Types of multiple pregnancy
The main thing that the doctor finds out at the first ultrasound is how many placentas and amniotic sacs the children have. With dichorionic twins, each child has its own placenta and bladder, and this pregnancy is the calmest. With monochorionic twins, there is one placenta and the children's blood vessels are interconnected, so uneven blood exchange is possible. The rarest and most difficult option is monoamniotic twins, when the children are in a common bubble. Chorionicity can be determined most accurately up to 14 weeks; later this is more difficult to do.
- Dichorionic diamniotic twins - two placentas, two bladders
- Monochorionic diamniotic - one placenta, two bladders
- Monochorionic monoamniotic - one placenta and common bladder
- Triplets and more fetuses are a separate surveillance tactic
- Chorionicity is determined by ultrasound in the first trimester
Why does multiple pregnancy occur?
Fraternal twins occur when two eggs mature and are fertilized in one cycle: such children are similar to ordinary brothers and sisters and can be of different sexes. Identical twins occur when one fertilized egg divides, and the children are always the same sex. The frequency of twins depends on heredity, the age of the mother and especially on infertility treatment, when ovulation is stimulated or multiple embryos are transferred. Identical twins occur with approximately the same frequency in different countries and are almost independent of heredity.
- Stimulation of ovulation and transfer of several embryos during IVF
- Maternal inheritance
- Mother's age over 35 years
- Repeated births
- Random division of one egg
How does a twin pregnancy proceed?
The belly grows faster, shortness of breath, heartburn, heaviness in the lower back, swelling and varicose veins appear earlier. Toxicosis is often more pronounced due to higher levels of hormones. The body needs more iron and folic acid, which is why most women with twins develop anemia. The uterus is stretched more, and the cervix may begin to shorten prematurely - hence the increased risk of premature birth. The average delivery time for twins is less than for one child, and this is a normal feature, not a complication.
- More severe toxicosis in the first trimester
- Anemia and increased need for iron
- Shortness of breath, heartburn, lower back pain
- Swelling and varicose veins of the legs
- Early shortening of the cervix
Surveys and observation
Visits to the obstetrician-gynecologist are scheduled more often than in singleton pregnancies, and with a shared placenta, ultrasounds are done approximately every two weeks from the middle of the term. An ultrasound evaluates the growth of each child, the amount of water in each bladder and blood flow using Doppler: this allows timely detection of growth retardation of one of the fetuses or feto-fetal transfusion syndrome. Regularly monitor hemoglobin, blood pressure and protein in the urine, because preeclampsia is more common with twins. The length of the cervix is measured transvaginally.
- Ultrasound with determination of chorionicity up to 14 weeks
- First trimester screening
- Regular ultrasound of fetal growth and water volume
- Dopplerography of fetal vessels and umbilical cord
- Cervicometry - measuring the length of the cervix
- Complete blood count, monitoring blood pressure and protein in urine
Childbirth and prevention of complications
The date and method of delivery are planned in advance, focusing on the type of twins, the position of the children and the course of pregnancy. Dichorionic twins are usually not carried to term until 40 weeks, while monochorionic twins are delivered earlier. Natural birth is possible if the first baby is positioned head down and there are no other obstacles; in other cases, caesarean section is more often chosen. Prevention comes down to simple things: iron and folic acid supplements as prescribed by a doctor, adequate rest, compression stockings for varicose veins and timely treatment for any alarming signs. All medications are selected by the doctor.
- The birth plan is discussed in advance, usually after 32 weeks
- Delivery in a hospital with pediatric intensive care
- Iron and folic acid supplements as prescribed
- Compression jersey and weight control
- Quitting smoking and heavy physical activity
- Immediate treatment in case of contractions or leakage of water
