Management of pregnancy and childbirth during multiple pregnancy. Multiple pregnancy Double placenta causes

In some African tribes, multiple births were considered a curse, and in some cases the second child was even killed. Among the American Indians, on the contrary, it was believed that twins born alive had divine superpower. At the same time, the very fact of such a birth was surrounded by special rituals, and children and their parents were given badges of honor. Europe also contributed to the cultivation of superstitions around multiple pregnancies: in the Middle Ages, there was a view of multiple pregnancies as evidence of adultery, since the second child was supposed to have a second father.

Causes and types of multiple pregnancies

Let's look at them using the example of twins, as the most common type of multiple pregnancy. It has now been established that the causes of multiple pregnancies can be two different processes.

The first (and most understandable) is the fertilization of two eggs by two different sperm. In this case, two independent embryos (or zygotes) are formed. This pregnancy is called bizygotic. Among multiple pregnancies, 2/3 are like this, that is, the majority.

The mechanisms for the formation of bizygotic twins, in turn, can also be of two types. The first is the so-called multiple ovulation, when two eggs mature in one cycle, which are then fertilized by two sperm. The cause of multiple ovulation may be the formation of hormones. It is this mechanism that is used to obtain several eggs during in vitro fertilization: during “in vitro conception”, to increase the likelihood of success, with the help of medications, several follicles - vesicles with eggs - mature in the ovary during one cycle.

However, another mechanism is also possible when, for reasons that are not entirely clear, after fertilization of the first egg, the maturation of the next follicle is not inhibited and ovulation and fertilization occur in the subsequent cycle. Thus, with an interval of approximately 28 days, two fertilized eggs sequentially enter the uterus. Such children are born together, but the length of stay in the womb (and therefore the weight and degree of maturity) of the second child will be 4 weeks less. Indirect evidence of the possibility of such a mechanism in humans are some results of ultrasound studies, when a doctor who discovered a singleton pregnancy in the early stages notes the appearance of a second fertilized egg in the uterine cavity after 4-5 weeks. It should be noted that there is no rigorous evidence for the existence of this mechanism yet. It is clear that bizygotic twins can be either same-sex or opposite-sex.

The remaining one third of the total number of twins develops from one egg and is called monozygotic. These twins still pose a mystery to obstetricians and often cause the most problems during pregnancy. The mystery lies in the fact that at a certain period of development, the zygote, for unknown reasons, is divided into two viable halves. Moreover, from a formal point of view, one of the future embryos is a clone of the other.

The division of an egg to form monozygotic twins can occur between 2 and 15 days after fertilization of the egg. If the division of the egg occurred on the 2-3rd day, then each of the halves of the zygote has full potential for independent intrauterine development. That is, two embryos are formed, each of which has a separate chorion (precursor of the placenta) and its own separate amniotic cavity (fetal bladder). Such twins will be called monozygotic (from one zygote), bichorionic (with two placentas) and biamniotic (with two membranes). If the division of the zygote occurred from the 4th to the 7th day after fertilization, then the mass of cells from which the chorion and then the placenta will subsequently develop has already separated from the main group of cells forming the body of the embryo. Thus, the separation process will only affect this last group. The result is twins with one common placenta and two amniotic cavities. This type of twins is called monochorionic biamniotic (one placenta, two membranes).

If the separation occurred in the interval of 8-12 days, then only the separation of the embryos occurs. In this case, they share not only the placenta, but also the amniotic cavity. Such twins are called monochorionic monoamniotic (one placenta, one amniotic sac).

Separation at 13-15 days after fertilization can no longer be completed completely and leads to developmental defects. In this case, twins can be joined by any part of their bodies. An example of such an incomplete separation is the famous Siamese twins. In a sense, even early separation, when the separation of the embryonic bodies is complete, cannot be considered a completely normal process, since the incidence of malformations in one or both monochorionic twins is several times higher than in the case of a singleton pregnancy or bizygotic twins.

It is quite obvious that since monozygotic twins came from the same egg, their gender, blood type and chromosome set should be the same. However, it happens that in monozygotic twins, one of the fetuses is born with a developmental defect, while the other does not have it. Obviously, the cause of this cannot be a genetic (chromosomal) pathology. In this case, the only reason can only be a defect in the bookmark - i.e. the influence of factors external to the embryo on the development of the internal organs of the embryo in the first trimester. These factors may include physical (ionizing radiation), chemical or infectious (viruses, bacteria).

Diagnosis and observation

Modern ultrasound technology makes it possible to detect multiple pregnancies at the earliest stages of development. Usually, already at the 5-6th week, two fertilized eggs are clearly visible, a little later the bodies of the embryos become visible and the contractions of their hearts are clearly recorded. At a later stage of pregnancy, it becomes possible to determine the number of placentas, the presence of partitions between the membranes and the dynamics of fetal growth. These data are very important for determining the synchrony of fruit growth. Since monozygotic twins have an increased likelihood of developing malformations, special attention is paid to the search for this pathology.

In twins, the incidence of spontaneous termination of pregnancy (spontaneous abortion) is increased. Probably, such spontaneous abortions of one of the bizygotic fetuses can explain the facts when, in the early stages of pregnancy, a woman experiences short-term bleeding, after which the pregnancy continues and ends relatively normally as a singleton.

Features of pregnancy

Numerous ultrasound studies of twins show that in the case of their normal development, the growth dynamics of each fetus up to 30-32 weeks of pregnancy corresponds to the growth of the fetus in a normal singleton pregnancy. Of course, a lot depends on the place where the placenta is located in each fetus. The most favorable place for the placenta to attach is the fundus, anterior and posterior walls of the uterus. The lower the placenta is, the fewer so-called spiral arteries of the uterus that supply blood to the placental villi, and the worse its nutrition. This is not a random dependence, but a completely justified biological mechanism that makes low placentation disadvantageous in order to reduce the likelihood of central placenta previa (the so-called condition when the placenta completely covers the internal os of the cervical canal uterus and makes the natural birth of a child impossible). If placentation occurs low enough, then the process of placental growth goes sideways better nutrition, and it seems to move upward. This is what explains the “raising” of the placenta at a low position in the case of a singleton pregnancy.

It is clear that if the placenta of one of the fetuses is low enough, then the likelihood of developing placental insufficiency increases, one of the manifestations of which may be gestosis.

After 32 weeks of pregnancy, the rate of increase in length and weight of twins decreases. By 37-38 weeks, the weight of each of these fetuses is less than the normative weight of a fetus from a singleton pregnancy. Studies show that the weekly weight gain of each twin fetus after 32 weeks corresponds to the weekly weight gain of the singleton fetus at the same time. Thus, it can be assumed that at the end of the third trimester, the main limiter on the growth of twin fetuses is the ability of the mother’s body to deliver oxygen and nutrients to the uterus. Obviously, in this situation, the body of a mother carrying a multiple pregnancy experiences significant additional stress. By the end of pregnancy, the overall increase in the mother's body weight in the case of twins is 30% greater than in a singleton pregnancy. The volume of circulating blood additionally increases (by 10-15%), but there is no corresponding increase in the number of red blood cells. Therefore, pregnant women with twins are more likely to experience anemia - a decrease in the number of red blood cells. To prevent the development of this condition, women with multiple pregnancies should eat more protein and be sure to take iron supplements.

During the development of a multiple pregnancy, the internal volume of the uterus increases at a faster rate than in the case of a single pregnancy. The uterus reaches the volume characteristic of full-term pregnancy earlier. The uterus’s own regulatory mechanisms at this point increase its contractile activity, preparing for upcoming birth. Therefore, with multiple pregnancies, labor often begins prematurely. But this is no reason to worry.

Interestingly, the incidence of multiple pregnancies is not the same in different countries and on different continents. It is possible that this is in some way connected with the ethnicity of the population of these countries. Thus, in Japan there is the lowest incidence of twins - 0.6% (i.e. 6 per 1000 births), in Europe and the USA it ranges from 1.0% to 1.5%, and in Africa this figure is the highest. So, in Nigeria this figure reaches 4.5% (45 per 1000). Such differences apply exclusively to bizygotic twins. Monozygotic twins occur with remarkable consistency in all parts of the world. Their frequency is 0.4% (4 per 1000). It was found that the likelihood of bizygotic twins is inherited - mainly through the maternal line. This may be due to the inherited increased synthesis of folliculin, a hormone that affects the number of eggs maturing in the ovary.

Complications of pregnancy with monochorionic twins

The term "monochorionic twins" suggests that the placenta has not separated between the two fetuses and they receive oxygenated blood from the same placenta. In this situation, it can be assumed that some of the vessels belonging to the vascular placental system of one fetus are connected to the same vessels of another fetus. Such connections of vessels are called anastomoses. Indeed, upon careful examination of the placentas, it turned out that in 98% of cases in monochorionic twins, the placentas are connected by vessels. However, in only 28% of cases, blood is pumped through these connections from one fetus to another. The reasons for this flow of blood are still not entirely clear. In this situation, the fetus from which blood is pumped acts as a donor, and the other as a recipient.

When such a complication occurs, called feto-fetal transfusion syndrome (FTTS), the discharge of blood from one fetus to another leads to bleeding of the donor and, conversely, to an overload of the recipient’s circulatory system. If feto-fetal transfusion is not stopped, it can quickly lead to the death of the donor, and then the recipient. Unfortunately, there are no effective methods for preventing and treating transfusion syndrome. The only way to prevent the development of feto-fetal transfusion syndrome today is therapy aimed at improving placental circulation.

Summarizing the currently known information about multiple pregnancies, we can draw the following conclusions:

• Multiple pregnancy places special, increased demands on the mother's body. Of course, doctors do not consider it as a pathology, but they believe that such a pregnancy (especially with monochorionic twins) requires closer attention from medical personnel.
• The likelihood of developing placental insufficiency and gestosis during a multiple pregnancy is greater than during a singleton pregnancy. Consequently, all measures aimed at preventing the development of these conditions are carried out from the beginning of the second trimester. Special attention The expectant mother is given complete protein nutrition: taking iron supplements and vitamins.
• It is advisable for a woman with twins to give birth in a high-level maternity hospital ( perinatal center), which has powerful qualified neonatal resuscitation. It is clear that the frequency of surgical delivery (caesarean sections) in multiple pregnancies is significantly higher than in singleton pregnancies. However, the method of delivery depends on many factors: on how the pregnancy occurred - spontaneously or with the help of IVF, on the nature of the twins (bichorionic or monochorionic), on the nature of the location of the fetuses, on the health status of the expectant mother and other factors. In each case, labor management tactics are developed individually.

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Multiple pregnancy - definition and types (twins and twins)

Multiple pregnancy- this is a pregnancy in which not one, but several (two, three or more) fetuses develop in a woman’s uterus at the same time. Typically, the name of a multiple pregnancy is given depending on the number of fetuses: for example, if there are two children, then they talk about the pregnancy with twins, if there are three, then with triplets, etc.

Currently, the incidence of multiple pregnancies ranges from 0.7 to 1.5% in various countries Europe and USA. The widespread and relatively frequent use of assisted reproductive technologies (IVF) has led to an increase in the incidence of multiple pregnancies.

Depending on the mechanism by which twins appear, dizygotic (fraternal) and monozygotic (identical) multiple pregnancies are distinguished. Children of fraternal twins are called fraternal twins, and children of identical twins are called twins or twins. Among all multiple pregnancies, the incidence of fraternal twins is about 70%. Twins are always of the same sex and are like two peas in a pod, since they develop from the same fertilized egg and have exactly the same set of genes. Twins can be of different sexes and look alike only like siblings, since they develop from different eggs and, therefore, have a different set of genes.

A twin pregnancy develops due to the simultaneous fertilization of two eggs, which are implanted in different parts of the uterus. Quite often, the formation of fraternal twins occurs as a result of two different sexual acts performed with a short interval between each other - no more than a week. However, fraternal twins can be conceived during the same sexual intercourse, but provided that the simultaneous maturation and release of two eggs from the same or different ovaries occurs. With fraternal twins, each fetus necessarily has its own placenta and its own amniotic sac. The position of the fetuses, when each of them has its own placenta and amniotic sac, is called bichorionic biamniotic twins. That is, in the uterus there are simultaneously two placentas (bichorionic twins) and two fetal bladders (biamniotic twins), in each of which the child grows and develops.

Identical twins develop from a single fertilized egg, which, after fertilization, divides into two cells, each of which gives rise to a separate organism. In identical twins, the number of placentas and membranes depends on the time of separation of the single fertilized egg. If separation occurs within the first three days after fertilization, while the fertilized egg is in the fallopian tube and is not attached to the wall of the uterus, then two placentas and two separate fetal sacs will form. In this case, there will be two fetuses in the uterus in two separate amniotic sacs, each fed by its own placenta. Such twins are called bichorionic (two placentas) biamniotic (two membranes).

If the fertilized egg divides 3–8 days after fertilization, that is, at the stage of attachment to the wall of the uterus, then two fetuses are formed, two amniotic sacs, but one placenta for both. In this case, each twin will be in its own amniotic sac, but they will be nourished by one placenta, from which two umbilical cords will depart. This type of twins is called monochorionic (one placenta) biamniotic (two membranes).

If the fertilized egg divides on days 8 - 13 after fertilization, then two fetuses will be formed, but one placenta and one amniotic sac. In this case, both fetuses will be in the same amniotic sac, and will be fed from the same placenta. Such twins are called monochorionic (one placenta) or monoamniotic (one amniotic sac).

If the fertilized egg divides later than the 13th day after fertilization, the result is Siamese twins, which are fused with different parts of the body.

From the point of view of safety and normal development of the fetus the best option are bichorionic biamniotic twins, both identical and fraternal. Monochorionic biamniotic twins develop worse and the risk of pregnancy complications is higher. And the most unfavorable option for twins is monochorionic monoamniotic.

Probability of multiple pregnancy

The probability of multiple pregnancy with a completely natural conception is no more than 1.5 - 2%. Moreover, in 99% of multiple pregnancies there are twins, and triplets and a large number of fetuses in only 1% of cases. With natural conception, the likelihood of multiple pregnancy increases in women over 35 years of age or at any age in the spring season against the background of a significant lengthening of daylight hours. In addition, women who have already had twins in their family are more likely to have multiple pregnancies than other representatives of the fairer sex.

However, if pregnancy occurs under the influence medicines or assisted reproductive technologies, the likelihood of twins or triplets is significantly higher than with natural conception. Thus, when using medications to stimulate ovulation (for example, Clomiphene, Clostilbegit, etc.), the probability of multiple pregnancy increases to 6 - 8%. If drugs containing gonadotropin were used to improve the chances of conception, then the probability of twins is already 25–35%. If a woman becomes pregnant with the help of assisted reproductive technologies (IVF), then the probability of multiple pregnancy in this situation is from 35 to 40%.

Multiple pregnancy with IVF

If a woman becomes pregnant using IVF (in vitro fertilization), then the probability of multiple pregnancy is, according to various researchers, from 35% to 55%. In this case, a woman may have twins, triplets or quadruplets. The mechanism of multiple pregnancy with IVF is very simple - four embryos are simultaneously implanted into the uterus, hoping that at least one of them will take root. However, not one, but two, three or all four embryos can take root, that is, be implanted into the wall of the uterus, resulting in a woman having a multiple pregnancy.

If an ultrasound after IVF revealed a multiple pregnancy (triplets or quadruplets), then the woman is offered to “remove” the extra embryos, leaving only one or two. If twins are detected, it is not recommended to remove the embryos. In this case, the decision is made by the woman herself. If she decides to keep all three or four implanted embryos, she will have quadruplets or triplets. The further development of a multiple pregnancy resulting from IVF is no different from that occurring naturally.

Reduction during multiple pregnancy

Removing the “extra” embryo during a multiple pregnancy is called reduction. This procedure is offered to women who have more than two fetuses in the uterus. Moreover, reduction is currently offered not only to women who become pregnant with triplets or quadruples as a result of IVF, but also to those who naturally conceive more than two fetuses at the same time. The goal of reduction is to reduce the risk of obstetric and perinatal complications associated with multiple pregnancies. During reduction, two fetuses are usually left, since there is a risk of spontaneous death of one of them in the future.

The reduction procedure during multiple pregnancy is carried out only with the consent of the woman and on the recommendation of a gynecologist. In this case, the woman herself decides how many fruits to reduce and how many to leave. Reduction is not carried out against the background of a threat of miscarriage or in acute inflammatory diseases of any organs and systems, since against such an unfavorable background the procedure can lead to the loss of all fetuses. Reduction can be carried out up to 10 weeks of pregnancy. If you do this for more later pregnancy, then the remains of fetal tissue will have an irritating effect on the uterus and provoke complications.

Currently, reduction is carried out using the following methods:

• Transcervical. A flexible and soft catheter connected to a vacuum aspirator is inserted into the cervical canal. Under ultrasound control, the catheter is advanced to the embryo to be reduced. After the tip of the catheter reaches the membranes of the reduced embryo, a vacuum aspirator is turned on, which lifts it off the uterine wall and sucks it into the container. In principle, transcervical reduction is essentially an incomplete vacuum abortion, during which not all fetuses are removed. The method is quite traumatic, so it is rarely used nowadays;
• Transvaginal. It is performed under anesthesia in the operating room, similar to the process of oocyte collection for IVF. The biopsy adapter is inserted into the vagina and, under ultrasound control, the embryo to be reduced is pierced with a puncture needle. After which the needle is removed. This method is currently used most often;
• Transabdominal. It is performed in the operating room under general anesthesia, similar to the amniocentesis procedure. A puncture is made on the abdominal wall through which a needle is inserted into the uterus under ultrasound guidance. This needle is used to pierce the embryo to be reduced, after which the instrument is removed.

Any reduction method is technically complex and dangerous, since in 23–35% of cases pregnancy loss occurs as a complication. Therefore, many women prefer to face the burden of carrying several fetuses rather than lose the entire pregnancy. In principle, the modern level of obstetric care makes it possible to create conditions for carrying multiple pregnancies, as a result of which completely healthy children are born.

Most multiple pregnancy

Currently, the most multiple pregnancy recorded and confirmed was ten, when ten fetuses appeared in the woman’s uterus at the same time. As a result of this pregnancy, a resident of Brazil gave birth to two boys and eight girls in 1946. But, unfortunately, all the children died before reaching six months of age. There are also references to the birth of the tenth in 1924 in Spain and in 1936 in China.

Today, the most multiple pregnancy, which can successfully end in the birth of healthy children without abnormalities, is gear. If there are more than six fetuses, then some of them suffer from developmental delay, which persists throughout their life.

Multiple pregnancy - timing of delivery

As a rule, a multiple pregnancy, regardless of the method of its development (IVF or natural conception), ends before 40 weeks, since the woman begins premature labor due to excessive stretching of the uterus. As a result, children are born premature. Moreover, the greater the number of fetuses, the earlier and more often premature birth develops. With twins, as a rule, labor begins at 36–37 weeks, with triplets at 33–34 weeks, and with quadruples at 31 weeks.

Multiple pregnancy - reasons

Currently, the following possible causative factors that can lead to multiple pregnancy in a woman have been identified:

• Genetic predisposition. It has been proven that women whose grandmothers or mothers gave birth to twins are 6 to 8 times more likely to have multiple pregnancies compared to other representatives of the fair sex. Moreover, most often multiple pregnancies are passed down through a generation, that is, from grandmother to granddaughter;
• Woman's age. In women over 35 years of age, under the influence of hormonal premenopausal changes, not one, but several eggs may mature in each menstrual cycle, so the likelihood of a multiple pregnancy in mature age higher than in youth or young. The likelihood of multiple pregnancy is especially high in women over 35 years of age who have previously given birth;
• Effects of drugs. Any hormonal treatment used to treat infertility, stimulate ovulation or disorders menstrual cycle(for example, oral contraceptives, Clomiphene, etc.) can lead to the maturation of several eggs at the same time in one cycle, resulting in a multiple pregnancy;
• A large number of births in the past. It has been proven that multiple pregnancies mainly develop in repeat pregnant women, and its likelihood is higher, the higher the more births the woman had in the past;
• In vitro fertilization. In this case, several eggs are taken from a woman, fertilized with male sperm in a test tube, and the resulting embryos are implanted into the uterus. In this case, four embryos are introduced into the uterus at once so that at least one can implant and begin to develop. However, two, three, or all four implanted embryos can take root in the uterus, resulting in a multiple pregnancy. In practice, twins are the most common result of IVF, but triplets or quadruplets are rare.

Signs of multiple pregnancy

Currently, the most informative method for diagnosing multiple pregnancies is ultrasound, but the clinical signs on which doctors of the past were based still play a role. These clinical signs of multiple pregnancy allow the doctor or woman to suspect the presence of several fetuses in the uterus and, based on this, perform a targeted ultrasound examination, which will confirm or refute the assumption with 100% accuracy.

So, the signs of multiple pregnancy are the following:

• The size of the uterus is too large and does not correspond to the term;
• Low position of the fetal head or pelvis above the entrance to the pelvis in combination with a high position of the uterine fundus, which does not correspond to the term;
• Discrepancy between the size of the fetal head and the volume of the abdomen;
• Large abdominal volume;
• Excessive weight gain;
• Listening to two heartbeats;
• The concentration of hCG and lactogen is two times higher than normal;
• Fatigue of a pregnant woman;
• Early and severe toxicosis or gestosis;
• Thrust locks;
• Severe swelling of the legs;
• High blood pressure.

If a combination of several of these signs is detected, the doctor may suspect a multiple pregnancy, but to confirm this assumption it is necessary to perform an ultrasound.

How to determine multiple pregnancy - effective diagnostic methods

Currently, multiple pregnancies are detected with 100% accuracy during routine ultrasound. Also, determining the concentration of hCG in venous blood has relatively high accuracy, but this laboratory method is inferior to ultrasound. That is why ultrasound is the method of choice for diagnosing multiple pregnancies.

Ultrasound diagnosis of multiple pregnancy

Ultrasound diagnosis of multiple pregnancy is possible on early stages gestation - from 4 to 5 weeks, that is, literally immediately after a delay in menstruation. During an ultrasound, the doctor sees several embryos in the uterine cavity, which is undoubted evidence of a multiple pregnancy.

The number of placentas (chorionicity) and amniotic sacs (amnioticity) is of decisive importance for choosing pregnancy management tactics and calculating the risk of complications, and not the dizygoty or monozygocy of the fetus. Pregnancy proceeds most favorably with bichorionic biamniotic twins, when each fetus has its own placenta and amniotic sac. The least favorable outcome and with the greatest possible number of complications is a monochorionic monoamniotic pregnancy, when two fetuses are in the same amniotic sac and are fed from the same placenta. Therefore, during an ultrasound, the doctor counts not only the number of fetuses, but also determines how many placentas and amniotic sacs they have.

In multiple pregnancies, ultrasound plays a huge role in identifying various defects or delayed fetal development, since biochemical screening tests (determining the concentration of hCG, AFP, etc.) are not informative. Therefore, detection of malformations by ultrasound during multiple pregnancies must be carried out in the early stages of gestation (from 10 to 12 weeks), while assessing the condition of each fetus individually.

HCG in the diagnosis of multiple pregnancy

HCG in the diagnosis of multiple pregnancies is a relatively informative method, but inaccurate. Diagnosis of multiple pregnancy is based on hCG levels exceeding normal concentrations for each specific gestational age. This means that if the concentration of hCG in a woman’s blood is higher than normal for a given stage of pregnancy, then she has not one, but several fetuses. That is, with the help of hCG it is possible to detect a multiple pregnancy, but it is impossible to understand how many fetuses are in a woman’s uterus, whether they are in the same amniotic sac or in different ones, whether they have two placentas or one.

Development of multiple pregnancy

The process of developing a multiple pregnancy creates a very high load on the mother’s body, since the cardiovascular, respiratory, urinary systems, as well as the liver, spleen, bone marrow and other organs continuously work in an intensive mode for a fairly long period of time (40 weeks) in order to ensure one, but two or more growing organisms have everything they need. Therefore, the incidence in women carrying multiple pregnancies increases 3 to 7 times compared to singleton pregnancies. Moreover, the more fetuses in a woman’s uterus, the higher the risk of complications from various organs and systems of the mother.

If a woman suffered from any chronic diseases before the onset of a multiple pregnancy, then they will definitely worsen, since the body is under very strong stress. In addition, during multiple pregnancies, half of women develop gestosis. All pregnant women experience edema and hypertension in the second and third trimesters, which are a normal reaction of the body to the needs of the fetus. A fairly standard complication of multiple pregnancy is anemia, which must be prevented by taking iron supplements throughout the entire period of bearing children.

For normal growth and development of several fetuses, a pregnant woman must eat well and intensively, since her need for vitamins, microelements, proteins, fats and carbohydrates is very high. The daily calorie intake of a woman carrying twins should be at least 4500 kcal. Moreover, these calories should be gained from foods rich in nutrients, and not from chocolate and flour products. If a woman has poor nutrition during a multiple pregnancy, this leads to depletion of her body, the development of severe chronic pathologies and numerous complications. During a multiple pregnancy, a woman normally gains 20–22 kg in weight, with 10 kg in the first half.

In multiple pregnancies, one fetus is usually larger than the second. If the difference in body weight and height between fetuses does not exceed 20%, then this is considered normal. But if the weight and height of one fetus exceeds the second by more than 20%, they speak of a delay in the development of the second, too small child. Delayed development of one of the fetuses in multiple pregnancies is observed 10 times more often than in singleton pregnancies. Moreover, the likelihood of developmental delay is highest in monochorionic pregnancy and minimal in bichorionic biamniotic pregnancy.

Multiple pregnancies usually end in premature birth because the uterus stretches too much. With twins, delivery usually occurs at 36–37 weeks, with triplets at 33–34 weeks, and with quadruples at 31 weeks. Due to the development of several fetuses in the uterus, they are born with less weight and body length compared to those born from a singleton pregnancy. In all other aspects, the development of a multiple pregnancy is exactly the same as a single pregnancy.

Multiple pregnancy - complications

During multiple pregnancy, the following complications may develop:

• Miscarriage in early pregnancy;
• Premature birth;
• Intrauterine death of one or both fetuses;
• Severe gestosis;
• Bleeding in the postpartum period;
• Hypoxia of one or both fetuses;
• Fetal collision (the adhesion of two fetuses by their heads, as a result of which they simultaneously find themselves at the entrance to the pelvis);
• Fetofetal blood transfusion syndrome (FTS);
• Reverse arterial perfusion;
• Congenital malformations of one of the fetuses;
• Delayed development of one of the fetuses;
• Fusion of fetuses to form Siamese twins.

The most severe complication of multiple pregnancy is fetofetal blood transfusion syndrome (FTS), which occurs in monochorionic twins (with one placenta for two). FFH is a disruption of blood flow in the placenta, as a result of which blood from one fetus is redistributed to another. That is, one fetus receives an insufficient amount of blood, and the other receives an excess amount. In FFH, both fetuses suffer from inadequate blood flow.

Another specific complication of multiple pregnancy is fetal fusion. Such conjoined children are called Siamese twins. The fusion is formed in those parts of the body with which the fruits are most closely in contact. The most common fusions occur with the chest (thoracopagus), abdomen in the navel (omphalopagus), skull bones (craniopagus), coccyx (pygopagus) or sacrum (ischiopagus).

In addition to those listed, with a multiple pregnancy, exactly the same complications can develop as with a single pregnancy.

Childbirth during multiple pregnancy

If a multiple pregnancy proceeded normally, the fetuses have a longitudinal arrangement, then natural delivery is possible. In multiple pregnancies, complications during childbirth develop more often than in singleton pregnancies, which leads to a higher frequency of emergency cesarean sections. A woman with a multiple pregnancy should be hospitalized in a maternity hospital 3 to 4 weeks before the expected date of birth, rather than wait for labor to begin at home. A stay in the maternity hospital is necessary for examination and assessment of the obstetric situation, on the basis of which the doctor will decide on the possibility of a natural birth or the need for a planned cesarean section.

The generally accepted delivery tactics for multiple pregnancies are as follows:
1. If the pregnancy proceeded with complications, one of the fetuses is in a transverse position or both are in breech If a woman has a scar on her uterus, a planned caesarean section is performed.
2. If a woman approaches childbirth in satisfactory condition, the fetuses are in a longitudinal position, then it is recommended to give birth through natural means. If complications develop, an emergency caesarean section is performed.

Currently, in multiple pregnancies, as a rule, a planned caesarean section is performed.

Multiple pregnancy: causes, types, diagnosis, childbirth - video

When is sick leave (maternity leave) given for multiple births?
pregnancy

In case of multiple pregnancy, a woman will be able to receive sick leave ( maternity leave) two weeks earlier than with a singleton, that is, at 28 weeks. All other rules for issuing sick leave and cash benefits are exactly the same as for a singleton pregnancy.

(placenta duplex)

see Placenta bilobed.

• - developmental anomaly: the presence of two separate one-horned M., each of which is connected to the corresponding part of the bifurcated vagina...

  Medical encyclopedia

• - disturbance of orientation, in which the patient simultaneously has correct and false ideas...

  Medical encyclopedia

• - a form of placenta accreta, characterized by the introduction of chorionic villi to varying depths into the myometrium...

  Medical encyclopedia

• - a variant of the structure of the placenta, in which it consists of two separate parts of approximately the same size, connected by non-permanent vessels...

  Medical encyclopedia

• Medical encyclopedia

• - see Placenta bilobed...

  Medical encyclopedia

• - an abnormality in the development of the placenta, in which it captures most uterine mucosa...

  Medical encyclopedia

• - an anomaly in the structure of the placenta, in which the amnion and chorion do not extend from the edge of the placenta, but 1-2 cm inward from...

  Medical encyclopedia

• - part of the placenta formed by the endometrium and its blood vessels...

  Medical encyclopedia

• - an anomaly in the structure of the placenta, in which it consists of lobes separated from one another...

  Medical encyclopedia

• - an anomaly in the development of the placenta, in which there are areas of thinning in it, up to the complete absence of placental tissue...

  Medical encyclopedia

• - an abnormality in the development of the placenta, in which it is thinned and spread over most of the surface of the uterine mucosa...

  Medical encyclopedia

• - developmental anomaly: the presence in a duplicated kidney of two renal pelvises that do not communicate with each other, passing into a partially or completely duplicated ureter...

  Medical encyclopedia

• - see Double histamine test...

  Medical encyclopedia

• - y, w. anat. An organ that carries out communication and metabolism between the mother’s body and the fetus during intrauterine development; children's place...

  Small academic dictionary

• - ...

  Russian word stress

"Double placenta" in books

Bridgehead

From the book SS Assault Brigade. Triple defeat by Degrelle Leon

Bridgehead The Walloon Assault Brigade accomplished the incredible by gathering in full force on the bridgehead at Derenkovets. But our position almost immediately became critical. Our positions ran like a horseshoe around the village: northeast, north, east. Inside the horseshoe behind us

AN INBREAKABLE BRIDGEHEAD

From the book Desert Foxes. Field Marshal Erwin Rommel by Koch Lutz

AN INBREAKABLE BRIDGEHEAD On January 22, 1944, the Allies landed on the coast of the Tyrrhenian Sea in the area of ​​Anzio and Nettuno. I immediately remembered Rommel and his thoughts out loud shortly before leaving for France: ...we will still leave one position after another, watering them abundantly

Bridgehead

From the book Hitler's Favorite. The Russian campaign through the eyes of an SS general by Degrelle Leon

Bridgehead The Wallonia Assault Brigade, after considerable effort, managed to regroup to create a bridgehead at Derenkovets. Our situation almost immediately became hellish. We were positioned in a horseshoe near the village, facing north, northeast and east. Between two ends

Bridgehead at Baranów

From the book Tank Battles 1939-1945. author

Sandomierz bridgehead

From the book "Eels" attack author Begeldinov Talgat Yakubekovich

Sandomierz bridgehead A village near Lviv. With her I have a painful memory of the treachery and meanness of the enemy. Even in the days when the war was raging on our land, we heard that a certain Bandera was operating in Ukraine. Under the guise of fighting for “independent Ukraine”

Bridgehead at Baranów

From the book Armored Fist of the Wehrmacht author Mellenthin Friedrich Wilhelm von

Bridgehead at Baranów At the beginning of August 1944, it seemed that the threat of complete defeat loomed over Germany. In Normandy, the Americans were breaking through at Avranches, and Patton's 3rd Army was preparing to begin its formidable campaign into Brittany and Anjou. In Italy, the Allies reached the Arno River, from the day

To the bridgehead

From the book I Fought in an Airacobra author Mariinsky Evgeniy Pakhomovich

To the bridgehead On this day we flew on a mission once again. Korolev led the four to cover the ground troops breaking into Krivoy Rog. “They’ve already gone far, more than a hundred kilometers from the Dnieper!” - the pilots rejoiced. Just a week ago they covered a narrow strip

KAKHOVSKY BRIDGEHEAD

From the book Blucher author Velikanov Nikolay Timofeevich

KAKHOVSKY BREACHHEAD Blücher's 51st division was firmly entrenched in the Kakhovsky bridgehead. At the end of August, during the second offensive of the 13th Army, its units reached the Serogoza area. Here they encountered Barbovich’s very combat-ready Wrangel cavalry corps. IN

Bridgehead

From the book In the Service of the Fatherland author Altunin Alexander Terentievich

Bridgehead The Soviet Military Encyclopedia defines the word “bridgehead” as a section of terrain captured by advancing troops during the crossing of a water barrier or held by them when retreating to the opposite bank... Depending on the position, bridgeheads can

Dniester bridgehead

From the book Guardsmen of Stalingrad Go West author Chuikov Vasily Ivanovich

Dniester bridgehead 1 The summer-autumn campaign of 1944 was planned by Headquarters with the transfer of the main attack to the central section of the Soviet-German front. The Dniester became a secondary section. But human psychology is so structured that it always seems to him that where he is

Sandomierz bridgehead

From the book Hidden Faces of War. Documents, memories, diaries author Gubernatorov Nikolay Vladimirovich

Sandomierz bridgehead “July 13 Our offensive began this morning. First we made a good artillery barrage, then the tanks and infantry moved in. They immediately captured the front line on the move so quickly that the Germans did not have time to escape and were taken prisoner. His artillery sometimes snapped.

The last bridgehead

From the book Trumpeters Sound the Alarm author Dubinsky Ilya Vladimirovich

The last bridgehead It was October 1920. Pan Pilsudski, after the “miracle on the Vistula”, which allowed him to win the Battle of Warsaw with the help of the French general Weygand, French cannons and American dollars, hurried to Stanislav. Here, at Petlyura’s headquarters, he said:

Springboard of Courage

From the book On the Black Sea Fairways author Voronin Konstantin Ivanovich

Bridgehead of Courage In 1943, the Soviet command carried out a number of offensive operations on the southern sector of the front. The crews of the OVR ships and minesweeping and barrage brigades took an active part in them, and above all in the landings. At the beginning of February 1943, the headquarters

Battle for the bridgehead

From the book Cover, I'm attacking! On the attack - "Sword" author Yakimenko Anton Dmitrievich

The battle for the bridgehead The gray Dnieper is seething, seething. How many bombs and shells were thrown and fell into it, how many planes crashed! Both German and ours. On the right side of it there is a small - two by two kilometers - Borodayevka bridgehead. Our troops are there, or rather a handful of people. But

Bridgehead

From the book Great Soviet Encyclopedia (PL) by the author TSB

As the fetus develops in the mother's womb, the structure of the placental tissue also changes. One of the important indicators of the placenta assessed by doctors is its maturity. This article will tell you more about what the second degree of placental maturity means and what week of pregnancy it normally corresponds to.

What does it mean?

Doctors distinguish several degrees of placenta maturity, which correspond to certain stages of pregnancy. Determination of the degree of maturity of the placental tissue is necessarily carried out during a comprehensive examination of the expectant mother during different stages of pregnancy.

The general classification of degrees of placental maturity includes 4 gradations - from zero to third. It is believed that the older the placenta, the fewer functions it can perform. This is understandable, since by the end of pregnancy the female body gradually begins to prepare for childbirth, after which the placenta is not needed.

Placenta is necessary children's body only during his intrauterine life. After birth, the baby can exist independently. By the time of birth, his internal organs and systems have already formed, which means that the child can breathe and independently process all the nutrients he needs for nutrition and growth. During pregnancy, placental tissue took an active part in providing these functions.

Each stage of pregnancy must correspond to a certain maturity of the placenta. If this does not happen, then, as a rule, the course of physiological pregnancy is disrupted. A variety of causes and pathologies observed in the body of the expectant mother can lead to early “aging” of placental tissue. In such a situation, doctors carefully monitor the condition of the pregnant woman and her baby, and also plan further management of the pregnancy.

If the second degree of maturity of a woman’s placenta was detected much earlier than the due date, then in the future to the expectant mother a number of recommendations are prescribed. So, she should carefully monitor her general condition and the well-being of the child.

If the placental tissue ceases to fully perform its functions due to excessively early “aging,” then in such a situation the child in the mother’s womb will begin to experience some discomfort. This may cause the baby's heart rate or motor activity to change. In such a situation, a mandatory consultation with an obstetrician-gynecologist and a possible change in tactics for further pregnancy management are required.

In some cases, if the placenta matures too early to 2-3 degrees of maturity, the expectant mother must be hospitalized in a hospital. A woman can stay there until she gives birth. This usually happens if the course of pregnancy becomes very complicated and there is a threat of premature birth.

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Norm

Placental tissue that has reached stage 2 of maturity is also called mature. The characteristic changes that have occurred in the placenta are considered normal for 34-39 weeks of pregnancy.

It is important to note that these data are averages. So, if an expectant mother, who has been carrying a baby for 32-33 weeks of pregnancy, has a 2nd degree of placental maturity, then she should not panic. In this situation, doctors also necessarily evaluate how a particular pregnancy is progressing in general. If the fetus develops well and its mother does not have any adverse symptoms, then such somewhat early maturation of the placenta does not pose any danger.

How to determine?

The degree of maturity of the placenta is determined by performing an ultrasound examination. Modern ultrasound machines make it possible to study placental tissue in pregnant women quite accurately. The indicators obtained as a result of the study are quite informative.

In order for the doctor to determine the 2-3 degree of maturity of the placenta, he must note several clinical signs. So, an ultrasound specialist must evaluate the structure of the placental tissue. In earlier stages of pregnancy, the placenta has a smooth and even surface. There are no external signs of changes on her. As pregnancy progresses, the structure of the placental tissue also changes - it becomes more uneven and even rough.

The placenta, which has a 2nd degree of maturity, has depressions and grooves on the outer surface. Its thickness gradually begins to decrease. The depressions that appear in the placental tissue are quite deep and extend into the placenta almost to the basement membrane. During an ultrasound examination of the placental tissue, the specialist also determines the presence of multiple linear stripes of echogenic zones.

As the placenta matures, special compacted areas begin to appear in it - calcifications. Placenta of the 2nd degree of maturity with calcifications is considered quite normal. The appearance of dense areas in the placental tissue is associated with changes occurring in the placenta in the final trimester of pregnancy.

The appearance of calcifications in the placental tissue at 34-39 weeks of pregnancy is quite normal. Many expectant mothers begin to worry greatly about this when they learn about such an ultrasound “find.” They are worried that the baby’s blood flow may be disrupted, but even in the presence of calcifications at this stage, the placental tissue is able to perform its functions as intended by nature.

During a routine ultrasound examination, during which the doctor determines the main clinical parameters of the placenta, Doppler ultrasound is also performed. It is usually performed during an ultrasound examination by the same specialist. The purpose of Doppler examination is to determine blood flow in the main blood vessels that provide blood supply to the fetus in the uterus.

With Doppler ultrasound, the doctor can assess how well the uteroplacental blood flow is functioning. With premature aging of the placenta, it can worsen, which can also negatively affect the well-being of the fetus. Also, with the help of Doppler examination, doctors can determine the development of fetoplacental insufficiency - a dangerous condition that can lead to disruption of the course of intrauterine development in the fetus. This pathology can also develop when the placenta matures too early to stage 2-3 in the early stages of pregnancy.

Determining the degree of maturity of the placenta is a very important clinical sign.

In order to promptly identify various disorders and pathologically early maturation of the placenta to the 2nd degree of maturity, the expectant mother must undergo ultrasound examinations prescribed by the doctor. This must be done according to the prescribed deadlines.

To assess the condition of the placental tissue, it is very important to conduct dynamic monitoring. This means that during the final period of pregnancy, women whose placental maturation is found to be excessively early may have several repeat ultrasound examinations. This is necessary so that doctors can promptly identify dangerous complications that may arise from this condition. This will allow doctors to intervene in a timely manner and choose the optimal tactics for further pregnancy management, as well as determine the correct method of obstetric care in a particular case.

In order for the placenta to reach the 2nd degree of maturity only by the due date of pregnancy, the expectant mother should follow a number of recommendations and conduct healthy image life. Scientists have found that active smoking can lead to excessively early maturation of the placenta. All bad habits expectant mothers should be excluded while carrying their babies.

The normal functioning of placental tissue will be facilitated by balanced diet, proper sleep, avoidance of stress, as well as regular walks in the fresh air.

For information about what the placenta is and what functions it performs, see below.

Double placenta (placenta duplex)

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First health care. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what “double placenta” is in other dictionaries:

- (placenta duplex) see Placenta bilobed... Large medical dictionary

Large medical dictionary

- (placenta bilobata, placenta bipartiata; synonym: double placenta, double-disc placenta, bilobed placenta) a variant of the structure of the placenta in which it consists of two separate parts of approximately the same size, connected by non-permanent... ... Medical encyclopedia

- (Primates), an order of mammals that includes humans, apes and other apes, as well as prosimians. Perhaps the tupai from Southeast Asia should also be included in this category. The name primates, meaning first, leading, was given to the order... ... Collier's Encyclopedia

- (Mammalia) the highest class of vertebrates. Their main features are the following: the body is covered with hair; both pairs of limbs serve mostly as legs; the skull is articulated with the spine by two occipital tubercles; the lower jaw articulates... ... Encyclopedic Dictionary F.A. Brockhaus and I.A. Ephron

- (uterus, metria) a special section of the genital ducts in female animals and women; is an expanded part of the Oviduct. M. has a powerful muscle wall and is well supplied with blood. Uterus in animals. M. is present in roundworms... Great Soviet Encyclopedia

Or lemurs in the broad sense (Prosimiae) are a detachment of mammals characterized by the following characteristics: the entire body is covered with thick and long hair, with the exception of the end of the nose; the large orbital sockets are surrounded by a complete bone ring, communicating... ... Encyclopedic Dictionary F.A. Brockhaus and I.A. Ephron

Or lemurs in the broad sense (Prosimiae) are a order of mammals characterized by the following characteristics: the entire body is covered with thick and long hair, with the exception of the end of the nose; the large orbital sockets are surrounded by a complete bone ring, communicating... ... Encyclopedic Dictionary F.A. Brockhaus and I.A. Ephron

Professor William Crooks and the materialized phantom "Katie King". Medium Florence Cook is lying on the floor. Photograph from 1874 Materialization in occultism, parapsychology and spiritualism is a phenomenon characterized by the emergence ... Wikipedia

Or lemurs in the broad sense (Prosimiae), an order of mammals characterized by the following characteristics: the entire body is covered with thick and long hair, with the exception of the end of the nose; the large orbital sockets are surrounded by a complete bone ring, communicating only... ... Encyclopedia of Brockhaus and Efron