Multiple pregnancy - Causes, Symptoms and Treatment .MF .
called multiple pregnancy, in which in a woman's womb simultaneously develop two or more fruits.If two fruits - they are called twins.If the three - triplets and so on.Babies who are born as a result of multiple pregnancies, called twins.
Twins can be identical (monozygotic) or fraternal (dizygotic).What is the difference between them?If after fertilization the egg divides only then obtained identical twins.They are similar to each other as the "two drops of water," since they have the same set of genes.Kids are the same sex.
Fraternal twins are formed when the immediately fertilized by two or more eggs.Fraternal twins have a different set of genes, as formed from different eggs.Therefore, they are similar to each other as siblings born in the same family, that is the minimum similarity.Dizygotic twins can be of different sexes, unlike identical twins.According to statistics, fraternal twins are born more often than identical.
Recently, the incidence of multiple pregnancy is increasing and amounts to
What is the cause of multiple pregnancy?
first factor that no one in doubt - it is hereditary.Twins are born more often in families in which the tribe of his father or mother were births of twins or triplets.
second factor - is the age of the mother.Noticed that women who become pregnant in late reproductive age (35 years), more common in multiple pregnancies.The fact that with age fertility (fertility) in women and decreases not ovulate each month.Unrealized hormones that promote ovulation and egg output, accumulated, and during the next menstrual cycle and is released with the "large scale", than it is necessary to stimulate the maturation and exit immediately 2 or more eggs.
Finally, the main cause of the growth of multiple pregnancy is associated with a wide popularization of technology "children conceived in vitro," ie, with the IVF (in vitro fertilization).Women wishing to become pregnant, carefully tended, planted in the uterus of several embryos in the hope of "the healing" of at least one embryo.But in the end after a woman replanting can easily zaberemet and double and triple, and even quadruplets!
These are the main causes of multiple pregnancy.Other factors that increase the chances of a multiple pregnancy, include national characteristics, the abolition of hormonal contraceptives after long-term use, re-birth.
Features multiple pregnancy
flow of multiple pregnancy is very different from a singleton.Pregnant with twins often complain of fatigue, urinary disorders, shortness of breath, constipation.Such women often severe toxemia with prolonged nausea and vomiting during the first months of pregnancy.In the second and third trimester pregnant rapidly gaining weight.The uterus in up to very large sizes, putting strong pressure on the abdominal organs.In late pregnancy appear expressed leg edema, increased blood pressure, protein in the urine can appear.
duration of multiple pregnancies is also different from a singleton.The larger the fruit, the earlier the birth.Thus, the duration of the pregnancy when you double the average is 260 days, that is, 37 weeks of pregnancy;In triple 247 days, that is, 35 weeks of pregnancy.
Diagnosis of multiple pregnancy
To prevent complications during pregnancy and childbirth, the woman should immediately register with a gynecologist at the antenatal clinic after the suspect at pregnancy.Starting from 5-6 weeks of pregnancy, that is, immediately after the first day of menstruation, the doctor can diagnose multiple pregnancy.
confirmed the presence of multiple pregnancy is possible only after the ultrasound.In the womb of a pregnant woman are rendered multiple embryos.Due to the high information content of ultrasound, it is possible not only to identify the multiple pregnancy, but also to ascertain the location of the fruit, the volume of amniotic fluid, the presence of malformations in the fetus, and so on.
addition to ultrasound - all other diagnostic methods are not always reliable.It is known that when a multiple pregnancy rate of human chorionic gonadotropin (hCG) in the blood is higher than in singleton pregnancies.Nevertheless, based on the level of hCG, it is impossible to diagnose multiple pregnancy.
gynecological examination, the gynecologist may suspect multiple pregnancy because of the large size of the uterus, is not relevant in pregnancy.However, this trait is relative, because the uterus can be greatly increased, and for other reasons, for example if there is a pregnant uterine fibroids.
Thus, the US is the main and most reliable method for diagnosis of multiple pregnancy in early pregnancy.In the later stages of pregnancy, ultrasound do very often, to the basis of the provisions of fetuses in the womb, is determined with the tactics of labor management.
During pregnancy, all women with multiple pregnancies are under enhanced supervision of an obstetrician-gynecologist.The doctor antenatal clinic in the first trimester of pregnancy is required to appoint the folic acid and iron supplements (Sorbifer, Maltofer) for the prevention and treatment of anemia, which is often the case with a multiple pregnancy.
If there is a risk of premature birth, administered agonists (ginipral, Salbutamol) to prolong pregnancy.
Births in multiple pregnancies
Even if pregnancy is totally normal, shows advance hospitalization in a maternity hospital in about 3-4 weeks before the expected date of delivery.
The most important issue is to choose the method of delivery in multiple pregnancies.If a pregnant woman feels good, all the tests are normal and both the fetus is in cephalic presentation, it is preferable to conduct birth vaginally.If the first fruit is in cephalic presentation, and the second in the breech-birth also can be conducted in a natural way.After the birth of the first fetus under ultrasound produce a second external version of the fetus in cephalic presentation.
During birth vaginally a careful cardiac monitoring heart activity of both fruits.In the event of the weakness of labor intravenous Oxytocin hormone active uterine contractions.For labor analgesia used an epidural.After delivery, continue to drip oxytocin for the prevention of postpartum hemorrhage.To effect obscheukreplyayushego postpartum glucose solution was administered intravenously for 2 hours.
When you are one of the fruits in the transverse position shown cesarean section.In addition to the lateral position of the fetus, indications for cesarean delivery in multiple pregnancies are the presence of polyhydramnios, complicated forms of preeclampsia (a stable increase in blood pressure, protein in the urine), large fruit, the presence of more than two fetuses, hypoxia of a fruit or two, breech presentation of the first fruit, collision fruits (when the head of the first fetus clings to the second head of the fetus at the entrance to the small pelvis, making it impossible to pass the fruits).
woman during pregnancy should rest more.The same rule applies to multiple beremennosti.Nachinaya with 29-30 weeks of pregnancy, a woman should stay in bed longer, since excessive activity can lead to premature birth.
Nutrition during pregnancy should be nutritious and balanced.The average weight gain in multiple pregnancies can be up to 20 kg.Pri presence of edema, especially in late pregnancy, fluid intake should be limited to 1.5 liters per day.
Complications of multiple pregnancy:
- miscarriages in early pregnancy;
- premature birth;
- fetal hypoxia / fruit; fruit conflict;
- antennal fetal death / fruit;
- severe forms of preeclampsia;
- postpartum haemorrhage.
Prevention of multiple pregnancy complications involves careful observation of pregnant antenatal clinic throughout the pregnancy, timely hospitalization before delivery.
Consultation of obstetrician-gynecologist.
1. Can I give birth to itself in the presence of twins?
possible, if there are no contraindications.
2. I have twins, but I do not want to give birth to two, is it possible to "remove" one fruit?
can spend the early stages of reduction (aspiration) of one of the fetuses.
3. Which is better to drink a dose of folic acid in multiple pregnancies?
1 mg per day.
4. How to conceive twins?
most often twins born after IVF (in 50% of cases), sometimes immediately after the abolition of contraceptive pills.
5. I already had twins.How to avoid becoming pregnant with twins for the second time?
Such methods do not.
6. Is it true that the first birth born fruit a strong, then weak?
not true, first born fruit, which is located close to the exit of a small basin and it does not mean that he is the strongest.
7. At what stage of pregnancy you can go on maternity leave with the twins?
In the 28th week of pregnancy.
Obstetrician-gynecologist, Ph.D.Christina Frambos