Multiple pregnancies.  Photo from www.creative.gettyimages.com

Multiple pregnancy may be associated with a number of difficulties. However, should not be afraid — if early diagnosis and proper conduct of all its problems can be resolved.

Problem 1. Miscarriage

The most common complication of multiple pregnancy is considered to be her miscarriage. The gestation period is directly dependent on the number of fruit: in the case of twins — the average is 36-37 weeks with triplets — 34-35 weeks. The trigger mechanism of labor is overstretching of the uterus because of a large number of fruits, and also due to polyhydramnios, often appearing in such pregnancies.

The solution: Prevention of premature birth is primarily restricted active lifestyle and in some cases the appointment of bed rest. After 20 weeks in the daytime expectant mothers, take a rest for at least 4-6 hours. At a later date — up to 8 hours a day.

In order not to miss the threat of premature birth, every two to three weeks gynecologist evaluates the state of the cervix. If up to 23 weeks, she begins to shorten, her stitches. This procedure is called Cervical cerclage. Most importantly — do not miss the time to perform this operation. After the 23 weeks to remove the threat of premature birth doctor prescribes special preparations — Tocolytic. In some cases, the threat of premature birth for pregnant recommend corticosteroids to accelerate lung maturation and prevention of respiratory disorders in the newborn.

Problem 2. High risk of complications

A multiple pregnancy is often a deficiency anemia. In addition, the risk of early toxicity and late toxicosis (gestoses) runs hard.

The solution: More than 90% of multiple pregnancies occurs with virtually no complications and successfully resolved. One reason for this success is the capability for early detection of various abnormalities by ultrasound. Indeed, in addition to determine the number of embryos, ultrasound allows us to observe their development status, number of placentas and amniotic fluid volume.

Naturally, in the case of multiple pregnancy a woman must often pay visits to the doctor after 20 weeks — every other week, and after 30 weeks of pregnancy — once a week. To prevent anemia in women with a multiple pregnancy prescribe large doses of iron supplements (60 mg daily) and folic acid (1 mg per day).

Problem 3. Impaired fetal growth

When the frequency of malformations raznoytsevoy twins fetal development is the same as in singleton pregnancy, and when identical twins — 2 times higher. During this pregnancy may be complicated by growth retardation of one of the fetuses (dissociated development). The most severe degree of dissociated observed in the syndrome twin-twin Transfusion: identical twins with one placenta feed as follows: onefruit from another. One becomes a donor, and the second — the recipient. In this case, both fetuses life is in danger.

The solution: In establishing syndrome twin-twin transfusion abroad produce separation of anastomoses with a laser, and both children continue to develop normally. Unfortunately, in our country, intrauterine fetal surgery is not yet widespread. Therefore, detection of this pathology treatment often is limited to the release of excessive amounts of amniotic fluid through a fine needle (amniodrenirovanie), which allows to roll over pregnancy, but does not eliminate the cause of the syndrome. In this situation, the woman should be under constant medical supervision. If necessary, it may require extra labor.

Problem 4. Low birth weight infants

In 40-60% of cases of twins at birth weight of children of less than 2500 Typically, the difference in body weight between both twins is low and is about 200-300 g's syndrome twin-twin transfusion may be a significant difference in weight: 1 kg and more.

The solution: To minimize the possibility of low birth weight, women should pay special attention to their diet, especially in the I trimester. Each child takes about 300-400 calories a day. At the same vitamins also are assigned in a double dose. If a singleton pregnancy optimal weight gain is 12-13 kg, for a multiple pregnancy weight gain should be at least 18-20 lbs.

On the labor required should attend neonatologists. In addition, the need to be prepared incubator facilities and neonatal intensive care.

The indications for cesarean section in a multiple pregnancy:

  • Severe preeclampsia (late toxicity), in which the counter-natural childbirth.
  • Pelvic position of the first fruits (nulliparous).
  • Excessive hyperextension of the uterus and large fruit (total weight of more than 6 kg).
  • Fetal hypoxia (s).

If no special indications for cesarean section are preferred natural childbirth. But when you have three or more children, regardless of the condition of the woman, it is recommended cesarean section at 34-35 weeks.

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