Multiple pregnancy
Summary/Definition
Multiple pregnancy is a condition in which two or more fetuses develop simultaneously after conception, for example, twins, triplets or quadruplets. There are two main types of twins: identical and fraternal. Identical twins develop from the same fertilized egg and have the same genetic material, including gender. While the development of fraternal twins occurs when two separate eggs are fertilized by different spermatozoa, which leads to the birth of genetically different children. In identical twins, mutations in the genes are extremely rare. With multiple pregnancies with placenta previa, a greater number of abnormal symptoms may appear in comparison with single pregnancies. These symptoms may include natural miscarriage, severe morning sickness, fetal malformations, fetal growth retardation, amniotic fluid, gestational diabetes, pyelonephritis, feto-fetal transfusion syndrome, placenta previa, placental abruption, abnormal fetal position, umbilical cord prolapse, and so on. Some of these complications may occur only in multiple pregnancies, such as fetal-fetal transfusion syndrome.
Symptoms
In mothers with multiple pregnancies, changes during pregnancy are similar to single pregnancies, but they are usually accompanied by a more significant increase in body weight. In addition, the level of hemochromatosis during pregnancy is usually slightly lower in multiple pregnancies compared to single pregnancies. Also, mothers with multiple pregnancies tend to gain more weight than mothers with single pregnancies. The average weight gain in a single pregnancy is about 11 kg, while in a pregnancy with twins – about 14.5 kg. With a single pregnancy, body weight usually peaks in the middle of term, while in the case of multiple pregnancies, it may continue to increase towards the end of term. Women with multiple pregnancies are more likely to develop anemia than mothers with single pregnancies. Blood volume in women usually increases in the third trimester of pregnancy. During pregnancy with twins, the plasma gain is greater than during a singleton pregnancy, but the increase in the number of red blood cells is relatively limited, which leads to a decrease in hemoglobin concentration and increases the risk of anemia.
Diagnostics
Diagnosis of multiple pregnancies is usually performed using ultrasound (ultrasound). By ultrasound, it is possible to determine the number of amniotic membranes and chorions during the first 14 weeks of pregnancy. The amnion is the shell surrounding the fetus, while the chorion is the shell surrounding the amnion. In the case of a twin pregnancy, when twins develop from two separate fertilized eggs, each is dichorionic and diamniotic, since they have separate shells and amniotic cavities. In the case of an identical pregnancy, when twins develop from one fertilized egg, the number of chorions and amniotic membranes may vary depending on the time of division of the embryo into two parts. This can lead to a dichorionic diamniotic sheath, a monochorionic diamniotic sheath, and a monochorionic monoamniotic sheath. Since treatment planning and risk may vary depending on the type of multiple pregnancy, it is important to determine the number of chorions and amniotic membranes in the early stages of pregnancy.
Treatment and course of the disease
Multiple pregnancies require special and careful medical supervision, as they can increase the risk of complications for both the mother and the fetus. In the case of multiple pregnancies, there is a relatively high probability of delayed fetal development, and there may be differences in growth between different fetuses. Therefore, regular ultrasound is performed at every stage of pregnancy in the hospital. These procedures allow you to determine the expected weight of fruits, the amount of amniotic fluid, assess the condition of blood vessels and much more. In addition, a woman must undergo various tests to monitor the condition of her fetuses, including incompressible tests and biochemical analyses. Proper nutrition, iron supplementation and regular blood pressure measurement also play an important role in maintaining the health of the mother and fetuses during multiple pregnancies.
- Childbirth in multiple pregnancies
- Fetal position, gestational age and fetal size are important factors, and the method of delivery is determined taking into account the various risks identified during examinations.
- Operation to reduce the number of fetuses
- Surgery to reduce the number of fetuses is performed during pregnancy with three or more fetuses in order to increase survival and reduce the risk of complications. The decision to perform surgery is usually made in the early stages of pregnancy. There is still debate as to whether this procedure improves the overall results of pregnancy, and there are ethical issues related to this practice, therefore, the procedure for reducing the number of fetuses should be approached with caution.
Complications
Complications of multiple pregnancies include miscarriage, congenital anomalies, low birth weight, differences in fetal development, preeclampsia, premature birth and unusual complications. Specific complications include the following: transfusion syndrome between twins, death of one of the twins, monoamniotic twins, siamese twins, anencephaly and acardial twins.
