The development of twins in the womb. How the pregnancy with twins or twins proceeds by week: the height and weight of the mother and children, the types of multiple pregnancies and the peculiarities of its development. Causes indirectly affecting the probable multiple births

Not every woman, in whose womb twins grow, is ready to calmly accept such news. Yes, this is understandable. After all, the classic version of pregnancy is the bearing of one baby, with whom, in the process of growing up, every woman is not easy. In a few years, the families are planning the birth of their youngest. And when two crumbs are born at once, it is even more difficult for women. Carrying twins is a double burden on the body, an increased risk of complications. Therefore, it is worth knowing in advance about the symptoms of multiple pregnancy.

Early signs of bearing twins, no ultrasound

Pregnancy with twins attracts increased attention of obstetricians and gynecologists. Such women and in families should be treated more carefully, relieved of prolonged or excessive physical work.

Early detection of multiple pregnancies helps a woman to fully prepare for childbirth. Signs that signal twins in the womb are divided into those that are shown by ultrasound and the symptoms that the woman herself determines. Among the latter, in particular:

1. The presence of twins in the family of future parents. This can be transmitted genetically, and a woman will become a happy mother of two or three babies at the same time. As practice shows, twins are born after a generation.
2. Multiple pregnancies can be suspected after taking a pregnancy test. The control strip on it will be obvious, more bold. This is evidence of an increased level of chorionic gonadotropin in the body of the expectant mother.
3. Sleepiness and lethargy. When carrying twins, a woman very often in the early stages suffers from a decrease in performance, increased fatigue, she sleeps literally on the go. This feature manifests itself already from the first days after successful conception, when a woman is still unaware of her new position.
4. More pronounced signs of toxicosis. In the early stages of gestation, almost half of women suffer from toxicosis. With multiple pregnancies, its manifestations can be double.
5. Changes in the skin of the face. When carrying twins, the excess of hormones produced affects the condition of the skin. Acne, redness, and obvious dryness may appear.
6. Accelerated growth of the abdomen... Even before identifying twins on an ultrasound scan, a woman sees that her belly is enlarging too quickly. This is due precisely to the fact that two babies in the mother's womb are cramped.

Medical Tips for Twin Pregnancy

Obstetricians-gynecologists distinguish the following signs of multiple pregnancy:

1. A horizontal groove that appears as the fruit develops. She indicates the presence of two babies.
2. Deepening of the fundus of the uterus, felt on palpation. Growing fruits protrude the corners of the genital organ. Also, on palpation, the doctor can detect two heads and two pelvic ends.
3. An ultrasound scan for a period of 8-12 weeks can already show the presence of two or three fetuses. But for such a period, an error is not excluded.
4. Phonoelectrocardiography. This study is done to the expectant mother after 20 weeks of the term. It helps doctors hear the beating of two hearts, their heart sounds, which additionally confirms a multiple pregnancy.
5. When listening to the abdomen by an experienced doctor in the early stages, he will hear the beating of hearts in different places.
6. Alpha-fetoprotein test. It is carried out in the second trimester of bearing a child. It determines the level of risk of fetal anomalies. As practice shows, with multiple pregnancies, the result of this test is not just positive, but also very high.

So, there are many signs indicating twins. Therefore, a woman has the opportunity to prepare in advance for double responsibilities and loads. And according to the current standards in obstetrics, such an expectant mother should attend an antenatal clinic every ten days, in the third trimester - weekly.

But do not be afraid of bearing and giving birth to twins (triplets). The danger of a severe pregnancy is only inherited. But even in this case, the level of modern medicine allows women to normally bear and give birth to their children.

Specially for- Maryana Surma

All aspects of multiple pregnancy: why is it possible, signs of pregnancy with twins in the early stages, what complications should be feared, is natural childbirth possible?

Gemini from conception to birth: double joy

Multiple pregnancies are rare. The chance of getting pregnant with natural conception is less than 1%, although with the development of reproductive technologies, in particular IVF, the number of twins born has increased. This is due to the peculiarity of the hormonal preparation of the body of the expectant mother for conception.

Difficulties come even before the birth of twins. Multiple pregnancy in gynecology is a priori considered complicated. This is a double burden on the mother's body, this is a great chance of miscarriage, placental abruption, premature birth, and malnutrition of babies at birth. That is why multiple pregnancies require careful monitoring, frequent screenings and a responsible attitude of the pregnant woman to her health.

Pregnancy with twins, twins: when possible

One of the common scenarios for the occurrence of multiple pregnancies is the implantation of several fertilized eggs at once into the uterine cavity during IVF. This increases the chances that at least one of the embryos will take hold in the uterine endometrium. Therefore, as a result of IVF, two, three or more embryos often develop in the uterus at the same time.

Twin pregnancies also occur naturally. The chances of multiple pregnancy are increased in a woman who has undergone ovarian hyperstimulation. As a result of this procedure, several eggs can mature at the same time. If there were twins in the family, the likelihood of conceiving twins also increases.

Statistics show a higher chance of conceiving twins in women after 30, as well as in women who have already carried twins.

Types of multiple pregnancies

There are two mechanisms for the occurrence of multiple pregnancies. The first scenario is the simultaneous maturation of two or more eggs. Normally, in each cycle, only one egg is released from the right or left ovary.

But the system can malfunction, as a result of which two eggs enter the uterine cavity at once. Once fertilized, these eggs attach in different areas of the uterus, and in the future, each of the embryos will have its own placenta. Such twins are called fraternal, they carry a different set of genes and can be of different sexes.

The second scenario involves the maturation of one egg, its fertilization, after which the zygote is divided in half. Depending on the stage at which division occurs, twins may have one fetal bladder or two. The placenta in such twins may have a common life, or each fetus may have its own.

How fertilization takes place

Fraternal twins are produced by fertilizing two eggs with different sperm. This process may not even be instantaneous - for example, one of the eggs has already entered the uterine cavity and was fertilized there, and the second entered the fallopian tube from the ovary a week later and met the sperm after another sexual intercourse. Such twins differ slightly in their development, this is especially noticeable in the early stages, when one fertilized egg on ultrasound looks noticeably larger than the other.

When identical twins are conceived, the usual fertilization of one egg with one sperm occurs. The further process of dividing a fertilized zygote into two has not yet been fully understood, the mechanism and previous factors are unclear.

How to determine in the early stages

The most important and accurate determinant of multiple pregnancies literally a week after the delay is ultrasound. The ultrasound doctor can observe two fetal eggs in the uterine cavity - on the monitor they look like round light spots. After the 5th week of pregnancy, listening to two heartbeats is added to the visual control.

An experienced gynecologist can also identify multiple pregnancies by manual examination at around 7-8 weeks. The uterus grows much faster, and its bottom is higher than at a similar period of singleton pregnancy. However, manual examination is not always accurate and depends on biased factors. For example, a woman who has given birth may have a larger uterus than a woman who has not given birth.

Signs in the early stages without ultrasound: are the symptoms of multiple fetuses different from usual

One of the classic signs of multiple pregnancy is early toxicosis. Usually, this unpleasant condition overtakes the pregnant woman no earlier than the 8th week, however, the twins begin to influence the mother's hormonal system earlier. Already from 6 weeks, the expectant mother of twins can be haunted by severe nausea with vomiting.

Signs

Folk omens are advised to listen to dreams and strange coincidences. The most frequently mentioned sign is that if a double yolk is found in an egg, this is a twins. In a dream, double sets or objects may dream: for example, a woman may dream that she is trying on two pairs of shoes or that she is buying two bicycles at once.

Drinking tea from two mugs at once or sweeping the floor with two brooms at once - to pregnancy with twins.

Popular rumor says that having same-sex twins is a sure sign that a woman will become pregnant with twins the next time. If twins are born of different sexes, then in the future the woman will no longer give birth to twins.

HCG level

HCG - human chorionic gonadotropin - begins to be secreted by the embryo almost immediately after it is fixed in the uterine cavity, that is, 6-8 days from conception. With multiple pregnancies, the hCG indicator is twice as high as with a singleton, and doubles every three days until 12 weeks, after which the process of hCG excretion dies out.

At the 4th - 5th week, hCG indicators with multiple variability averaged 100,000 mU / ml. Depending on the characteristics of the wife's body and the course of pregnancy, the range of indicators at this time ranges from 5000 to 160,000 IU / ml. Within a week, the hCG indicator reaches 200,000 IU / ml and reaches its peak by 11 weeks. At 11-12 weeks, the hCG level in twin pregnancy can reach 600,000 IU / ml.

Features of the course of multiple pregnancy

Pregnancy with twins differs in its development from a singleton pregnancy. First of all, this is due to the double load on the mother's body already from the first trimester of pregnancy. The hormonal background makes a pregnant woman prone to acute toxicosis, chronic fatigue. Immunity drops significantly. Such a pregnant woman needs more rest, sleep, and limit stressful situations.

Towards the end of pregnancy, carrying twins can be a serious challenge for the mother. The huge belly makes it difficult to move, it becomes uncomfortable even to lie down.

Pregnant twins often complain of sleep disturbances. Anxiety before childbirth, which is also complicated by multiple pregnancies, only aggravates the nervous state.

Dangerous periods

1. The most difficult period for the development of twins is the first trimester. Approximately 20% of multiple pregnancies end in the reduction of one of the embryos up to 12 weeks. One of the baby for some reason receives less nutrition and stops developing. The dead embryo is absorbed in the uterine cavity.
2. The chance of death of one in two babies decreases significantly after 14 weeks, but this is possible in the second and third trimesters. When one of the twins dies in the second trimester, the so-called "paper fetus" is formed.
3. The second critical period for twins awaits at a period of 18-22 weeks. There is a high risk of placental abruption. Due to the double load, isthmic-cervical insufficiency often develops at this time - the cervix shortens and opens. In this case, stitches are applied to the neck or a special pessary is installed, which will keep it from opening until the end of pregnancy.
4. The next critical period for bearing twins occurs at 28 weeks and lasts up to 32-34 weeks. Premature labor often occurs at this time. With signs of approaching labor, cramping pains, critical shortening of the cervix, the woman is hospitalized and dexamethasone is given to open the lungs of children. If childbirth occurs at this time, there is a high chance of keeping the twins alive.
5. In addition to the risk of miscarriage, late gestosis occurs. This condition is dangerous not only for the fetus, but also for the mother. Placental nutrition is impaired, babies may begin oxygen starvation, leading to intrauterine growth retardation until the death of both twins. The pregnant woman suffers from hypertension. If preeclampsia is left unattended and left untreated, a dangerous condition may develop - preeclampsia, which turns into fatal eclampsia. Skeletal muscle cramps begin, sudden pressure surges occur, during which a large cerebral vessel can burst.

Complications

With multiple pregnancies, doctors put a woman at a special risk for pregnancy and childbirth. If a woman had any diseases even before pregnancy, then during the gestation of twins, they become aggravated. The cardiovascular system, kidneys, liver, gastrointestinal tract are examined with special attention - these systems and organs give complications most often.

The percentage of complications in multiple pregnancies reaches 85%. The most common dangerous condition is gestosis of varying severity at all periods, placenta previa. Half of the mothers of twins are at risk of interruption. Iron deficiency anemia is also diagnosed in every second pregnant woman. Polyhydramnios after 18 weeks is diagnosed in 5% of gestating twins.

When the belly starts to grow

In each case, the tummy grows differently, and this depends on many factors:

• Placenta attachment site. With placentation along the back wall of the uterus, the abdomen grows later and sticks out less.
• With a developed abdominal press, strong muscles will hold back the bulging of the abdomen longer.
• Number of previous pregnancies. In the second and third pregnancies, the belly, as a rule, begins to grow earlier and sticks out more than in the first.
• Mom's set. In tall and large women, the belly becomes noticeable later.

If you summarize all these factors, you can predict that with multiple pregnancies, the tummy will become noticeable for a period of 10 to 16 weeks. Most often, the intensive growth of the abdomen begins after 14 weeks.

When research is prescribed

When registering, the doctor usually prescribes to undergo specialist studies and take tests within 8-10 weeks. However, if you suspect a multiple pregnancy, your doctor may order an ultrasound scan even before the first screening (which takes place at 12 weeks). If two fetal eggs are found in the uterine cavity, the woman is recommended to pass all tests as soon as possible to exclude the threat of termination of pregnancy.

When seen on ultrasound

An ultrasound can fairly accurately show the presence of two fetal eggs as early as 5 weeks. However, due to the “disappeared twin syndrome”, when one of the embryos stops developing, closer to 10-12 weeks, ultrasound can show only one embryo.

Pregnancy after cesarean

After undergoing a cesarean section, pregnancy with twins can stretch the seam very much (especially if it is too thin) in the later stages. Such a pregnancy requires careful monitoring, especially pregnancy with twins occurred soon after cesarean.

At a later date, there is a great threat of seam rupture. At the first warning signs, an emergency caesarean section is performed. Natural birth of twins after cesarean is not practiced, as there are too many risks.

After IVF

The likelihood of getting pregnant with twins after the IVF procedure when replanting several embryos is 20% - this applies to fraternal twins. The likelihood of having monozygotic twins with IVF is as low as with natural conception and is only 1%.

Re-pregnancy with twins

If a woman has already given birth to twins, the likelihood increases that the next pregnancy will also be multiple. Doctors associate this with a change in the hormonal background of a woman, with the restructuring of his systems during pregnancy with twins. Thus, the chances of successfully bearing two children at once in the future increase.

Multiple pregnancy by week: fetal development and changes in the woman's body

If you feel good, a pregnant woman should walk a lot in the fresh air (but not until tired), eat right, try to consume more protein, fresh vegetables and fruits. Avoid stress, conflict situations. If you feel any worsening, see your doctor right away.

Early dates up to 12 weeks

In the first trimester, all vital organs are laid. At 8 weeks, a neural tube is formed, the ultrasound can clearly hear the heartbeat of two hearts. By the time of 10 weeks, the uterus is already above the small pelvis, and by the size of the uterus, with a manual examination, we can confidently talk about multiple pregnancies. By 12 weeks, the placenta is well formed, the likelihood of miscarriage is reduced several times. If by this time two heartbeats are still detected on the ultrasound, there is no need to fear that one of the twins will be reduced. The size of the babies by this time is about 5 centimeters.

14-15 weeks

At 14-15 weeks, a sharp growth of the uterus occurs, the mother may have pain in the lower back and ligaments located in the lower abdomen. The fundus of the uterus is already 3 centimeters above the pubis. By 15 weeks, the twins' height increases to 10 centimeters, and the weight is 50-60 grams.

21-22 weeks

At 21 weeks, the mother already feels the jolts of her babies well, although so far they are felt as a slight tickling. At this time, babies have already formed an excretory system, they can urinate in the amniotic fluid. The bones are getting stronger. Hair appears on the head.

At 22 weeks, a scheduled ultrasound scan is scheduled for expectant mothers of twins. The average weight of babies at this time is about 400-500 grams. One fruit is often slightly larger than the other, but you shouldn't worry about that. Hypothetically, during childbirth at this time, it is possible to save the life of babies, but until they are ready to meet the outside world, and premature birth can result in their death or serious disability.

23 week

During this period, the pregnant woman often develops anemia and edema. The doctor again prescribes tests and examination of specialists. There are 3 more weeks until maternity leave, but a big belly already interferes with easy movement, it becomes difficult to perform work duties, and fatigue increases. In this regard, many doctors recommend lying down for this period for preservation.

34 week

At 34 weeks, each of the twins weighs an average of 2 kg. Their height is about 40 centimeters. Babies feel cramped in their stomachs, they move less and prepare for an early release. The abdomen with multiple pregnancies descends by this time.

Due date for multiple pregnancies: when will they give birth?

Multiple pregnancies differ from normal pregnancies in many ways. Mother Nature in caring for babies and their mothers usually directs labor to begin before 40 weeks. Therefore, although the weight and height of twins is usually less than that of ordinary children, their lungs open earlier.

Harbingers of childbirth

The first harbinger of childbirth is abdominal prolapse. The woman notices that it has become easier for her to breathe, as the pressure of the uterus on the diaphragm has decreased. But from the moment of prolapse of the uterus to childbirth, it can take up to two weeks.

The pelvic bones and lower back may begin shortly before childbirth. Ligaments diverge to facilitate the birth of babies. Unusual discharge may turn out to be a mucous plug - this harbinger means that there are from a few stubs to several hours left before childbirth.

What week is considered full-term

Twins are considered full-term from 37 weeks, although most twins are born before this date. Usually, twins are quite viable from 34 weeks, which means that after giving birth they do not have breathing problems and they are able to suck on their mother's breast on their own.

Weight and height of children during childbirth

The weight of twins will depend on the term of delivery, but on average, the weight of twins is 2000-2500 grams with a height of about 40 cm. Even twins, full-term before 38 weeks, which is very rare, weigh less than ordinary babies. At this time, the weight of the twins reaches 3000 - 3200 kg.

Is natural childbirth possible

The possibility of a natural birth depends on the presentation of the twins in the uterus. Cephalic presentation of both twins occurs only in half of the cases. Only with such a presentation, the doctor can recommend a pregnant woman to give birth herself. The choice of the method of delivery is also influenced by the state of the placenta.

If a woman is carrying monochorionic twins (who have one placenta for two), she should not give birth herself, as there is a high probability of placental abruption during childbirth.

When is a cesarean section prescribed?

Caesarean section is unambiguously assigned when one of the fetuses is in the wrong position - transverse or pelvic. If the weight of the twins is too small - up to 1800 grams - natural childbirth is not recommended in order to avoid the risk of hypoxia for babies.

The indication for a cesarean section is a serious condition of the mother, for example, edema with late gestosis, hypertension.

With placenta previa, a narrow maternal pelvis, polyhydramnios, intrauterine hypoxia, an operative delivery is performed.

First of all, a pregnant woman needs to realize the seriousness of her situation. Multiple pregnancies in half of the cases end in miscarriage or premature birth. Therefore, it is imperative to take all routine tests, be monitored regularly and report all changes in well-being to your gynecologist.

From the very beginning of a multiple pregnancy, the expectant mother is shown sexual rest.

Pregnancy with twins is very difficult for the body, but it is in your power to treat yourself as carefully as possible during this period. Gemini is not easy work for parents, but it is also a great joy. Such an opportunity is very rare, so the chance to become a mother of two wonderful babies at once is a real success.

Typical gestation (pregnancy) is characterized by bearing one fetus, while multiple pregnancies are characterized by two or more fetuses. According to the number of developing embryos, we can talk about twins, triplets, etc. The relevance of issues related to polyembryonic pregnancy is due to the fact that its course is fraught with the development of various complications, prematurity of newborns, premature birth and other features. In addition, perinatal mortality in polyembryonic gestation is about 10%, fetal malformations are recorded twice as often. These and other features are prerequisites for studying the causes of multiple pregnancies, the correct management of pregnancy and childbirth.

Causes of multiple pregnancies

The issues related to the emergence of polyembryonality have not been fully studied. Many factors are involved in its development:

• Heredity. A predisposition to multiple pregnancies is noted if one of the spouses is a twin or twin and female relatives have a tendency to develop multiple pregnancies.
• A high amount of follicle-stimulating hormone in the blood of a woman. It stimulates the maturation and development of two or more eggs at once.
• Stimulating therapy for infertility.
• IVF (in vitro fertilization), during which ovarian hyperstimulation is used.
• Malformations of the uterus.
• The number of gestations (with each repeated case, the likelihood of polyembryony increases).
• Hormonal changes in a woman over the age of 35. As a result of hormonal accumulation, ovulation of two or more eggs can occur.
• Fertilization of eggs from different ovulation periods, when a new pregnancy is superimposed on an existing one.

Classification

The classification of polyembryony is quite complex and is explained by the many reasons for its occurrence. Determining its type is important for the correct management of pregnancy and childbirth. In solving these issues, zygosity, chorionicity and the number of amniotic cavities are of great importance. The classification of multiplicity is associated with concepts such as:

• Monozygous, or pregnancy with twins, triplets, etc. It develops from a single fertilized egg, the division of which produces similar embryonic structures that develop independently under favorable conditions. As a result, identical twins are born, having the same sex and similar external features, as well as the same blood group, dental structure, etc.
• Bizygotic gestation, which develops when two or more eggs ripen at once in both ovaries. Their fertilization leads to the development of double embryos. They can be variable: same-sex and opposite-sex, with a different blood group and have other differences. If there are more than two embryos, then there may be options for the development of monozygous and dizygotic fetuses. The peculiarity of bilingual embryos is that they have their own membranes - chorionic, placental and amniotic. Each has its own placenta, they are separated from each other by a multilayer membrane septum.

Features of the development of multiple pregnancies

Gestation with two or more fetuses puts a great strain on the woman's body and affects the development of embryos. Features of the course of multiple pregnancy are manifested in the following:

• The gestation period has been reduced to 35-37 weeks.
• Changes are taking place in the work of systems and organs. The volume of circulating blood increases up to 50%, which causes additional stress on the cardiovascular system, respiratory system, urinary system. Toxicosis and gestosis occur (loss of protein in the urine, as a result of which a serious complication develops - eclampsia, which threatens the life of a woman and fetuses).
• Polyhydramnios can cause kidney failure.
• Isthmico-cervical insufficiency (ICI) is a softening of the cervix, which progresses rapidly and requires surgery. Treatment consists of suturing the cervix and inserting a pessary.

There are other risks of polyembryony that threaten the life and health of women and fetuses:

• Development of gestational diabetes.
• Disturbance of blood circulation of the placenta, its presentation, early detachment.
• The threat of miscarriages.
• Retardation and malformations of fetuses.

Signs of multiple pregnancy and its management

Early signs of polyembryonic gestation are no different from normal pregnancies. The woman experiences rapid fatigue, shortness of breath, and frequent urination. It is quite difficult to recognize multiple pregnancies in the early stages, and women who have multiple pregnancies in their history or with relatives should be closely monitored.

The main visual sign of multiple pregnancy in the early stages is the rapid growth of the uterus and an increase in the abdomen of the pregnant woman.

Diagnosis of multiple pregnancy allows ultrasound. The accuracy of this method is 99%. Also, in the formulation of the diagnosis, the determination of the concentration of the hormone hCG and placental lactogen in the woman's blood is used. Their rates are significantly higher than the norm for singleton pregnancies.

Features of conducting

Gestation with multiple fetuses is associated with many risks, even if it is normal. Therefore, its maintenance is mandatory from the moment of diagnosis. A woman must strictly follow the recommendations of specialists:

• See your obstetrician / gynecologist twice a month before 30 weeks and every week after 30 weeks.
• Carry out weight control (recommended weight gain is 20-22 kg).
• Take preventive medications prescribed by your doctor.
• Undergo an ultrasound scan within the specified time frame.
• Visit specialists in order to monitor the state of the cervix, organs and systems.
• Undergo laboratory blood tests and the necessary control hardware studies (CTG, Doppler ultrasonography, echography of the fetoplacental system).

If necessary, the pregnant woman is assigned additional studies. Hospitalization in the maternity hospital is necessary from the 36th week, and in some cases even earlier.

Childbirth with multiple births

Childbirth with multiple gestation is a crucial moment for both the woman in labor and the doctors. This is due to the frequent complications associated with the condition of both the woman in labor and the fetus:

• In 30% of women in labor with multiple pregnancies, there is an early or premature discharge of amniotic fluid and premature birth.
• Due to the overstretched muscles of the uterus, weakness of labor pains develops, the cervix does not open. As a result, the expulsion of the first fetus from the uterus is delayed.
• The second fetus often tends to enter the pelvis at the same time as the first, which is fraught with serious complications.

All this leads to prolonged labor, there is a threat of infection of the uterus and the development of fetal hypoxia. There are cases of rapid childbirth with perineal tears. During the period of fetal expulsion, there is a risk of developing a serious complication - premature placental abruption and severe bleeding. If this happens while the second fetus is in the uterine cavity, then it is a threat to his life.

Correct management of multiple births means minimizing the risk of complications.

It is necessary to constantly monitor the cardiac activity of the fetus and the state of the woman in labor. Childbirth in the first period is desirable to lead us to the left side. With weak labor, stimulation and pain relief are performed.

If necessary, during the expulsion period, obstetric operative actions are performed to extract the fetuses with the help of instruments. Umbilical cord ligation is carried out not only in the fetal area, but also in the maternal area. If this is not done, then the death of the fetus in the uterus is possible. The second child enters the birth canal 10-15 minutes after the first. If there is a delay, the doctor breaks through the fetal bladder to drain the amniotic fluid and the child independently leaves the small pelvis.

If the child is in a transverse position or his head is not inserted correctly into the small pelvis, then the woman is given general anesthesia and the child is mechanically rotated and removed. In complicated cases, delivery is carried out by cesarean section.

Women with polyembryonic pregnancies are entitled to an extended postpartum leave. They are recommended quality contraception for three months and planning subsequent pregnancies only after two to three years. Newborns also need special attention and, in accordance with their maturity and maturity, require a certain amount of nursing.

As a rule, multiple pregnancies are observed in those who underwent artificial insemination (IVF), or the lucky ones who already had twins or triplets in their family. If you dreamed so much about twins or triplets, and at least one of these factors was taken into account, then I would like to know about this event as soon as possible. It is for this reason that today we will consider the signs of twins in early pregnancy.

The doctor will be able to please you with this news only after an ultrasound examination, and then, not the first, but already in the second trimester of pregnancy. But in this position, special medical supervision is needed.

And so, what is multiple pregnancy and what signs of twin pregnancy can an expectant mother notice at an early stage? This is the gestation of two, three, four or more babies in the womb. Let us immediately note the statistics: in Europe, the rate of multiple pregnancies has now increased to 1% under the influence of IVF. At the moment, 1 pregnancy out of 89 is multiple.

Early signs

To begin with, in this section, we list the conditions that increase the chances of multiple babies being born at once. These include:

1. Age from 35 years (this is a scientifically proven fact, the whole point is that with age there is an increase in the hormonal background, which is responsible for the maturation of eggs).
2. Genetic factor (if there have already been such cases in the family, then the chance of becoming a happy mother of several babies at once increases).
3. Failure in the work of the ovaries (about once in 200 menstrual cycles a failure occurs - the maturation of 2 eggs at once).
4. In vitro fertilization (for a greater likelihood of a successful outcome of the procedure, several fertilized eggs are implanted in a woman at once).
5. Stimulation with the help of some drugs (they enhance the work of the ovaries, and this is how 2 eggs form and mature at once).
6. Refusal from OK - oral contraceptives (when taken, a hormonal background is created, as during pregnancy and the ovaries rest, and refusal to take it contributes to the enhanced work of this organ).
7. Large family (the more a woman has given birth to children, the greater the chance of giving birth to twins).
8. Men in the Middle East and Africa are more likely to "get" twins (ethnicity).
9. The duration of the menstrual cycle, which is 21 days, contributes to the appearance of multiple pregnancies.
10. Bicornuate uterus (this organ pathology leads to the formation of two eggs at once).

The classic variant of pregnancy is carrying 1 fetus. But bearing several babies creates an additional burden on the woman's body. For this reason, every expectant mother should know the signs of twins in the early stages. These include the following:

• genetics (note that the rebirth of twins or triplets is possible in a generation);
• on a test carried out by women at home, the second strip will be very clear and oily, which indicates a high level of hCG;
• very drowsy;
• severe toxicosis;
• the appearance of acne is possible, which becomes possible due to the large amount of hormone production;
• rapid growth of the abdomen;
• early and active movements.

Medical confirmation of multiple pregnancy

The above signs of twins, which the mother herself can note even before the visit to the gynecologist, are not always easily tolerated by a woman. If you notice these signs, then notify your doctor about it.

Here are the signs that a gynecologist may notice during multiple pregnancies:

• horizontal groove separating babies;
• deepening of the fundus of the uterus;
• detection of 4 large parts on palpation of the abdomen (two heads and two pelvis);
• Ultrasound at 12 weeks of gestation;
• phonoelectrocardiography (there is a beating of two hearts at once);
• when listening, there is a beating of the heart in different places;
• the AFP test in the second trimester of pregnancy is not just positive, but rather high (a test to identify abnormal fetal phenomena).

Fatigue

Above, we highlighted a number of signs of twins in the early stages that the expectant mother herself can detect, now let's talk about them in more detail. Let's start with increased fatigue. It is important to note that expectant mothers of twins, triplets and so on literally sleep on the go (sitting, standing, lying). This can be noticed even at the stage when they do not even know about their pregnancy (that is, from the first day of fertilization).

During pregnancy, lethargy, fatigue and drowsiness, especially in the first trimester, are normal, but with multiple pregnancies, they literally double.

If a woman is already expecting not her first child, then she will easily feel the difference, but her condition is not always clear to the primiparous. How easy is it to recognize twins on this basis? If you have a pregnant girlfriend, you can see fatigue on her, but she still flutters, enjoys life, and so on, and for you to get to work is a real feat, then most likely you are expecting twins. However, it is worth excluding many more factors that contribute to severe fatigue:

• stress;
• poor nutrition;
• heavy workload and so on.

Morning sickness

Another sign of twins is morning sickness. Please note that this will not necessarily be severe nausea or vomiting with a vengeance, it may simply be a breakdown that goes away by the middle of the day.

As for toxicosis, it is worth remembering that each organism is individual. Some happy mums of twins and triplets have felt great during pregnancy. And those who are expecting one baby may experience very strong discomfort due to severe toxicosis. If you feel great, this is not an indicator that you are carrying only one baby in the womb.

Do not forget about a woman's intuition, which is greatly exacerbated during pregnancy. The expectant mother can herself feel how many children she has and what gender they are.

Stirring

Another sign of twin pregnancy is early perturbation. As a rule, the mother first feels her baby moving only at the nineteenth week. If you have a second or more pregnancy, you may feel the tremors already at the sixteenth week.

Often in women who are expecting two or more babies, earlier and more intense movements are observed. In addition, with multiple pregnancies, there is a discrepancy between the size of the uterus and the period of delay in menstruation. Already at a later date, the doctor, by palpating and listening to the tummy, will be able to determine the number of babies. Pay attention to the fact that the movements during multiple pregnancies do not differ at all from those that mothers feel when carrying one baby.

HCG

When you do a pregnancy test, it is the human chorionic gonadotropin that notifies you about the "interesting" situation. After you have registered with a gynecologist (starting from the tenth day from the day of fertilization), the doctor constantly monitors the level of this hormone throughout pregnancy. One of the most common signs of twins is high hCG levels.

In addition, mothers who are expecting twins gain about five kilograms more in weight than women who are pregnant with one baby. However, please note that this is not the only factor affecting weight gain. Pay attention to your food, in this position it is better not to overeat. Eat less, but more often, and be sure to monitor your diet, because the well-being of the baby now also depends on this.

Gestational age

Another sign of early pregnancy twins is a high gestational age. What it is? When you visit your gynecologist, he is sure to measure the distance between the top of the uterus and the top of the pubis. This is necessary to determine the gestational age of the child.

If you have a multiple pregnancy, then the uterus expands more, therefore, the indicator increases. But, do not forget that this is not the only reason for this phenomenon. This is why it is imperative that you visit your doctor regularly.

AFP

How else can you recognize multiple pregnancies without an ultrasound scan? We examined a lot of signs of twins in the article, but the AFP test went unnoticed. It is done with the aim of detecting birth defects in a child. Do not be alarmed if the result is high enough or positive, this often happens with multiple pregnancies. To confirm the result, an ultrasound scan is required.

Note that twins are not always visible on the first ultrasound scan. Although there were many cases when multiple pregnancies were detected as early as the sixth week. At 22 weeks, it is already more likely that the doctor will find several babies on an ultrasound scan. A mistake at this time occurs only if the mother is expecting five or more children.

Risks of multiple pregnancies

We examined in detail the first signs of twins, which the mother herself can notice without consulting specialists. Now we turn to the question of why, especially with multiple pregnancies, you should definitely visit your doctor regularly?

The risks are directly related to the connection between the membranes, placenta and twins. Every third multiple pregnancy is monochorionic (babies share one placenta). Among them:

• more than 30% - dichorionic-diamniotic (two umbilical cords, a thick septum between children);
• more than 60% - monochorionic-diamniotic (thin septum);
• 2% - monochorionic-monoamniotic (common fetal bladder and placenta).

In the first case, the risks are minimal if the first child has a head presentation. This case does not require special medical supervision. With a monochorionic-diamniotic pregnancy with twins, there is a chance of developing fetal-fetal transfusion syndrome. Mom was recommended to undergo control examinations twice a month. The most difficult and dangerous case is the third. Here, babies run the risk of merging body parts (Siamese twins) or intertwining with umbilical cords. Ultrasound examinations are often necessary, and a cesarean section is necessary during childbirth.

Features of the course of pregnancy

If you listen to the recommendations given by the attending physician, then you will spend this time no less happily than women who are expecting one child. Since in case of multiple pregnancies, a double load is immediately imposed on the mother's body, the doctors give you more close attention.

When you are expecting two or more babies, there is a high likelihood of termination of pregnancy or premature rupture of amniotic fluid. This is especially true in recent months. Do not overexert yourself, do not do heavy physical work. For some, bed rest or hospitalization is recommended.

As a rule, twins are born earlier (at 36 or 38 weeks). Their weight is less than that of other children, however, they are distinguished by an increased ability to adapt. Weight and abdominal circumference will be slightly larger than that of women expecting one child.

Be sure to monitor your diet, consult your doctor about taking vitamins and mineral complexes. With multiple pregnancies, the body can quickly exhaust its reserves.

Pregnancy with two future babies at once is not only a double joy and a huge responsibility, because two people live and develop at once inside the fair sex.

Twin pregnancy refers to the specification of multiple pregnancies - the process of carrying more than one fetus at a time. Children born from this state are called twins.

According to official statistics, before the era of in vitro fertilization, every eightieth woman gave birth to twins. The development and mass introduction of reproductive technologies has increased the frequency of multiple pregnancies several times.

Multiple pregnancy

Multiple pregnancy is a generalized concept and usually determines the presence of more than one fetus in a pregnant woman. Depending on their number, it can be twins, triplets, and so on.

Common causes

There are only two basic reasons for multiple pregnancies:

1. Maturation of several eggs at once in one uterus.
2. Division of the zygote into several parts after fertilization.

In the first case, there is no septum between the twins on the ultrasound, in the second it is, but the degree of separation of the embryos may differ. If the zygote is divided in the first days, then the degree of isolation of future children will be high. In the event that this process dragged on for several weeks, then the likelihood of the formation of Siamese twins becomes very high.

There are a number of indirect and direct signs that indicate multiple pregnancies.

Medical signs

1. Ultrasound results.
2. Abnormally high AFP blood test results.
3. The beating of two hearts, diagnosed by the Doppler system.
4. Significant enlargement of the uterus, determined when diagnosing the height of the uterine fundus.

Early signs of twin pregnancy

1. A very bright and rich strip on the express test for determining pregnancy, caused by a significant increase in the HcG hormone in the blood.
2. The presence in the family of women who have previously carried multiple pregnancies.
3. Early onset of toxicosis, which is harder to tolerate than during normal pregnancy. At the same time, acne and signs of severe fatigue, characteristic of medium rather than early periods of gestation, are formed faster.
4. Earlier (from the fifteenth week), the movement of babies due to the close presentation to the walls of the uterus.
5. Large belly.

Fetal development with twins

The development of two babies at once during pregnancy is quite similar to the classic singleton gestation, but for the mother this process is more problematic, primarily due to possible additional complications.

In the first trimester, twins each grow in a separate zygote. By the end of the first month, the zygote is implanted into the endometrium. In the second trimester, children have their own fingerprints, start drinking amniotic and even squint, the ultrasound already shows their exact gender. The third trimester is the final formation of children.

The fair sex will have to visit a doctor more often for additional control over the state of the body and fruits, get more rest, consume the required amount of vitamins and fruits. Often, from the beginning of the third trimester, she will be offered to go to preservation, up to 36 weeks and the beginning of labor.

Possible complications

Multiple pregnancy implies the appearance of possible additional complications, both for the mother and for future children. The most common ones:

1. Incorrect fruit position.
2. Polyhydramnios.
3. Placental presentation.
4. Great fatigue, shortness of breath and palpitations.
5. Anemia.
6. Prematurity and fetal developmental disorders.
7. Delays in intrauterine growth and, accordingly, very low birth weight of babies.

1-10 weeks

Your body is actively responding to pregnancy. The mammary glands swell and rise. By the eighth week, the embryos already have a length of about three centimeters - they can already be detected using ultrasound.

The symptomatology of sensations coincides with the classic singleton pregnancy, only toxicosis and other negative sensations appear earlier. After the eighth week, future babies finish embryonic development, and by 10-11 weeks, hearts are formed, the voice-forming apparatus begins to form. The weight of your babies is about five grams.

10-20 week

The uterus with two future babies is actively expanding, you start wearing large-sized clothes. Twins are actively growing at a fast pace, from the 16th week, you can determine their gender through ultrasound. Their movements become more and more active (from the twentieth week they are clearly perceptible), while the coordination of the hands and the head is poorly expressed. The placenta remains the main metabolic organ, but the rudiments of the excretory and digestive system are already present: future children swallow amniotic fluid and, at the same time, expel decay products through urination.

By the sixteenth week, the body length of the twins is about 17 centimeters, and the weight is up to two hundred grams. In the twentieth, they gain another 100 grams and up to ten centimeters in height, while they can react to sounds.

20-30 week

The rapidly growing uterus provokes the appearance of stretch marks, the metabolism in women during this period is significantly accelerated. Future babies literally compete for the best position in the womb, the result of the struggle is constant tremors.

By 24-25 weeks, the growth of fruits is already about thirty centimeters, the weight reaches 700 grams. The appearance of babies is almost close to newborns, the noses are finally formed, the formation of facial features is nearing completion.

Frequent urination gradually returns to the woman, extensive edema occurs, fatigue becomes deeper. By the 28th week, future children step on the threshold of viability and, in the event of a premature birth, are most likely to be saved. By the thirtieth week, the weight of each baby is about a kilogram, growth is up to 35 centimeters. The body is 95 percent complete.

30-40 week

Calmness and only calmness - for mothers one of the most important phases begins, namely, the third final trimester. Kids are almost ready to see the world, their bone skeleton is formed, calcium and iron are gradually accumulating, pancreas is developing. The size of the bodies almost caught up with the head and now, in general, the body looks familiar.

From 32 weeks, false contractions may appear, not exceeding a few minutes. It is very uncomfortable for a mother to sleep because of a large belly and other negative factors, in addition to this, the representatives of the sex are suffering from heartburn. From the 36th week, the planned hospitalization of the pregnant woman in the maternity hospital takes place.

By 37 weeks, future babies are considered fully term and ready to go. The sucking apparatus is formed, the growth of the children reaches 55 centimeters, and the weight is about 2.3–3 kg, which is slightly lower than in a singleton pregnancy.

Pregnancy with twins, as mentioned above, has some peculiarities - in particular, it is a larger list of possible complications for the mother and future children, a more active manifestation of symptoms of toxicosis and other negative factors, less weight and growth of individual fetuses, as well as a high probability of premature birth.

Pregnancy with twins after a cesarean section

Caesarean section is a rather complicated operation that significantly increases the risks to the mother and fetus in the subsequent pregnancy, especially if the patient has multiple pregnancies.

With twins and a normally not healed scar on the uterus, doctors often recommend that the pregnancy be terminated even with normal metabolic processes and the absence of other negative factors. If a woman, who has previously undergone a cesarean, bears twins before the thirtieth week, in any situation the attending physician performs a second operation - this will partially remove the risk of uterine rupture and other processes that can even lead to death.

Second pregnancy with twins

A second multiple pregnancy is very rare. In part, the low probability of such an event is increased by the performed IVF, but the very process of gestation and childbirth in this situation significantly overloads the body. In any case, the pregnant woman is put on a very strict record in the antenatal clinic. At the same time, it is recommended to go to preservation from the second trimeter in order to monitor the state of the body of future babies and the fair sex in a hospital environment.

Childbirth with multiple pregnancies usually occurs earlier than 40–42 weeks, closer to 36–38. At the same time, future children are fully formed, although they have a weight and height below the classical norm, therefore, to prevent possible consequences, the babies are immediately sent to intensive care.

Unfortunately, even qualified specialists are far from always able to predict the exact course of such childbirth due to a number of features, in particular.

1. Features of the behavior of babies, each of which can interfere with the birth of the other.
2. Possible monoplacental structure, often leading to the death of one of the newborns due to oxygen deprivation.
3. Asynchronous collision of fetal position: one of the babies may have a breech presentation, while the second has a head presentation. In the process of childbirth, a catch and simultaneous exit of both into the pelvic opening sometimes occurs. Which is fraught with serious herbs for the mother and future children.

Nowadays, with multiple pregnancies and the absence of direct contraindications, doctors often recommend natural childbirth, albeit under the strict supervision of a doctor. If the mother has a narrow pelvis, polyhydramnios, breech presentation of one of the fetuses, large weight of future babies, anomalies in intrauterine development (one placenta, hypoxia, breech presentation, etc.), then the specialist will probably prescribe a cesarean section.

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Question answer

What is the chance of pregnancy with twins after IVF?

IVF significantly increases this likelihood, since several embryos are implanted into the uterus: if more than one takes root, then a multiple pregnancy is formed.

What is the belly size for twin pregnancy? What is the rate of weight?

During the development of multiple pregnancies, the belly of the fair sex is larger in size than that of women with one unborn child. However, its exact dimensions depend on the type of attachment of the fetus to the uterus (along the front or back wall), the size of the future children themselves, and other factors.

Maternal weight norms for carrying twins differ from the standards for weight gain in singleton pregnancies. To do this, you need to make a simple calculation and calculate your body mass index (BMI).

IDMT = weight in kilograms / current height in meters squared

If your BMI during pregnancy was less than 18.5, then the normal weight gain is 13-18 kilograms. With IDMT from 18.5 to 25 - the norm is 11-16 kg. From 25 to 39 - 7-11 kg and body mass index was more than thirty - from 5 to 9 kg.

Are there any peculiarities of wiggling twins during pregnancy?

Twins subjectively begin to move faster than one child. In fact, both types of pregnancy develop in approximately the same way, just in the case of twins, the fetuses take up more space and are located closer to the upper edges of the epithelium of a woman, who feels movements more clearly and strongly.

It is also worth noting that from the second trimeter of pregnancy, both future children move together more actively than one, in fact, "fighting" with each other for the free space in the mother's belly.

Is it possible to get a second pregnancy with twins after the twins of a previous pregnancy?

If you have not used IVF, then the chance of repeated multiple pregnancy in a woman who has already given birth is negligible. However, if it nevertheless happened or reproductive technologies were involved, the next birth and, accordingly, gestation, is carried out under the strict supervision of doctors, who often prescribe a cesarean section to minimize the risks for the newborn and the mother.