalities that the fetus has. For this reason, the woman is prescribed an examination by an uzist.

Ultrasound, especially performed after 10 weeks, it will be able to tell with high accuracy whether the expectant mother is carrying several embryos or one. If the twins are fraternal, then this may become obvious already at 5–6 weeks, when two or more fertilized eggs can be distinguished in the uterine cavity.

If the twins are identical, then the diagnosis can be more accurate in the second and even third trimester. The doctor will have to determine whether each baby has his own placenta or whether they are shared, as well as the level of development of the children, because there are often cases when one of the twins receives little nutrition and lags behind his brother or sister.

If the doctor suspects twins, then ultrasound remains the only accurate and safe way to determine a multiple pregnancy.

Babies develop in exactly the same way as if they were alone in the mother's womb. The only peculiarity in this regard may be that they may not gain weight as steadily and intensively as in the case of a singleton pregnancy. But some differences can be observed in the mother’s well-being and in the doctor’s attitude:

Increased tiredness and fatigue. In this regard, the gynecologist will give a recommendation to observe semi-bed rest more often, especially if increased uterine tone is diagnosed.
During a multiple pregnancy, the abdomen can have much larger volumes - this is associated with the risk of severe stretch marks, which will then be difficult to remove.
The doctor's attention will be more careful, since when carrying twins and triplets, the risk of developing eclampsia and pre-eclampsia is much higher than when carrying one child.

Features of childbirth during multiple pregnancy

The main task of the gynecologist is to prolong the pregnancy until such time that the children are viable and the likelihood of brain hemorrhage at birth is minimal. Births during multiple pregnancies often become premature, especially for triplets and quadruplets.

If doctors have even minimal doubts that natural childbirth may be complicated, then the woman is usually sent for a caesarean section to minimize risks.

Babies are born with a short interval of a few minutes. There are cases when a second child was born a few days after the first, but such situations are rare, and they are possible only with fraternal twins.

The main reason for such a large interval is considered to be a weekly delay in the development of one of the children in a multiple pregnancy.