Multiple pregnancy is a gestational process in which 2 or more fetuses develop simultaneously in the uterus. It occurs in 1-1.6% of all pregnancies. Now there is an increase in the incidence of multiple pregnancy, which is associated with the active use of assisted reproductive technologies.
Causes of multiple pregnancies
Considering the features of multiple pregnancy, doctors often pay attention to the causes of their occurrence. According to their studies and observations, this may not happen to every potential mother. Among the factors that cause the onset of multiple pregnancies, doctors identify the following:
- Genetic predisposition. According to studies of geneticists, women who have had multiple pregnancies in the female line (from grandmothers, great-grandmothers) are 6-8 times more likely than others to become twin moms.
- Age. Under the influence of hormonal premenopausal adjustment after 35 years in women, several eggs can ripen during the menstrual cycle, which increases the chances of conceiving twins.
- Reception of medicines. Often, against the background of taking prescribed hormonal drugs (infertility treatment, stimulation of ovulation), there is a simultaneous maturation of several eggs that can be fertilized.
- Presence of several births in the anamnesis. Multiple pregnancies are more often recorded by physicians in re-pregnant women.
- ECO. In the procedure of extracorporal fertilization , several sex cells are sampled at once, which, after fertilization, are inserted into the uterus. The chance of several embryos hanging at once is high.
Pregnancy twins
At conception of dizygotic twins, twins appear on the light. Genetics often refer to them as raznoyaytsevye. The development of such fruits occurs with the simultaneous fertilization of two different oocytes. In this case, maturation of these germ cells can occur in one ovary as well as in different ovaries. Predisposition to the development of dizygotic twins can be inherited on the maternal line. Children born as a result of such a pregnancy can be either unisexual or heterosexual.
Describing the pregnancy of twins, the peculiarities of this process, doctors notice that in case of raznoyaytseva double in the mother's womb, 2 placentas are always formed. Often they are close to each other, even touching, but they can always be divided. Each embryo is placed in a separate fetus (fetus), which are separated by a septum. In this anatomical formation there are 2 chorionic and 2 amniotic membranes.
Pregnancy by twins
In this case, the development of multiple pregnancies occurs as a result of the separation of one fetal egg at different stages of its development. The frequency of birth of such children does not exceed 3-5 cases per 1000 births. The division of a fertilized egg into 2 equal parts at one of the stages may be caused by a delay in implantation, a violation of the acidity and ionic composition of the environment, and the impact of external factors on the body.
The development of monozygotic twins may be due to the fertilization of the ovum, which had 2 nuclei at once. When the separation of a fertilized egg occurs within 3 days after fertilization - the fruits have each its placenta and amniotic cavity. When dividing in the interval of 4-8 days from the sex cell, 2 embryos are formed, each of which has its own amniotic sac, but with a common placenta for two.
When the separation is observed on the 9-10th day after fertilization, the embryos receive a common amniotic sac and one placenta. Separation of the egg on day 13-15 can cause pathology - incomplete separation, which leads to the development of Siamese twins. There is such an extremely rare - 1:50 000-100 000 cases of pregnancy.
Probability of multiple pregnancies
With natural conception, the probability of having several children at once is small - 1.5-2%. In 99% of cases this is twins, and triplets and more fruits are much less common - less than 1% of all gestations. At the same time, doctors discovered regularity - more often there is a multiple pregnancy with IVF. This assisted reproductive technology involves the implantation into the uterine cavity of several embryos at once, which can be successfully implanted. In the case of natural conception, the chance of twin birth increases after 35 years.
Signs of multiple pregnancies
When a multiple pregnancy develops, the signs observed in the early stages do not differ from those recorded by the woman when carrying one child. This fact also causes a frequent question of expectant mothers who are interested in doctors, at what time can a multiple pregnancy be determined. Effective in this case is ultrasound, which gives the most informative result and can be carried out as early as 4-5 weeks.
Ultrasound of multiple pregnancy
Before determining the multiple pregnancies with the help of ultrasound, the doctor conducts an examination of the pregnant woman. The assumption that a woman is carrying twins, experienced gynecologists can make an increased size of the uterus, which is more than the norm for this period. Other symptoms of multiple pregnancies are absent. Only when carrying out ultrasound in the uterine cavity, several embryos are visually detected. In doing so, pay attention to important features that may further affect the tactics of delivery:
- amount of placenta (choriality);
- number of fetal blisters (amniotic).
HCG in multiple pregnancies
The level of hCG in the diagnosis of multiple pregnancy has little informative value. An increase in this indicator can be regarded as a sign of pathology, a violation of the fetal development process. This method does not fully understand the specific features of a particular pregnancy - it is impossible to determine how much a woman is pregnant with. How the hCG changes approximately in multiple pregnancies by week, you can see in the table below.
Multiple pregnancy - risks
Multiple pregnancy affects the body a lot. As a result, the chance of developing pathologies associated with the health of a woman or with the process of pregnancy is higher. More often in practice, the following complications of multiple pregnancies occur:
- miscarriage at an early age;
- premature delivery ;
- intrauterine death of one of the fetuses;
- late gestosis;
- postpartum haemorrhage;
- hypoxia of one or both babies;
- delay in development;
- fusion with the formation of Siamese twins.
Childbirth with multiple pregnancies
When a multiple pregnancy occurs normally, the toddlers are located longitudinally, the delivery is possible in a natural way. Considering the peculiarities of conducting labor during multiple pregnancy, doctors note an increase in the chances of developing the need for emergency caesarean delivery. 3-4 weeks before the expected date of delivery, a woman is hospitalized, examines and assesses the obstetric situation. Development is possible according to one of the following scenarios:
- If there were complications during pregnancy, one of the fetuses is located transversely, both have pelvic presentation or there is a scar on the uterus from the previous pregnancy - they conduct a planned cesarean section.
- The condition of the pregnant is satisfactory, the babies are in a longitudinal position - they perform natural childbirth.