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The course and management of multiple pregnancies. Why does multiple pregnancy develop?

Termination of multiple pregnancies is much more common than termination of singleton pregnancies. A particularly high risk occurs in the second trimester and in the third. Women who are pregnant with twins are under the special supervision of a specialist. To avoid miscarriage, doctors prescribe a woman special drugs that relax the uterus throughout the pregnancy. In the later stages of pregnancy, a woman is observed with particular inattention. If the drugs are not enough, then in this case the woman is hospitalized until the onset of childbirth.

During pregnancy with twins, the load on the cardiovascular system increases, so the expectant mother may have problems with the work of the heart. If there are at least any symptoms of disruption of the cardiovascular system, then in this case you need to urgently consult a doctor, because the consequences can be negative.

Reasons for the birth of twins, twins

Identical (monozygotic) twins. A fertilized egg in the early stages of development begins to divide into two absolutely identical parts. Each part develops independently. Monozygotic twins always have the same gender, they are similar in appearance, have the same blood type, their characters converge, they can suffer from the same diseases at the same time, and monozygotic twins also have the same set of genes.

Dizygotic twins (fraternal). When two eggs in a woman’s egg mature at the same time, two spermatozoa manage to fertilize them at the same time, then we are talking about fraternal twins. The children born are similar to each other, like brothers and sisters who were born at different times, because each child has a different genetic structure. The appearance of children, their character, blood group and gender can be different. Fraternal twins share approximately 50-60% of their genes, which is the same as normal siblings.

"Siamese twins" (those that have grown together) in all cases develop from one egg. The egg is not completely separated, so the children remain fused together.

Reasons for multiple pregnancy

Of course, the hereditary factor plays a huge role. Approximately 10 out of a hundred women who gave birth to twins have a history of multiple pregnancy among relatives.

If you take hormonal contraceptives for a long time, and then abruptly stop taking it, this can provoke the simultaneous maturation of two eggs.

Women aged 35-40 have a very high chance of getting pregnant with twins. At this age (before the onset of menopause), a certain last hormonal surge occurs. For this reason, very often at this age women become pregnant with twins (triplets and so on).

The hormone that stimulates the ovary is produced better during long daylight hours. In the spring, the sun warms up well, the activity of sex hormones increases and the likelihood of conceiving twins increases.

Also, the intervention of modern medicine can become the cause of multiple pregnancy. Recently, reproductive technologies have been actively used to treat infertility. A very common method is IVF (in vitro fertilization), when the conception of a child occurs in a test tube, and not in the womb of a woman. It often happens that couples who have not been able to have children for a long time have twins or even triplets!

Features of the course of multiple pregnancy

Carrying twins is no easy task. Women who carry two babies at the same time are heroines, and these are not just words. Already at the stage of gestation, twin babies are at biological risk. A woman's body is programmed to carry and feed only one baby.

In the first three months, in 20-25% of women, one of the fetal eggs dies, the fetal egg, which froze, stops its development and gradually dissolves over time. But in some cases, the remains of a frozen fetal egg remain in the uterus until the onset of childbirth.

With twins, the volume of circulating blood increases by about 50-65% (compared to 40-50% with a singleton pregnancy). Plasma volume increases, while hemoglobin levels decrease, especially in the second trimester. In women, the process of hematopoiesis is actively taking place, they have much more red blood cells than in the initial stages of pregnancy. This condition can cause iron deficiency anemia in some women, as limited iron stores are depleted.

If a woman is pregnant with twins, then she can tolerate toxicosis and morning sickness much worse. Toxicosis is provoked by various factors, one of which is human chorionic gonadotropin, that is, HCH (its increase). HCG levels are much higher in twin pregnancy than in singleton pregnancy, which explains why toxicosis in women pregnant with twins is much stronger.

Toxicosis disappears at the twelfth to fourteenth week of pregnancy (in the same way as with a singleton pregnancy).

Mothers of twins are much more likely to complain of heartburn, back pain, and sleep problems.

Since there are two children, the uterus has to increase much more in size so that the children are not crowded there. The enlarged uterus begins to compress the diaphragm and the work of the lungs and heart becomes difficult, the pregnant woman gets tired very quickly, she has shortness of breath. Pregnant women often experience constipation and frequent urination.

More common (late toxicosis), which are manifested by protein in the urine, edema, high blood pressure.

If a woman is pregnant with two children, this does not mean that she can feel the movement of the children earlier than women who are carrying one child. During pregnancy with twins, the movements of the embryo can be felt at about 18-20 weeks. If a woman has already been pregnant and can distinguish the movement of the baby from the work of the gastrointestinal tract, then she may feel the movement a little earlier.

The weight of a woman pregnant with twins should also be controlled. With a singleton pregnancy, weight gain from 8 to 12-15 kg is considered normal (it all depends on what body weight the woman had before pregnancy). And with multiple pregnancy, a normal weight gain is 18-20 kg. During pregnancy, the diet should be saturated, healthy and high-calorie. If there is swelling, then you should reduce fluid intake to 1.5 liters per day.

Women who are pregnant with twins need to enrich their bodies with large amounts of folic acid so that birth defects do not develop. If a woman with a singleton pregnancy is recommended to take 0.4 mg of folic acid per day, then with twins the dose should be increased to 1 mg.

A woman with twins is sent to the hospital about 2-3 weeks before the birth. Childbirth is usually carried out for a period of 36-37 weeks. The most favorable period for the birth of twins is 36-38 weeks.

A woman can give birth to twins on her own, natural childbirth proceeds normally. But in some cases, complications may occur, such as prolapse of umbilical cord loops, prolapse of small parts of the fetus (legs, arms), hypoxia (oxygen starvation), premature rupture of amniotic fluid, premature detachment of the placenta of the second child after passing through the birth canal of the first child, weak birth activity (due to overstretching of the uterus), postpartum hemorrhage.

But nature took care of the twin babies. They have a much higher ability to adapt than a single baby. It has been proven that twin babies have lungs that mature much earlier so that babies who are born prematurely can breathe on their own. In the postpartum period, the adaptation period for identical twins and fraternal twins is slightly different. If fraternal twins adapt without problems after birth, then identical twins endure this process a little more difficult. Children from monozygotic twins are prone to respiratory disorders, swelling, and icteric syndrome.

Caesarean section for twins

Indications for caesarean section with twins: overdistension of the uterus due to polyhydramnios, very large fetuses, breech or transverse presentation of the first child from twins, extragenital diseases, the birth canal after 38 weeks is unprepared for childbirth, severe preeclampsia, the age of the primiparous woman, along with other indications, especially if before that there was prolonged infertility or a complicated course of pregnancy, fetal hypoxia.

Women who are pregnant with twins have a high risk of losing large amounts of blood during childbirth. To avoid large blood loss and transfusion of someone else's blood, a woman can donate her own blood plasma during pregnancy. Plasma is stored until the onset of childbirth. If necessary, this plasma is transfused. Auto transfusion products can also be used to help collect blood during surgery. After washing, the patient is transfused with her erythrocyte mass. Thus, the risk of losing a large amount of blood is reduced to a minimum.

Multiple pregnancy is not a pathology, but doctors believe that such a pregnancy should be observed very carefully. It is best to give birth to twins in high-level maternity hospitals, which have a fashionable qualified resuscitation of newborn babies.

How to eat healthy when pregnant with twins?

There is no special diet designed for twin pregnancy. Nutrition should be balanced and healthy. The foods used should provide the children with all the necessary substances so that they can develop and grow normally. We know that twins are usually born prematurely, so during this period, children must receive enough nutrients, otherwise they may be born with a small birth weight.

To the daily norm of the usual diet, you need to add 300 calories per baby, that is, with twins, you need to add 600 calories per day. In order for twins to develop normally, a woman needs to increase her daily diet and reduce physical activity.

Not all women who are pregnant with twins simply eat well, because severe toxicosis occurs, taste preferences change greatly. There are frequent. Indigestion. In such cases, you need to consult a doctor.

In the second and third trimester, it becomes even more difficult to gain the desired weight, because the uterus squeezes the stomach and a woman, having eaten very little, already feels full. In this case, you should try to eat five to six small meals a day.

You need to include foods rich in iron in your diet. This will help prevent iron deficiency anemia. Iron supplements are not recommended because they can often cause constipation.

As for prenatal vitamins, supplements that contain omega-3 polyunsaturated fatty acids, be sure to first consult your doctor before taking them.

Multiple pregnancy is a very responsible process and hard work, but at the same time it is a huge gift of fate.

Today we will discuss all the issues of the development of twin pregnancy, the features of the course of pregnancy itself and childbirth. As a pediatrician, I will even say a few words about my observations of the development of twins and pairs of twins after birth in my area.

So, it is customary to call a pregnancy multiple, when two or more fetuses develop. But, since triplets and even more multiple pregnancies are not so common, today we will only talk about twins. If for some of you the problem of triplets is relevant, then I will say that everything is developing in approximately the same way.

Twins vs Twins: What's the difference?

Twins develop when not one egg, but two, matures in a woman's body. These sex cells can develop both in one ovary and in different ones at the same time. Of course, a prerequisite is that both of them will be fertilized by two spermatozoa (of course, different ones).

So it turns out two organisms with different genetic material. They may be of the same or different gender. There is no particular resemblance in their appearance, they are just like brothers and sisters.

Since children develop from different eggs, they may be called fraternal twins. Regarding medical details, I will explain, each of the babies has its own fetal sac, its own placenta.

Twins are called babies developing from one egg fertilized by one sperm, which at a certain time was divided into two parts, and from each part the development of a separate organism began. One egg, one sperm, same genetic material. Thus, twins are always the same sex, have an identical set of genes and the same appearance.

Twins can also have two of their own amniotic sacs and two placentas. Doctors call such twins bichorionic and biamnionic. The earlier the separation of the egg occurs, the greater the likelihood of the formation of a separate placenta and a separate amnion (fetal bladder). So, for example, the above-described variant of twins will turn out if the separation of the egg occurred on the 3rd day from the moment of fertilization.

But more common are twins with one placenta and two separate amniotic sacs (biamnic monochorionic twins). This scenario is possible if the fertilized egg decides to give two lives 3-8 days after meeting with the sperm.

The third version of the development of twins is also common. This is when one amnion and a single placenta are formed (monochorional monoamnionic twins). Usually this option is possible with a fairly late division of the egg - 9-10 days after conception.

Why does multiple pregnancy develop?

Double happiness is not given to everyone to experience. The frequency of twin births in the human population is approximately 1.5%.

The main reasons for the development of twins and, in general, multiple pregnancy are:

  • ovarian hyperstimulation by hormones. It is used in medicine as an auxiliary technique for the early conception of a child. Hyperstimulation is indicated for a woman in whom the cause of infertility has been identified, and it consists in a violation of the maturation of female germ cells in the ovary;
  • twins are often born after in vitro fertilization. To increase the likelihood of pregnancy during IVF, several embryos are simultaneously fertilized and implanted into the uterus of the expectant mother (in Russia, up to three embryos are possible at once). In the early stages, the death of the embryo may occur, so doctors are counting on the successful fixation of at least one of the implanted embryos.
  • Of course, at the request of the parents, the reduction of the embryo is possible if two have taken root. But this is a rather risky step, not to mention a sin. Reduction of the engrafted embryo at the request of the parents after unsuccessful attempts to conceive is infrequent;
  • recent withdrawal of oral contraceptives after prolonged ovarian rest also increases the likelihood of multiple oocytes maturing at the same time;
  • hereditary factor. Heredity occupies not the last place in this phenomenon. Moreover, this feature is transmitted more along the female line, and more often through a generation. That is, for a woman who has given birth to twins, her granddaughter, and not her daughter, is more likely to give birth to twins. Although not a fact. For example, my mother never had twins in her family. But in the family of the father, having delved into the pedigree, they nevertheless found a case of twins. Few people remembered this case, since only one of the two children survived after giving birth. And the fact that the possibility of multiple pregnancy was passed down the paternal line does not contradict genetic patterns.

Are there early signs of multiple pregnancy?

It is practically impossible for a woman to find out about her multiple pregnancy on her own. More often, pregnant twins note the appearance of early toxicosis. Moreover, a pregnancy test can be with the usual color intensity of the indicator strip. Only at the appointment, the doctor can note the too large size of the uterus and their discrepancy with the calculated gestational age.

It is not always possible to recognize two embryos on the first ultrasound confirming the fact of pregnancy. But at a gestational age of 8-10 weeks, when it is possible to determine the heartbeat using doplerometry, it is already possible to say with accuracy about the beating of two hearts. And at the obligatory first screening ultrasound, which is carried out up to 12 weeks, the specialist will always notice the development of two babies, since their sizes at this time are no longer tiny.

At a later date, women with twins report more pronounced heartburn, shortness of breath, and swelling of the lower extremities. A pregnant woman gains weight more rapidly. Normally, during a multiple pregnancy, a woman can gain 20-22 kg.

After 18-20 weeks, a woman may feel tremors simultaneously in different parts of the abdomen. And the doctor can feel several large parts, for example, two heads and two butts of babies.

Features of the course of multiple pregnancy

About the earlier appearance and more pronounced toxicosis, I already wrote above. It is understandable that pregnancy with one child puts an enormous burden on all systems and organs of a woman, and with twins, it is even more difficult for the body to withstand the load.

Women with twin pregnancies are more likely to suffer from iron deficiency anemia, since it is incredibly difficult to provide oxygen and iron for the synthesis of red blood cells in the blood of two babies.

During pregnancy with twins, the volume of circulating blood increases. Since the mother's blood has the function of providing nutrients to the fetuses, the blood in the mother's body must circulate more intensively than during a normal pregnancy in order to provide nutrition for two babies.

Fetoplacental insufficiency is a fairly common occurrence during pregnancy with two babies, since two embryos require a more intensive metabolism in the placenta. Because of this, changes in the structure of the placenta inevitably appear, leading to disruption of the blood supply and nutrition of babies.

More often, this malnutrition occurs in one of the babies, which can lead to fetal fading in the early stages. There is another option that is often found - one baby develops more intensively and is born with noticeably more weight than the second.

As a rule, during pregnancy with twins, the size of the placenta is more impressive than during pregnancy with one fetus. That is, it is often partially or completely attached to the baby's path at the time of delivery. This phenomenon is called placenta previa. With this development of events, childbirth through the birth canal is contraindicated. Placenta previa is one of the absolute indications for operative delivery.

Since a double burden also falls on the kidneys of pregnant twins, very often edema in such women appears earlier and manifests itself to a greater extent than during pregnancy with one baby.

An excessively enlarged uterus causes a change in the location of the internal organs - the stomach, intestines, ureters. In this regard, such women have more pronounced heartburn, constipation, and a greater risk of urinary tract diseases during pregnancy.

The expectant mother can hear the movements of the babies already at the 15th - 16th week. The intrauterine development of children in both singleton and multiple pregnancies is the same. However, during pregnancy with twins, due to the proximity of the enlarged uterus to the surface of the skin, the woman notices the first movements earlier.

The intensity of fetal movements also differs from their intensity in a more familiar singleton pregnancy. In the later stages, babies push very hard, trying to compete for a more comfortable position in the cramped space of the uterus.

A woman with multiple pregnancy is observed in the antenatal clinic more carefully and examined more often. Until the 30th week, an attendance is prescribed every 10 days, and after the 30th week of pregnancy - once a week.

The condition of the cervix is ​​carefully monitored, since isthmic-cervical insufficiency (prenatal opening of the cervix) due to overdistension of the uterus is a fairly common occurrence in multiple pregnancies.

A woman with twins can receive maternity leave and a disability certificate two weeks earlier than with a singleton pregnancy. That is, at 28 weeks, and not at the prescribed 30 weeks of pregnancy. Payments of benefits after the birth of babies do not differ in terms. But they are charged for each of the kids.

twin pregnancy calendar

Obstetrician-gynecologists count the first week of pregnancy from the first day of the last menstruation, when, in fact, menstruation is still going on and the egg is not fertilized. That is why, with the arrival of a delay in regular menstruation, a woman learns about the existence of pregnancy with a fairly decent period of 3-4 weeks.

We will analyze by week what happens to babies and mothers at different stages of pregnancy.

First trimester

  • 1-4 weeks

As a rule, a woman does not even suspect that she is pregnant.

After the fusion of the egg and sperm in the fallopian tube, a zygote is formed. This is a single cell, from which a multicellular organism will be formed in the future. If initially there were two eggs, and they are fertilized by two different sperm, then two zygotes are formed, and fraternal twins will develop.

In the process of crushing, the zygote turns into a morula. This is at first 2 cells (one cell split in half), then 4, then successively 8, 16 and 32 cells, arranged in a dense cluster in the form of a raspberry. It is at the morula stage of 32 cells that the proembryo enters the uterine cavity. It can be implanted into the wall of the uterus not immediately, but after 2-3 days.

I will dwell in more detail on the moment when one fertilized egg gives two lives. This happens if, during crushing, the morula at some point suddenly “falls apart” into two parts, and each part begins to develop further independently, forming a separate organism.

If the division of a single fertilized egg occurs in the first three days after meeting with the sperm, twins develop with separate amniotic sacs and separate placentas (second column in the figure).

If this egg division occurs between days 3 and 8 after conception, the twins will have separate amniotic membranes and a shared placenta (third column in the figure).

If the egg decides to separate later than 8 days, but before the 13th day from the moment of fertilization, twins with a single fetal membrane and a single placenta will develop (fourth column in the figure).

Late division of the egg (after 13 days of life) threatens the development of undivided twins (Siamese).

Before implantation, a cavity forms between the cells of the morula, and it turns into a blastocyst - a hollow vesicle filled with liquid contents.

Implantation occurs approximately on the 7th day after conception. At this stage, the process of cell division only progresses. The process of introducing the embryo into the uterine wall can take a couple of days. This is considered the first critical period in the development of pregnancy.

In the second week, the formation of primary and secondary chorionic villi (the future placenta) and the differentiation of the germ layers, which subsequently give all the organs and systems of the baby, take place. This is considered the second critical period in obstetrics.

Up to 14 days, the embryo looks like a vesicle, consisting of three germ layers. From the third week, blood vessels form and grow into the chorionic villi. Due to this, with direct contact of the chorionic villi with the mother's blood, the fetus receives nutrients. Thus, the type of nutrition of the embryo changes to hematotrophic (through the blood).

With the beginning of the third week, all organs are laid down (organogenesis). First, the neural tube, heart and gonads are laid, then the liver, lungs, primary intestine and primary kidney. Starting from the 3rd week, it is possible to determine the fetal heartbeat on ultrasound, if the permission of the apparatus and the qualifications of the doctor allow this.

At the 4th week, the nervous system continues to develop, the rudiment of the brain and spinal cord is formed. At this time, the rudiments of the upper and lower extremities are already visible in the embryo.

Until the end of the 4th week, the embryos will be no larger than 2 cm.

  • 5-8 weeks

During this period, organogenesis continues, that is, the formation of organs and body systems of developing children. The structure of all previously laid down organs and systems becomes more complicated. Nerve fibers are formed that connect organs with the central nervous system, that is, with the brain and spinal cord. The head of the embryos at this time is disproportionately large.

At the sixth week of pregnancy, the embryos can already bend and straighten the neck, changing the position of the head. Facial features are gradually emerging, eyes, auricles, mouth are formed. A clear difference between the upper and lower extremities emerges, the fingers differ.

At this stage, gender has already been formed, but it is not yet possible to determine the sex. The sexual organs visible on ultrasound have yet to form.

The blood flow in the uterus and placental bed becomes more intense to ensure such intensive growth and development of the embryos.

The eighth week ends the embryonic period of development of babies. At this time, the length of the embryos is usually 4.5-6 cm, weight is about 15-20 g.

  • 9-12 weeks

By the ninth week, the babies have everything formed to be called no longer embryos, but fruits. There is a blood type and Rh factor. With the end of the embryonic period, complete differentiation of the brain and spinal cord, central and peripheral nervous system is observed.

The fetuses swallow amniotic fluid. They have a functioning bladder and kidneys. The movements of the fetuses become more diverse - they can cover their faces with their hands, suck their thumbs, move to the sides. The external genitalia are formed. The structure of the placenta becomes more complicated. It begins to perform more and more functions (respiratory, protective, metabolic, hormonal).

At 12 weeks, the length of the babies is approximately 85-90 mm, the babies weigh up to 30 g each.

So the first trimester of pregnancy has come to an end.

What changes await the expectant mother of twins in the first trimester?

The expectant mother of twins in the first trimester may experience an earlier and more pronounced toxicosis, which may also be felt in the second trimester.

The uterus is rapidly increasing in size. By the end of the first trimester, it more often already goes beyond the small pelvis, therefore it puts pressure on adjacent organs and can disrupt their usual work. So, pregnant twins feel frequent urge to urinate already in the first trimester. Constipation is also a frequent (but not mandatory) companion of multiple pregnancy.

In women during this period, the mammary gland actively increases, becomes moderately painful and sensitive. But this sign is typical not only for twin pregnancy, but for any pregnancy.

A woman should visit her doctor once a month. The gynecologist, at his own discretion, can set an individual schedule of visits for you. Up to 12 weeks, women must undergo an ultrasound scan, during which all violations and malformations of babies are excluded.

Second trimester

  • 13-16 weeks

The skeletal system of babies is actively developing. The rudiments of the ribs are formed. The bones of the skull become smooth and more dense. You can already observe superficial respiratory movements. It's more like exercising the chest muscles. The digestive system begins to function. There are peristaltic waves of the intestine. The production of bile in the liver of babies begins. Interestingly, it is at this time that taste sensations are formed in babies.

The movements of developing children in the uterus become more and more active. They already have a fairly rich facial expression, but so far it remains involuntary (children frown, smile, open their mouths, perform sucking movements).

The skin of babies is quite thin, blood vessels are clearly visible through it. There is practically no subcutaneous fat. The scalp is gradually covered with the first vellus hair.

The approximate size of 16-week-old babies from the sacrum to the crown is about 12 cm, they weigh about 90 g each.

  • 17-20 weeks

Children are actively growing. The growth of the trunk of children at this time prevails over the growth rate of the head.

At the seventeenth week of pregnancy, the size of the babies from the sacrum to the crown is about 14-15 cm, each already weighs about 130-140 g.

Children at this stage of prenatal development already hear and distinguish sounds, react to them with certain movements. With loud sharp sounds, babies move more intensively. Their eyes are still closed, but they already distinguish between light and darkness. On ultrasound, you can observe that the baby, reacting to some external influences, tries to cover his face with his hands, bring his chin to his chest, that is, bend his head.

Twins have been proven to sense each other's presence.

As a rule, women bearing twins hear the first movements of the fetus earlier than usual (16 weeks for nulliparous, 18 weeks for pregnant women again). Since the babies are cramped in the uterus, they are more actively repelled from its walls. At this time, a woman can feel up to ten movements of babies per day. At this time, the blink reflex is formed in babies.

The heartbeat of the fetus can already be clearly heard with a phonendoscope or an obstetric stethoscope. The rudiments of teeth, including permanent ones, are intensively formed. During this period, a cheese-like protective lubricant is also formed on the body of the fetus. Subcutaneous fat is formed.

In the body of babies, immune cells are already being produced. Fetal hemoglobin is gradually replaced by adult hemoglobin.

By the end of the fifth month, the coccygeal-parietal size of babies reaches 21-24 cm, and the weight is already quite decent - 320-340 g.

  • 21-24 weeks

During this period, all pregnant women already felt the first movements of their babies. The sleep time of babies gradually decreases, and the time of wakefulness and active movements increases.

There is an active strengthening of bones. The skin is still wrinkled and has many folds, in large folds especially a lot of cheese-like lubricant of the fetus accumulates.

The child actively swallows amniotic fluid containing particles of lubricant, desquamated epithelium, and dark green fetal feces are already accumulating in his intestines. In a normal pregnancy, the emptying of the intestines of babies can occur only after birth.

At this time, the amount of subcutaneous adipose tissue increases, including brown adipose tissue, which will protect babies from hypothermia after birth.

Toddlers are already very good at distinguishing sounds. It is noticeable that for themselves they distinguish sharp, loud, pleasant or unpleasant sounds, react to them in a certain way (by excitement or fading).

By the end of this period, babies reach a height of 26-28 cm, their weight increases to 450-550 g.

  • 25-28 weeks

The facial features of the children are becoming more and more clear, they already have eyelashes and eyebrows. The curves of the auricles are gradually formed.

The lungs are actively developing, the so-called air sacs (alveoli) are formed. While they are not yet filled with air, but at the 25th week, a substance such as a surfactant begins to be produced, which will not allow these sacs to subside after birth, when they are filled with air.

Babies actively gain weight by increasing the amount of adipose tissue, muscle growth, growth and strengthening of bones.

During this period, in boys, the testicles begin to descend into the scrotum, and in girls, the genitals continue to form.

By the 28th week, as a rule, the final presentation of the fetus is established, since they are already cramped in the uterus, they cannot roll over from head presentation to pelvic presentation or vice versa.

By this period, the babies are practically formed. In the case of premature birth, with proper nursing, they are already quite capable of surviving.

By the end of this period, the mass of babies is approximately 800-900 g, growth is up to 35 cm.

Changes in the body of the expectant mother of twins in the second trimester of pregnancy

The uterus has already grown enough, the tummy is noticeably rounded. It is already more difficult for a pregnant woman to lead a habitual active lifestyle at this time. But the correct alternation of periods of rest and activity will help to avoid problems with constipation, varicose veins, and swelling.

During this period, the expectant mother should pay special attention to the diet, namely, the sufficient content of protein and calcium in it. It is worth enriching the diet as much as possible with products containing calcium and phosphorus, vitamin D 3 (fish, canned fish, eggs, nuts, hard cheeses, dairy products), since the skeletal system in babies is actively formed. At this time, the future mother may be disturbed by heartburn.

It's time to use a support bandage, since during this period most often a woman still has to work, and back pain and heaviness in her legs are already bothering her. Already the physiologically changing gait (swinging) itself contributes to less back tension and pressure of the uterus on the pelvic bones. But in the case of multiple pregnancy, it is difficult to do without additional support of the bandage.

Often pregnant women complain that it is difficult for them to find a comfortable position during sleep. Experts recommend sleeping on the left side, bending the upper leg at the knee and straightening the lower one. Specially designed pillows for pregnant women are designed to relieve the bones of the pelvis and lower back, to support the already enlarged tummy of a woman.

Actively in the mammary gland, adipose tissue is replaced by glandular tissue. To the touch, the mammary gland has a fine-mesh structure.

The pigmentation of the peripapillary region on the chest, the median line on the abdomen is becoming more and more pronounced. Age spots and freckles may appear on the body. This is due to an increase in melanin content in the skin of a pregnant woman.

Before the 22nd week of pregnancy, women undergo a second mandatory (screening) ultrasound. In this study, they may already be told the sex of the babies, if, of course, the position of the twins allows them to consider their gender.

third trimester

  • 29-32 weeks

In babies, the brain, the cerebral cortex are actively developing, the number of its convolutions is increasing. The mass of the brain of babies is 25% of the mass of an adult.

Now one of the cerebral hemispheres is already beginning to function more actively, which determines whether the child will be left-handed or right-handed, whether left-hemispheric or right-hemispheric activity will prevail.

The endocrine glands that produce hormones (thyroid and parathyroid glands, pancreas, pituitary gland) are actively working.

Surfactant accumulates in large quantities in the lungs, and they begin a test mode of operation.

By the end of this period, the weight of the babies is 1500-1600 g, the length is about 40 cm.

  • 33-37 weeks

The skin of babies becomes lighter, as subcutaneous fatty tissue accumulates (about 10-15 g per day). Vellus hair is gradually wiped off. By birth, they can remain on the shoulders and back. There is more and more cheese-like lubricant on the body.

During sleep, the eyes of babies are closed, and during periods of wakefulness, the eyelids are open. The color of the iris of the eyes of all children is the same (deep dark blue) and only after birth can it change. The pupil already reflexively reacts by constriction or expansion to the intensity of the penetrating light.

The pulmonary and digestive systems are fully formed. The kidneys are fully functional, excrete up to 500 ml of urine per day. Amniotic fluid is updated about eight times a day (every three hours). The bones of the skull are denser, but mobile and pliable, which is so important for the normal passage of the head through the birth canal.

The babies are fully formed and ready to meet their mother. By the end of this period, the weight of babies can vary significantly - from 2200 to 3000 g, height - about 43-46 cm.

Pregnancy at 37 weeks is already considered full-term, and a woman pregnant with twins is being prepared for planned delivery.

Changes in the condition of the mother of twins in the third trimester

Future mothers of twins have the right to finish work early and go on a well-deserved rest. For them, maternity leave starts at 28 weeks. In the third trimester, until the 30th week, gynecologists prescribe a visit to a pregnant woman every 10 days, and after the 30th week of pregnancy - once a week.

During this period, the intensity of the movements of the babies decreases (they are cramped), but the strength of the shocks increases. A greatly enlarged uterus can compress the inferior vena cava in the position of a woman lying on her back. Therefore, in this position, pregnant women often experience weakness, dizziness, and a pre-fainting state appears.

Constipation, incessant heartburn, hemorrhoids are frequent (but again I repeat - not at all necessary!) Companions of the third trimester of multiple pregnancy. During this period, women may notice the first droplets of colostrum from the breast. This is fine. The mother's body is preparing for the birth of babies. The genital tract, the mammary gland are prepared for childbirth and functioning after childbirth, the hormonal background changes.

At 32 weeks, women undergo a third screening ultrasound. Here you can finally see the position of the babies, their presentation, which fetus is closer to the womb. It is possible to assess the state of the placenta, since with the development of twins, it often prematurely shows signs of aging (fast and intense metabolism through the placenta quickly wears it out). This is another reason for earlier delivery of multiple pregnancies.

The future mother of twins is hospitalized in advance in an obstetric hospital. This happens about 3-4 weeks before the expected due date. This is done to finalize the method and term of delivery.

In just the third trimester, a mother of twins can gain up to 6-7 kg. In the last weeks of pregnancy before childbirth, a woman can lose from 500 to 1.5 kg. The body gets rid of excess fluid, the mother's blood thickens, swelling decreases.

Features of childbirth when carrying twins

A woman with twins should be prepared for early hospitalization before delivery. This situation requires more careful monitoring of the pregnant woman in the later stages.

Preterm birth in these women is very common. The reason for this is the overstretching of the muscles of the uterus, which can serve as one of the triggers for the onset of labor. As a rule, if operative delivery of a multiple pregnancy is required, then it is planned for 36-37 weeks.

If there are problems with bearing twins and it is difficult to safely bring intrauterine development to 36-37 weeks, doctors try to maintain and bring the pregnancy to at least the 32nd - 34th week.

During this period of development, children already have surfactant in their lungs. This is a substance that prevents the air sacs of the lungs (alveoli) from collapsing, and the lungs become more or less prepared to perform their function after the birth of babies.

But more often there is a different picture - when one child is in the head, and the other - in the breech presentation. It happens less often when one child is located in the head or pelvic, and the other in a transverse presentation.

Natural childbirth with a single placenta of twins is dangerous because at the birth of one of the babies, placental abruption may occur and, accordingly, the nutrition of the other child will be disturbed. In this regard, you still have to resort to an emergency caesarean section in order to save the second baby.

Thus, preliminary hospitalization of a woman with twins 3-4 weeks before the expected date of birth is necessary to clarify the obstetric status and additional examination of the future woman in labor, as well as to resolve the issue of the method of delivery. More often, the issue is resolved in favor of a planned caesarean section, since the natural birth of twins much more often ends in complications for both the fetus and the mother.

My observations on the development of twins and twins after birth

As a pediatrician, observing the development of twins and twins after natural childbirth, I always note that the first born child of twins is larger and stronger for health reasons. It is he who tolerates the period of adaptation after birth more easily.

Children born first are less likely to experience transient (borderline) conditions after birth (toxic erythema, physiological jaundice, transient neurological disorders: depression or arousal syndrome).

And development in the first year of life, as a rule, shows that the first child of twins develops faster than the second born.

These observations are confirmed by my twins in the family. The twin sister was born larger and earlier than the twin brother by 5 minutes. So, let's say, the brother, like a true gentleman, let the lady go first.

And in life, the sister quickly acquired new skills. She quickly sat down, crawled. She learned to walk much earlier than her brother.

Now I am a mother of two children, the youngest of whom has just learned to walk. It so happened that at different times I had to lead both by the hands for a long time before the children themselves went. The little man wants to walk, but his strength is still not enough. So he demands: “Take me, mother, by the hand!” Although there is still a question of who drives whom)) J Rather, the baby drives his mother. He also demands with his hand: “Take me there!”

I asked my mother how she coped with the twins in such a difficult time. It's necessary to drive, keep two. But then nature itself, probably, took care that the twins did not simultaneously enter a new period of development. One is still crawling, the other is learning to walk.

So it is possible to cope with twins, although it is not easy. If, having learned about your double joy, you doubt and are full of fear about the upcoming birth and the future in general, then do not hesitate.

Double happiness is not given to everyone to experience, which means that you are a special person. The time of pregnancy will fly by. The good news is that instead of 18 months pregnant, you will only have 9 months. The result will be two crumbs, your two wonderful little bloods. Double positive emotions and double your difficult happiness await you.

Health and happiness to you and your children!

A practicing pediatrician, twice mother Elena Borisova-Tsarenok told you about the pregnancy with twins.

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

Endure twin pregnancy - a difficult task for a woman, as the load on her body increases significantly. increases the risk of developing health problems for the expectant mother, increases the likelihood of complications such as,. That is why this condition requires increased attention from medical personnel.

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

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

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

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

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

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

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

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

Main dangers

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

The most common problems are::

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


Behavior of the expectant mother

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

This rarely happens. Most often, a second pregnancy with twins occurs as a result of a second successful IVF. In any case, the woman is placed under strict control in the antenatal clinic. From the second trimester, she is recommended hospitalization in a hospital in order to control how the twin pregnancy will proceed by weeks.

Pregnancy Calendar

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

1-10 weeks

Signs of twins in early pregnancy coincide with a singleton pregnancy, but toxicosis appears earlier. By 8 weeks, both fetuses grow up to 3 cm, so they can be seen using ultrasound. After 8 weeks, embryonic development ends, by 10 weeks hearts are formed. Each fruit weighs approximately 5 g.

10-20 week

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

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

20-30 week

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

Signs of pregnancy with two fetuses or twins according to the gestational calculator are expressed in the form of frequent urination, expressed, increased fatigue. By week 28, babies become viable, subject to premature delivery, they have a high chance of surviving. By week 30, the weight of one fetus is about 1000 g, height - 35 cm.

If twin pregnancy is about you and you don't know what to expect from your situation, then this article is for you. Many women who are expecting twins have no idea what they should be prepared for.

What to expect from a twin pregnancy

Pregnancy with twins is twice the happiness, but it also carries more risks compared to a singleton pregnancy. In Russia every Three women out of a hundred give birth to two or three children at the same time. Due to the factors of poor ecology, increasing infertility and numerous IVF procedures, this statistic is growing from year to year.

So, if you're expecting twins or triplets, be prepared for the following:

Fact 1: You are more likely to get pregnant with twins naturally if you are in your 30s or 40s

We have all heard that the older we get, the harder it is to get pregnant. However, with age, the chance of conceiving twins increases. Here is what Abdullah Al-Khan, MD, and director of the Hackensack University Medical Center in New Jersey, says: “If you are in your 30s or 40s, your ovulatory cycle is disrupted. In this case, within one menstrual cycle, two ovulations can occur at once. If fertilization of eggs occurs, then pregnancy with twins without the intervention of any reproductive technologies is guaranteed for you.

Fact 2: If you're expecting twins, you may need more folic acid

In order to avoid the development of malformations in children, women who are expecting twins may need more folic acid. So says Manju Monga, MD, who is also director of the Health Science Center at the University of Texas at Houston.

Fact 3: Women with twin pregnancies should spend twice as much time in antenatal clinics

Multiple pregnancies require more careful monitoring than single pregnancies. For example, in America, it is customary for women expecting twins to spend twice as many ultrasounds. Expectant mothers with one child in the womb there on special devices are looked at only twice during the entire pregnancy.

However, enhanced medical examination leads to a high percentage of miscarriages, for example, during amniocentesis. If such a procedure leads to a miscarriage in one in 1,000 women with a singleton pregnancy, then those who are expecting twins, this statistic is doubled.

Fact 4: Morning sickness can be twice as bad in women pregnant with twins

One of the causes of morning sickness is high hormone levels. hCG in blood. In the case of twin pregnancy, the level of this hormone promoted. That is why women who are expecting twins are more prone to morning sickness in the first trimester. The good news is that, as in the case of a singleton pregnancy, toxicosis completely disappears by 12-14 weeks.

However, that's not all. Monga says pregnant twins are more likely to complain of back pain, insomnia and heartburn. They are also more prone to anemia and postpartum hemorrhage.

Fact 5: Spotting is more common in mothers who are pregnant with twins

According to Al-Khan, women with twins in the womb have an increased risk of miscarriage if she bleeds. in the first trimester. The latter, by the way, are also more marked in women in anticipation of twins, triplets or quadruplets.

A small bloody speck is not a reason to panic. But, if you feel numbness in the limbs, cramps, dark clots on the pad along with bleeding, then you urgently need to go to the hospital.

Fact 6: Don't Expect Early Tummy Moves

At twin pregnancy fetal movements become more noticeable 18-20 week. For a singleton pregnancy, these terms are similar. How early you feel the first movements depends on whether you have been pregnant before. Distinguishing fetal movements from GI activity during primary pregnancy is difficult.

Fact 7: Moms with twins gain more weight than moms with single pregnancies

Obviously, women who are pregnant with twins gain more weight. This is due to two fetuses, two placentas and two amniotic fluid sacs. To fully bear twins, you will also need more calories.

However, there is no generally accepted formula for weight gain by weeks. According to Dr. Mong, the average weight gain during a twin pregnancy is 14-16 kilogram, while pregnant women with one child recover by 11 kilograms.

Data from the US National Academy of Sciences on weight gain during twin pregnancy is slightly different:

  • Women with normal weight should fit within the framework of 17-25 kg;
  • Overweight women - 14-23 kg;
  • Obese women - at 11-19 kg.

No one will give you an exact answer on how many pounds you should gain during pregnancy. Your weight should be monitored by your gynecologist, as each case is unique.

Fact 8: The risk of developing gestational diabetes is higher in women expecting twins

According to Dr. Mong, the larger the fetus, the higher the risk of developing gestational diabetes. As a rule, twin children are born with low weight, but here in nature it happens paradox and in mothers expecting twins, this diagnosis is more common.

Fact 9: The risk of developing preeclampsia is higher during twin pregnancy

Until now, scientists have not exactly established the reasons why preeclampsia begins, but it has been proven that it happens more often in pregnant twins. This dangerous syndrome is accompanied by high blood pressure, protein in the urine, and swelling of the feet, legs, and hands. Often this is a harbinger of a more serious complication - eclampsia, which leads to lethal outcome.

Fact 10: Labor and labor can start earlier

Most mothers with twins safely enter the birth phase at 36-37 weeks of pregnancy. Some may give birth even earlier. Basically, it is believed that if twins were born after 34 weeks, there is no cause for concern. Although in the latter case this will be the usual premature children. Twins are more likely to experience respiratory problems and are born with low birth weight. In view of this, twins have to face more health problems than children born weighing over 2500 grams.

Fact 11: Twin pregnancies are more likely to end in a caesarean section

According to Professor Al-Khan, the probability that one of the fetuses, or both at once, will be in breech position immediately before childbirth, is much higher than with a singleton pregnancy. And in this case, a twin pregnancy can only end with a caesarean section.

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

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

At what time can a multiple pregnancy be determined?

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

Modern medicine has more opportunities to determine multiple pregnancy in the early stages, and hence for a successful course and delivery.

Expert opinion

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

How is a multiple pregnancy observed?

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

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

Expert opinion

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

What are the complications of multiple pregnancy?

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

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

  • Anemia;
  • the threat of termination of pregnancy;
  • preeclampsia;
  • gestational diabetes;
  • premature birth;
  • lagging or developmental features of one or more fetuses;
  • delivery through .

Expert opinion

During pregnancy with twins, triplets, the load on the body of the expectant mother increases several times, depending on how many babies she carries. Unfortunately, this means that complications during such a pregnancy are more common.

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

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

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

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


Nutrition rules for the expectant mother of twins

The most important rule: do not allow hunger and overeating, Follow the diet recommended by your doctor. During pregnancy, a woman's need for calories increases, especially since several little men grow and develop in your stomach at once.

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

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

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

Expert opinion

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

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

Lifestyle during multiple pregnancy

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

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

Expert opinion

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

As the term of childbirth approaches, the expectant mother needs to lie more (preferably on her side so that the heavy uterus does not squeeze the inferior vena cava), rest three times for 1-2 hours during the day. It is worth remembering about the bandage supporting the uterus - it will be easier for you to walk.

Birth before term

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

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

Expert opinion

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

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