Interesting Facts 

The course and management of multiple pregnancies. Delivery in multiple pregnancy. Twin pregnancy: threatened miscarriage

The news that a woman will soon become a mother is perhaps the most memorable event in life. The reaction of a woman about multiple pregnancy does not always cause positive emotions. Most often, a married couple experiences fear, shock and a sense of the unknown.

Feelings of confusion and discouragement are a completely normal reaction to a twin pregnancy, as parents understand that they have a double responsibility. As a rule, very soon a married couple gets used to this news and looks forward to the birth of babies.

A multiple pregnancy proceeds a little differently than a pregnancy with one baby. This article will reveal all the features of the course of twin pregnancy by week. Thanks to the information received, the pregnant woman will feel more confident and know what to expect.

How to understand the term "multiple pregnancy"?

Multiple pregnancy

Many people, having heard the words "twins" and "twins", do not really understand how they differ from each other. If we recall the school course of human biology, then we know that the formation of the embryo occurs after the fusion of two gametes (male and female germ cells).

If in a woman's menstrual cycle two eggs mature at once, which were subsequently fertilized by two different sperm, then we are talking about the conception of twins. It is important to understand that fertilization occurs with two different spermatozoa that have a completely different genetic set of chromosomes. Twins can be born of different sexes, have different heights, eye and hair colors, and not be very similar to each other. Such a pregnancy is called dizygotic.

If during the cycle there was a maturation of one egg, fertilized by one sperm, then either one embryo or the conception of identical twins is obtained. Sometimes in a woman's body such hormonal disruptions occur when the egg is divided into two absolutely identical halves. These two female cells are fertilized by the same sperm, resulting in twins. The set of chromosomes in such children is absolutely the same.

These are necessarily same-sex babies, very similar to each other, have a hereditary predisposition to the same diseases, have moles and birthmarks on the same part of the body. Even the characters of identical twins are very similar. This pregnancy is called monozygotic. Obstetrician-gynecologists can easily determine monozygotic and dizygotic pregnancy using ultrasound.

Why do multiple pregnancies happen?

Not everyone is blessed with such happiness.

Despite the constant development of obstetrics and gynecology as sciences, physicians and scientists still cannot indicate the exact cause of multiple pregnancy. The following are predisposing factors for conceiving more than one baby.

Heredity. This factor is the most important. Most often, multiple pregnancy is transmitted to women on the maternal side, that is, if in the family the woman had cases of the birth of twins and twins. Most often, this feature is transmitted through one generation, but exceptions are possible.

Infertility treatment. After treatment of the secondary form of female infertility, there are frequent cases of conception of more than one embryo. This fact is due to the intake of hormonal drugs that stimulate the maturation of several germ cells at once. If they are all fertilized by sperm, then a multiple pregnancy is obtained.

IVF procedure. The method of artificial insemination in 60% of cases ends with a multiple pregnancy. This factor is due to the transfer of several embryos into the uterus of a woman at once. Several embryos do not take root and die, and 2-3 continue to successfully grow and develop in the uterus. Sometimes doctors carry out reduction (removal) of extra embryos, leaving one or two babies in the uterine cavity.

Despite the constant improvement of scientific methods and the deep knowledge of obstetrician-gynecologists, it is not yet possible to accurately predict the conception of monozygotic twins.

How does a multiple pregnancy proceed?

Having twins is associated with certain risks.

Having studied the pregnancy calendar with multiple pregnancy and bearing one child, a woman will not notice much difference. The development of babies in both cases occurs at almost the same time. A feature of the difference between a multiple pregnancy and a normal pregnancy is the development of complications. Mothers who carry several babies at once face complications more often.

Complications:

    Iron deficiency anemia - more common with multiple pregnancies. This is due to the increased need for iron of the mother and children. To prevent such a complication, iron preparations are prescribed for the expectant mother from the very first days of pregnancy;

    Toxicosis of the second half of pregnancy (preeclampsia) - often develops in multiple pregnancies. Protein appears in the urine of the expectant mother, and blood pressure indicators reach high levels;

    Placenta previa is a common complication of multiple pregnancies. It is characterized by the location of the placenta in such a way that the entrance to the uterus is blocked;

    Fetoplacental insufficiency - since the placenta performs "double work", its premature aging and wear occurs, as a result of which children experience a lack of oxygen and nutrients;

    Presentation of fetuses - children in the uterus are located in such a way that natural childbirth becomes impossible and the woman is prescribed a caesarean section;

    Developmental delay - as a result of insufficient blood supply to the placenta and the supply of nutrients to the fetuses, the development of children often does not correspond to gestational age;

    Developmental dissociation - this complication of multiple pregnancy is characterized by a lag in the development of one of the fetuses. This is due to the peculiar deprivation of one of the children of nutrients in favor of the second. If treatment is started in a timely manner, then, as a rule, nothing threatens the life and health of the baby;

    The risk of developing anomalies and defects - with multiple pregnancies is much more common than with the bearing of one child;

    Risk of preterm birth.

In the first trimester of pregnancy (the first 12 weeks), a fifth of women with multiple pregnancies experience the phenomenon of the death of the fetal egg. In this case, one embryo remains in the uterine cavity and continues to grow and develop, while the second one freezes, stops developing and decreases in size (involutes). Such involution does not harm the developing fetus at all.

Ultrasound of two fetal eggs

After the 12th week of pregnancy with multiple pregnancy, the risk of premature birth and amniotic fluid discharge is especially high. A third of all multiple pregnancies end in miscarriage or premature birth.

To prevent miscarriage and premature birth, a woman carrying twins is prescribed medicines throughout her pregnancy that relax the muscles of the uterus. If taking muscle relaxants does not give the expected effect, then the expectant mother is hospitalized in the maternity hospital. A woman is in the hospital either until the birth itself, or until her condition stabilizes and the threat of miscarriage disappears.

Often during pregnancy, a woman complains of violations and abnormalities in the work of the heart and blood vessels. During the period of bearing one baby, the load on the cardiovascular system doubles, and when bearing two fetuses, it triples! Malfunctions in the work of the heart can lead to negative consequences for babies growing in the womb.

Gynecologists strongly recommend that pregnant women seek medical help in a timely manner for any abnormalities in the work of the heart. A woman must understand that she is responsible not only for her health, but also for the lives of her children, and the slightest delay can lead to sad consequences.

It has already been noted above that with multiple pregnancy, the risk of developing iron deficiency in the blood of the mother increases many times over. When carrying several fetuses at once, the placental tissue has a large mass, in contrast to the placenta of a singleton pregnancy. This leads to an increase in placental blood flow and a decrease in the level of hemoglobin in the blood.

In women who carry more than one fetus in the womb, in most cases, childbirth begins prematurely. Gynecologists believe that the main cause of this complication is the overstretching of the muscle fibers of the uterus. Women bearing twins should especially carefully monitor their well-being and health, and if there are any complaints, you should immediately seek medical help.

Multiple pregnancies are at risk, so gynecologists especially carefully monitor women carrying twins. Such women need to visit the doctor more often, take urine and blood tests more often. Many expectant mothers are outraged by the need for frequent visits, but do not neglect the recommendations of a gynecologist, because the health of babies is much more important than temporary inconvenience.

How is a multiple pregnancy recognized?

The main thing is to find out about multiple pregnancy in time

This question, perhaps, worries many women in whose family there were cases of multiple pregnancies. From the first days of pregnancy, the expectant mother is interested in signs by which you can find out how many fruits she carries under her heart. The most reliable way to determine multiple pregnancy is to visit the office of an obstetrician-gynecologist.

An experienced specialist can accurately diagnose multiple pregnancy, starting from the 4th obstetric week of pregnancy. Already from this period, the woman's uterus is twice as large as during pregnancy with one fetus.

There are women who are trying to independently determine by some signs whether their pregnancy is multiple. It is important to understand that there are no reliable signs indicating multiple pregnancy. Until the end of the 12th week of pregnancy, you can talk about multiple pregnancy based on the size of the uterus, and already from the 13th week, a woman is prescribed an ultrasound scan. During this study, it is possible to say with accuracy how many fetuses develop in the uterus.

There are cases when, during the first ultrasound, the doctor sees two fetal eggs on the monitor screen, one of which subsequently freezes and only one child is born. It rarely happens that on ultrasound the doctor sees only one fetal egg, and on the next study two fetuses are found. This happens if one fetal egg overlaps the second, but when the embryos grow up a little, they are clearly visible on the monitor screen during an ultrasound scan.

Many women mistakenly believe that multiple pregnancies can be diagnosed if they undergo a blood test for the results of a triple test for hCG, alpha-fetoprotein and estriol. Such a test is done to confirm the fact of pregnancy and early detection of malformations of the embryo, however, such an analysis does not always help determine whether the pregnancy is multiple.

How does a multiple pregnancy proceed? Features of childbirth with multiple pregnancy

It has already been said above that when carrying more than one fetus, the expectant mother is forced to visit the gynecologist's office more often. With a successful pregnancy, a woman, starting from the 13th week, should come to the doctor every 10 days. Starting from the 28th week of pregnancy, the expectant mother should come to the consultation at least once every 7 days.

Obstetricians and gynecologists pay special attention to the weight gain of a pregnant woman. When carrying one fetus, the total increase by the time of birth is usually about 12 kg. If a woman is carrying twins, then by the time of childbirth, weight gain should be no more than 15 kg. The expectant mother should carefully monitor the kilograms and in no case allow weight gain. Every extra kilogram gained while carrying twins can greatly complicate the course of pregnancy and the condition of growing babies in the womb.

During the bearing of several fetuses, a woman should be prepared for the fact that at any time it may be necessary to go to the maternity ward for preservation. Obstetrician-gynecologists prefer not to risk the life of children and the health of a woman, therefore, at the slightest deviation in the course of a multiple pregnancy from the norm, the expectant mother is offered hospitalization in the maternity hospital.

Two weeks before the expected date of birth with multiple pregnancy, the woman is sent to the maternity hospital. The woman is invited to immediately take with her all the necessary things for herself and the children, as well as documents. Starting from the 37th week of pregnancy, childbirth can begin at any time, and it would be reasonable if the woman is under medical supervision at this time.

Methods of delivery in multiple pregnancies are still a topic of discussion among doctors. There is no specific method that applies to all women with twins. The method of delivery for multiple pregnancy is selected individually for each pregnant woman, depending on such factors:

    How was the pregnancy?

    How does a woman feel?

    How do babies develop and grow?

    Is there placenta or fetus previa?

An agonizing wait

Obstetricians pay great attention to the presentation of the baby who should leave the uterus first. If the fetus is in a breech presentation, then doctors prefer delivery by caesarean section. In natural childbirth, babies can get their heads stuck in the birth canal, often resulting in fetal death.

Often with multiple pregnancy in the process of childbirth, an anomaly of labor activity occurs. This pathology is characterized by weakness of the birth process, or, conversely, by swiftness. Both are bad for the mother and children, therefore, to prevent the development of complications, doctors use medications that correct the intensity of labor.

In addition to medical correction, there are other methods of managing childbirth. For example, with weakness of labor activity after the birth of the first fetus, the woman's fetal bladder is pierced, and then the interval between the birth of twins is significantly reduced. If both fetuses show signs of severe oxygen starvation, then the question arises of an emergency caesarean section.

Unlike pregnancy with one child, childbirth with multiple pregnancies always begins earlier than expected by 2-3 weeks. And in this case, wise nature took care of the kids. During the bearing of two children at once, the formation of a sufractant (a substance that helps the lungs of children open after birth) in the fetus occurs earlier than in a singleton pregnancy. This fact suggests that preterm birth in multiple pregnancies is less dangerous for the fetus and the risk of complications than premature birth when carrying one baby.

In addition, scientists noted an interesting fact. The adaptation period in monozygotic twins is more difficult than in dizygotic children. Identical babies are more likely to suffer from postpartum jaundice and chronic bronchitis due to prematurity.

The beginning of the birth process with multiple pregnancy is not much different from a normal singleton pregnancy. Most often, a woman's amniotic fluid departs, and their number is much greater than when carrying one child.

Due to polyhydramnios, the muscle fibers of the uterus of a woman are stretched, which subsequently threatens the woman in labor with the primary weakness of labor. To prevent this complication, obstetricians try to open the fetal bladder even at the very initial stage of labor, when the cervix is ​​ajar by a few centimeters.

Due to the fact that childbirth with multiple pregnancies is more often accompanied by the risk of complications, doctors prefer to perform epidural anesthesia even with natural delivery. This is necessary in order to be able to urgently perform a caesarean section if something goes wrong during childbirth, without wasting time on anesthesia.

The postpartum period of a woman with multiple pregnancies is no different from the recovery after the birth of one child. And even breastfeeding both babies is quite possible. A newly-made mother only needs to get used to her new status a little and show patience and dexterity.

Many couples who are expecting twins often worry about the weight of the babies at birth. All concerns about excessively low body weight in twins at birth are just an exaggeration. If a woman's pregnancy proceeded normally, and the children developed according to gestational age, then the birth weight differs by only 400-500 grams from a newborn from a singleton pregnancy. The subsequent development of twins is also no different from a newborn from a singleton pregnancy.

The whole truth about government payments for the birth of twins

All expectant mothers know that after the birth of a child, the state provides material assistance for a certain period of time. With multiple pregnancies, women often wonder about the amount of payments at birth.

If two or three children are born in a family at the same time, then a one-time allowance is paid for each newborn child. In order to receive material assistance, parents of babies must provide local labor authorities with a certificate stating that at the time of childbirth, the spouses were not officially employed anywhere.

If during pregnancy a woman worked officially, then in order to receive payments for children, she needs to contact the accounting department of her enterprise. The list of documents and certificates required for payments must be clarified at the place of receipt of financial assistance. If the parents are students, then the allowance is paid at the place of study.

In addition to state payments of childbirth benefits, there are also regional payments. Such assistance is provided at a time, and the amount depends on the region of residence. To receive a regional benefit payment, you must contact the local social security authorities.

If a woman gave birth to a child out of wedlock and has the status of a single mother, then in order to receive payments, she must provide documents confirming the absence of a father in children. A woman can receive such a certificate at the registry office, when registering newborns.

Residents of Russia should know that at the birth of the second, third and subsequent babies, the family has the right to receive maternity capital.

Parents must complete all paperwork on time

In case of multiple pregnancy, maternity capital is paid for the second baby. To receive this type of material assistance, a married couple must apply to a pension fund located at the place of registration of their residence. The following list of documents must be submitted to the pension fund:

    An application for receiving maternity capital, filled out according to the model;

    Original and photocopy of the applicant's passport;

    Originals and copies of newborns and existing children;

    Certificate of Russian citizenship of the child;

    Original and copy of the pension insurance certificate.

The state does not provide additional benefits for multiple pregnancies, however, if there are other children in the family besides the born twins, then the family automatically receives the status of having many children and receives all the benefits that are due in such cases.

Do not worry about excessive bureaucratic red tape with documents. The process of obtaining all certificates and benefits will end very soon, and you will enjoy parenthood. All this will still be, but for now, get used to your position and enjoy every day of pregnancy so that no troubles can overshadow your happiness from waiting for your babies.

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.

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.

Gemini - great or better not? Discuss it with your friends on social networks!

Multiple pregnancy differs in its course from the bearing of one child. The risks of complications for the mother and newborns increase, the birth of twins in a natural way differs from the standard ones. For women with multiple pregnancies, schedules for visiting a gynecologist are being adjusted, and the pregnancy management plan is changing. The chances of getting to the hospital ahead of time increase, so mothers with twins are under special supervision.

Chances of getting pregnant with twins

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

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

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

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

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

The mechanism of twin formation

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

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

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

The mechanism of the course of childbirth, the choice of a suitable method and term of delivery is affected by:

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

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

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

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

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

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

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

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

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

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

Caesarean section shown:

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

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

Terms of delivery

Women with multiple pregnancies rarely carry babies before 40 weeks.

What week do twins give birth?

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

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

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

Critical periods are defined for preterm birth:

  • 22-24 weeks;
  • 25-27 weeks.

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

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

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

How is a normal birth

With the correct position of the fetus, the woman in labor gives birth on her own. Childbirth is rarely resorted to. In the first period, careful monitoring of the fetal heartbeat is necessary. It is recommended that women be referred for admission to high-level maternity hospitals that have good equipment.

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

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

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

  • standing;
  • sitting;
  • On knees;

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

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

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

What complications interfere with normal labor

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

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

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

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

Indications for a caesarean section

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