Timing of twins. Can a doctor not see twins on ultrasound: the possibility of diagnosing multiple pregnancies in the early stages. Birth management in multiple pregnancies

They require careful medical supervision, as the risk of complications is higher than with singleton pregnancies.

If in your family there were cases of the birth of two, three or more children at the same time, then you also have a certain probability of becoming a mother of twins. However, every woman has this opportunity, regardless of heredity, especially if the conception occurred through IVF or certain medications were taken in preparation for it.

This is the development of several embryos in the uterus. A woman can carry twins, triplets (3 fetuses), quadruplets (4 fetuses), etc. The growth of multiple pregnancies, frequent in Europe (1 pregnancy out of 89), literally exploded under the influence of artificial insemination.

Stimulation of the ovaries (the appointment of drugs that favor the maturation of eggs in the ovaries) and cases of multiple pregnancy in the family are favorable factors for its development. Such a pregnancy carries more risks than others: the risk of miscarriage, premature birth, eclampsia, low birth weight, etc. is increased. In addition, it may be difficult for a woman to carry more than two children in socially. There is a high risk of problems with caring for them after birth, social and family conflicts caused by the fact that parents in some cases (4 embryos or more) are offered to reduce the number of embryos in a medical way. Multiple pregnancy requires early adapted and enhanced monitoring (this is possible thanks to ultrasound). In most cases, it is suggested to induce labor long before the due date to avoid an accident at birth.

Nowadays, the number of pregnant women expecting twins is constantly increasing. This is due to both the increased average age of pregnant women and the widespread use of artificial insemination. If twins have already been born in the family, the likelihood of multiple pregnancy increases. Twins and fraternal twins are at greater risk of the disease during fetal development. But with its timely detection, many complications can be avoided. Most often, the doctor ascertains multiple pregnancy already on the first or second preventive examination. It is extremely rare that a twin pregnancy is discovered only during childbirth. Therefore, parents of twins usually have enough time to properly prepare for the upcoming double load. And this is very important, because the better organized the beginning of a new family life, the easier it is to adjust. There is great benefit in sharing information with other parents of twins. Contacts with them can be established through forums on the Internet.

Multiple pregnancies are becoming more common

The birth of twins, and even more so of triplets, was rare in the 1970s. Naturally, such phenomena took place, but in families where there were already similar cases. Today, more than 1% of all pregnancies are multiples (twins, triplets). This is a consequence of the increased use of medically assisted reproduction (MPR) technologies. With MPR, one in five pregnancies is multiple.

Accordingly, for you, the level of having twins or triplets increases if your family already had such cases or if you used MPR (ovulation stimulation).

Symptoms and signs of multiple pregnancy

The diagnosis is established on the first ultrasound, which demonstrates the presence of several gestational membranes in the uterus. In one third of cases, we are talking about "real" twins (monozygous, or identical). In two-thirds of cases, we are talking about "false" (dizygotic, or fraternal) twins. Later, the doctor or midwife will be able to state that the uterus is too large to contain only one fetus.

Overweight

With a second baby in the womb, your weight increases not because of the baby itself, but because of the second placenta (there are two if they are fraternal twins) and double the volume of amniotic fluid.

Identical and heterogeneous

• When it comes to twins, we often hear the adjectives “real” and “false”, meaning from a biological point of view, completely different things.
• Identical, or monozygotic, twins are the result of fertilization by one spermatozoon of one egg. Then the formed egg is divided into two. The fetus can develop in one amniotic sac or in two, the placenta can be one for both children. The two children have the same genetic basis, they are the same sex and look alike like two peas in a pod.
• Fraternal, or dizygotic, twins were formed as follows: two eggs were fertilized by two sperm during one menstrual cycle. Each fetus develops in its own amniotic sac, and their placentas are different. The genetic heritage is completely different, hence the different sexes of the children, and they look alike just like brother and sister.

Risks in multiple pregnancies

Often, multiple pregnancies proceed without any problems, complications are rare. True, the time between control examinations is significantly reduced.

The emergence of risks largely depends on the formation of bonds between the fetal membranes and the placenta, on the one hand, and the twins, on the other.

In the event that both children are attached to the same placenta, their life support can be severely affected.

Even before the 15th week of pregnancy, with the help of ultrasound, you can get a clear picture of the current situation. That is, already early dates it is possible to assess the probability of occurrence of risks and understand which of them should be taken into account.

The state of affairs with the placenta is described by the concept of chorionicity. A monochorionic pregnancy means that both babies share the same placenta.

Approximately every third multiple pregnancy is just such a case.

Of these, again, 33% are dichorionic-diamniotic, in which there are two umbilical cords, and the fetal bladders are separated from each other by a thick septum. 65% are monochorionic-diamniotic twins, here the septum is thinner and more transparent. 2% of twins are distinguished by monochorionic-monoamniotic chorionicity, when both the fetal bladder and the placenta are common. Which of these possible situations realized depends on the moment of cell division.

• Dichorionic-diamniotic twin pregnancy. In most cases, just such a favorable relationship develops between both twins and the fetal membranes. The risk of complications is small, therefore, special medical supervision is not required. If the first child has a head presentation, then nothing will interfere with normal childbirth.
• Monochorionic-diamniotic twin pregnancy. Such twins can only be identical. Since there is a risk of developing feto-fetal transfusion syndrome, starting from the 12th week, it is recommended to conduct follow-up examinations twice a month.
• Monochorionic-monoamniotic twin pregnancy. These twins are also always identical. Along with the risk of fusion of twins like Siamese, there is also the danger of intertwining the umbilical cords. This type of pregnancy requires frequent ultrasound examinations. To avoid complications associated with cord entanglement, a caesarean section is recommended.

Controlled Risks

If the risk of giving birth to twins is increasing these days, then the chances of giving them good health are much greater, not least thanks to ultrasound and medical control. There is a high risk of a premature baby, as well as malnutrition (a child with underweight).

In addition, in such cases, the daily life of the expectant mother is subject to much more severe restrictions, and she needs a lot of rest.

In France, various associations are being created to help expectant mothers: for example, the Twins Plus Association, founded in 1979 and known for its socially useful activities since 2003. In Russia, help for mothers of twins is not so developed.

I dialed big weight. Is it possible that I am expecting twins?

Multiple pregnancy or just overweight?

Most likely you just typed excess weight compared with the average possible in the 1st trimester. If you have a naturally fragile constitution, the increase in the weight of the uterus will be noticeable earlier than in a woman of a more dense constitution. The stomach does not get big because you are waiting for two at once. During the examination, your doctor will consider: genetic predisposition, the size of the uterus (not the abdominal cavity), the beating of one or two hearts, more severe symptoms (morning sickness, gastrointestinal disorders), etc.

In our company, everyone thinks that giving birth to twins is wonderful, but we have a different opinion! What's happening?

Twin pregnancy and disappointment

Few couples dream of buying two cribs, a double stroller, two high chairs, in a word, two babies! A woman prepares both psychologically and physically for the arrival of a single child, and the news of a twin pregnancy can be a source of disappointment and fear for her. Indeed, taking care of one child is a huge responsibility, which she lacks in abundance, and she does not at all need this responsibility to be doubled. Accept calmly these conflicting emotions at the news of the arrival of two babies and try to avoid feelings of guilt. On the contrary, take advantage of these weeks to get used to the idea that two will appear in your family at once.

Talk to your partner, talk to other twins' parents. If you do not know them, ask your doctor, he will give you the coordinates of associations where you can get acquainted with them. You can also search the Internet. The fact that you are not the first parent to be confused and doubtful will help you to accept the situation and even enjoy it. If at first the efforts to care for two babies should be multiplied by two, then happiness should also be multiplied by two.

Twins do not always end up in the incubator, it all depends on the degree of "full-term" and weight.

Three types of twin pregnancy

If you are expecting twins, the doctor's first task will be to determine by ultrasound, starting in the 1st trimester and as soon as possible, the number of placentas and amniotic sacs. In the presence of two placentas and two amniotic sacs, the pregnancy is defined as "bichorionic biamniotic". If one placenta and two amniotic sacs are identified, it is defined as "monochorial biamniotic". In very rare cases where there is one placenta and one amniotic sac, this is a "monochorionic monoamniotic" pregnancy. All three types of twin pregnancies are different.

Ultrasounds once or even twice a month, starting from the 22nd week of amenorrhea, are of great importance in monitoring the development of both babies. One that receives less nutrition may have malnutrition (low weight) as a diagnosis, the other is prone to cardiovascular disease .

If you are expecting three or more babies

The precautionary measures taken when expecting two babies are greatly enhanced when it comes to expecting three or more children. For future mother pregnancy is marked by anxiety and anxiety, so she may need the help of a psychologist, starting from the early stages and ending with the moment of childbirth.

If there are more than three fetuses, the risk of complications increases proportionally. There is a small chance that childbirth will occur at an acceptable time, that is, after 34 weeks. Careful medical supervision is necessary, childbirth should take place in a maternity hospital of at least a level.

Your doctor may suggest that you reduce the number of embryos to two. It is often difficult for parents to make such a decision, but even more - and this is the most common case - - if the pregnancy was the result of infertility treatment (namely, in vitro fertilization). In rare cases, one or more embryos freeze in their development.

Increased medical attention

Expecting twins or triplets means taking very good care of yourself. And your gynecologist and midwife will help you with this, who will very carefully monitor your well-being, since various complications are possible: premature birth(about 25% of multiple pregnancies end in the 32nd week, that is, at the end of the 7th month), arterial hypertension(the risk doubles or triples), malnutrition (low weight of the child), "donor-recipient" syndrome.

More frequent consultations

Clinical observation is getting closer. In the case of multiple pregnancies, the midwife should visit you at home once a week, starting from the 22nd week of amenorrhea. She must make sure that you get enough rest so as not to provoke cramps in the uterus. She will also check your blood pressure and protein levels in your urine. Use these visits to get the information you need - for example, about the food system. Also, if you are expecting twins or triplets, food portions must be increased (by 10-20%).

Leisure Benefits

Among other things, you should rest as much as possible, thereby reducing the risks. No need to lie down - although sometimes it is necessary - eat during the day during rest periods, avoid long walks and transport trips, starting from the 5th month.

Often the doctor prescribes in the 2nd trimester sick leave in a preventive mode, in order to avoid premature birth, you can also receive help with the housework. However, in some cases, hospitalization is necessary.

Soft delivery

In the case of a twin pregnancy, the term of delivery is 38 weeks, and not 41 weeks, as in a single pregnancy. It is necessary that childbirth be carried out in a maternity hospital, where specialists are able to help in any situation.

After the second time, ultrasounds are performed once a month to monitor the development of the embryos.

What are twins

Why does it become possible development during one pregnancy several fetuses at once? In the first days after conception, a fertilized egg can divide into two or more completely identical parts. In this case, babies are born, who are called monozygotic, or identical, twins. They are always of the same sex, always have the same blood type, and have an amazing resemblance in appearance.

At the same time, depending on the period of development of the zygote, it was divided into two parts, future babies can each have their own placenta and amniotic cavity, different amniotic cavities, but one placenta, as well as common placenta and amniotic cavity.

Another way is also possible. In the ovary of the expectant mother, the simultaneous maturation and release of several different eggs occurs. If each of them on the way to the uterus is fertilized by a spermatozoon, then several embryos will be implanted into the mucosa at once. Such babies are called fraternal twins, or heterozygous (dizygous - in the case of twins, trizygous - in the case of triplets, etc.).

These children will be different from each other, as sisters and brothers born from different pregnancies are different. They may be of the same sex or different, their blood types may be different, and they may have little resemblance in appearance.

After all, unlike identical twins, all these differences are laid down in them at the gene level.

At a later date, the doctor makes an assumption about the presence of two or more fetuses in the uterus based on its rapid increase, which is usually observed in the second trimester of pregnancy.

A little later, the doctor, during an external examination, can determine the position of several heads or pelvic ends of the fetus, listen to heartbeats at different points of the uterus.

Features of multiple pregnancy

Carrying two or three babies at the same time creates an additional burden on the body of the expectant mother, so she is provided with the closest attention of doctors from the very beginning of pregnancy. However, this condition in itself is not a pathology, therefore, if you are expecting several babies at once (and most often twins are expected in multiple pregnancies), following all the doctor's recommendations and regular monitoring will help you spend the next eight to nine months with no less pleasure. than all other mothers.

Due to the more intensive growth of the uterus, which is observed with multiple pregnancies, the risk of termination of pregnancy is slightly higher than usual. Particular attention is required for the expectant mother in recent months - at this time there is a possibility of premature pouring of water. Most likely, your doctor will recommend you a sparing regimen, restriction physical activity, especially on later dates pregnancy, and in some cases - bed rest and even hospitalization.

Be careful when doing exercise, give preference to swimming, do not plan long trips and trips.

It should be remembered that childbirth in such cases most often begins a couple of weeks earlier, at 36-38 weeks of gestation, and twins are born with a slightly lower weight than normal newborns. But you should not be afraid of this - nature takes care of these babies and provides them with increased adaptability.

The needs of a pregnant woman for nutrients and vitamins inevitably increase, since she must provide everything necessary for two organisms at once. The needs of the expectant mother, who is expecting two or three babies, increase even more. You should carefully consider this problem, as your body can deplete its resources quickly enough, and this will lead to the risk of developing anemia, beriberi, and late toxicosis of pregnant women. Carefully consider nutrition, including protein products, multivitamin preparations and mineral complexes that your doctor will recommend to you.

Under the special supervision of your doctor will be your the cardiovascular system and the normal functioning of the kidneys, since these organs are subjected to the greatest load.

With a normal location of the placenta until the 30th - 32nd week of pregnancy, the size of future babies does not differ from the size of the fetus in a singleton pregnancy. In the following weeks, their overall weight gain is approximately equal to that of a fetus in a normal pregnancy. At the same time, it is quite natural that the volume of the abdomen and the weight of the expectant mother somewhat exceed these figures for women who are expecting the birth of one child.

Organization of medical care for women with multiple pregnancies

As a rule, multiple pregnancy is detected already during the first ultrasound examination. The most reliable data on the status of the membranes can be obtained between the 9th and 15th weeks of pregnancy. If the twins are fraternal, they may be of different sexes. But even if the born babies are of the same sex, their similarity will not be as great as that of identical twins.

Identical twins receive identical genetic information from their parents, so they are always the same sex. Babies are so similar to each other, at least in infancy and childhood that they can be confused. They often have the same likes and dislikes. However, for pregnancy and childbirth, it is not the division into identical and twins that is important, but how their connections with the placenta and fetal membranes are formed.

Frequency of multiple births

• Multiple pregnancies: 2-5% of all pregnancies up to 10 ng.
• Monozygotic twins: 3-5/1000.
• Dizygotic twins: the frequency is variable, depending on family history, age of the mother, infertility treatment.
• The frequency of mono- and dizygotes in multiple pregnancies: 70% dizygotes (necessarily dichorionic / diamniotic). 30% monozygotes (necessarily same-sex, shell ratio: 29% dichorionic/diamniotic, 70% monochorionic/diamniotic, 1% monochorionic/monoamniotic).

Sonographic diagnosis of chorions/zygotes

1st trimester: clearly distinguishable chorionic cavities, sometimes in one anmiotic sac (wide bridge!) - the most favorable moment for diagnosis!

II and II trimesters:

• The sex of the fruit.
• The location of the placenta (with monochorionic - necessarily unilateral placentation on both sides.
• Thick bridge (> 1.6 mm = 4 layers - dichorion).
• X-sign in dichorionic twins (triangular protrusion of the placenta in the region of the radiated amniotic membrane during chorionic involution).
• T-signs in the case of monochorionic twins (vertically protruding amniotic membrane separating the amniotic sac at the placenta).

Postnatal diagnosis of chorions/zygotes

• Gender of children.
• Histology of the placenta.
• Blood type of children (method reliability 99.9%).
• Enzyme-histochemical and tissue-typing analysis (high specificity).
• Check similarity/similarity (method reliability 98%).

Prenatal problems in multiple pregnancies

• Uncontrollable vomiting of pregnant women (20% of twins, 60% of triplets).
• Premature contractions, cervical insufficiency, premature birth.
• Premature effusion amniotic fluid, amniotic infection.
• Polyhydramnios (12%).
• Preeclampsia (risk is 5 times higher compared to singleton pregnancy).
• Intrauterine growth retardation (twins from 35 weeks, triplets from 32 weeks).
• Feto-placental insufficiency.
• An increased rate of malformations (congenital heart defects), especially in monozygotic twins.
• Increased risk of chromosomal aberrations.
• The risk of spontaneous abortions (2 times higher).
• Increased risk of hypoxia during vaginal delivery (for the second of twins).
• Dyspnea in the mother due to the high position of the diaphragm, gastrointestinal complaints (in the 3rd trimester).
• Varicose veins, severe swelling.
• "Twin Disappearance Syndrome"(Vanishing Twin Syndrome) - 30% of all initially multiple pregnancies end in the birth of one child (Fetus papyraceus, paper / mummified fetus).
• "Dead Fetal Syndrome"(Dead Fetus Syndrome) - intrauterine death of one of the monochorionic twins: possible (20-50%) damage to the survivor due to a hypoxic crisis due to disturbances in the joint circulatory system of the deceased child. The original theory of damage to the surviving child due to the introduction of thromboembolic material through open vascular connections has never been confirmed. Late consequences: disturbances in the maternal blood coagulation system caused by fetal thromboplastic material is debatable.

Feto-fetal transfusion syndrome (FFTS)

Definition: intrauterine blood transfusion in monochorionic twins through placental vascular anastomoses.

Frequency: 1:1100-10000 (15% of all monochorionic multiple pregnancies), is the cause of death of twins in the perinatal period in 15-17% of cases.

Acute FFT syndrome develops peripartum (growth and amount of amniotic fluid are slightly changed, the donor is anemic, the hematocrit is normal depending on the circumstances, the acceptor is hypervolemic).

Syndrome of chronic TFT (prolonged hemodynamic imbalance) - Triad:

• Violation of growth and development> 15%.
• Reducing the volume of amniotic fluid.
• Hemoglobin change > 5 g/dL.

Donor: IUGR (intrauterine growth / developmental delay), anemia, hypovolemia, hypoglycemia, oligo / anuria, ahydramnia, dropsy due to anemia. Sometimes renal failure is formed with anuria, which postnatally, after a few weeks, undergoes a reverse development (good prognosis!).

Acceptor: polycythemia, hypervolemia, increased rheological blood viscosity, hyperbilirubinemia, hyperglycemia, polyuria, polyhydramnios, heart failure, often with dropsy, severe postnatal hypertension.

Differential Diagnosis: discordant growth of twins (also with dichorionic twins).

Forecast: the sooner and more suddenly disturbed hemodynamics, the worse. In the absence of treatment, mortality is up to 100%. Morbidity - periventricular leukomalacia.

Therapy:

• Drainage (repeated) of the amniotic fluid - a decrease in intra-amniotic pressure, the survival rate is 60-70%.
• Fetoscopically guided laser photocoagulation of shunts: overall mortality 53%. Has a significant advantage in terms of morbidity (neurological) at high risk of intervention.
• Amnioseptostomy [E1].

Multiple pregnancy with acrania and acardia - 1:35,000

Definition: asymmetric malformation of one of the twins, the perfusion of which is carried out at the expense of the other twin through an arterial bypass. Massive puffiness leads to the formation of a "heartless monster" (absent or improperly developed heart, head, upper limbs).

Diagnosis: various forms of acrania-acardia, generalized edema (dropsy), with color Doppler sonography - signs of retrograde arterial perfusion of the twin.

Associated anomalies: chromosomal aberrations in 50%.

Mortality: 50% among donor twins.

Therapy [E2]: The principle is to interrupt the retrograde circulation in the umbilical cord of a fetus with acrania-acardia.

• Ligation of the umbilical cord.
• Laser coagulation of the umbilical cord.
• Intravascular installation of fibrin glue.

Pregnancy with Siamese twins -1:50,000

Definition: violation of early embryonic development due to incomplete divergence of monochorionic twins.

Types: thoracopagi (70%), craniopagi, pyopagi, ischiopagi.

Diagnosis: lack of separation of body surfaces and fixed mutual position of both twins during ultrasound.

Forecast: depending on the position of the organs and the possibilities of interventional pediatric surgery.

Monitoring of multiple pregnancies

More frequent sonographic studies - especially in monochorionic twins.

Doppler control (every 1-2 weeks from 25 weeks of gestation).

Sonographic control of growth and amount of amniotic fluid (every 2 weeks).

Features of delivery in multiple pregnancy

With multiple pregnancies, natural childbirth is possible under the same conditions as with a singleton. Doctors resort to surgery if the uterus and fetuses are too big sizes, and the birth canal of a woman is not prepared for a period of 38 weeks or more.

Overdistension of the uterus - primary and secondary weakness labor activity, atony of the uterus.

Premature detachment of the placenta for the second of the twins - after the birth of the first.

Prolapse of the umbilical cord.

Children's mechanical clutch.

Violation of the separation of the placenta.

Birth management in multiple pregnancies

Indications for vaginal delivery: cephalic presentation of the first of the twins; the difference in weight between twins is less than 500 g.

Desirable terms of delivery 39-40 weeks.

Indications for caesarean section: transverse position breech presentation the first of twins, the difference in weight between children is more than 500 g; premature birth, more than 2 fetuses, monoamniotic twins (from 32 weeks).

Some women dream of becoming mothers of several babies at once. This is possible as a result of multiple pregnancy. During it, most often, two children develop, who are called twins or twins. They can result from the division of a fertilized egg. In this case, the twins are called identical. They can also be - in case more than one egg was fertilized. Future mothers are wondering at what stage of pregnancy twins can be determined. It is also interesting to understand what methods exist for this. After all, it is so important to know about such a peculiarity in order to pay additional attention to your health together with your doctor.

At what time is twins determined?

There are various methods that differ in their accuracy and allow you to establish a multiple pregnancy.

A blood test does not show whether conception has occurred. If, as a result of the test, the value is above the norm, then this may indicate the development of several fetuses at once.

To diagnose various conditions, doctors often use ultrasound. The expectant mother will have to regularly undergo such an examination. It is this method that will allow you to find out how many babies are in the uterus. It is worth finding out when you can identify twins by ultrasound. The specialist can see the number of embryos at about 5-6 weeks. But for various reasons, in a short period of time, it is established that there are several fetuses in the uterus, not always. In some cases, the doctor accurately diagnoses this fact later, for example, during screening in the first trimester.

It is also interesting how long it is possible to determine twins without ultrasound. A qualified gynecologist can do this without the use of special equipment. For a period of about 9 weeks, during a manual examination, the doctor has the opportunity to notice that the woman will become the mother of twins.

Most effective method definition of twins at this stage of development of medicine - ultrasound. It is ultrasound that makes it possible to see whether the fetus is developing in the uterus, whether it is a multiple pregnancy, etc. But even an ultrasound may not detect twins in the early stages.

Early terms are 5-6 weeks of pregnancy. Very often, the doctor sees only one embryo or sees two, one has a tapped heart, while the other does not. There is no need to panic here, although all doctors immediately warn that the second child very often "dissolves", as if dying due to unclear circumstances, while the second one continues to live and develop.

At what time is twins determined?

At 8 weeks of gestation, an ultrasound should reveal two developing fetuses, if it is twins, and, accordingly, two heartbeats. But before 12 weeks, you shouldn’t rejoice and talk about it to everyone, it’s better to wait for the second screening, then see how many children are in the womb. It may sound harsh, but intrauterine death of a second child is common.

Although at 6 weeks of pregnancy, twins are also visible if the development of the embryos corresponds to the gestational age (monthly period, when the first day of the last menstruation is the first day of the first week of pregnancy), and also if a professional is sitting behind the ultrasound machine.

How to identify twins without ultrasound?

There are several options for identifying twins:

1. Donate blood for hCG, this is a hormone that is produced only during pregnancy. The result of this analysis will show inflated figures. In fact, the amount of human chorionic gonadotropin (hCG) is twice as much as during pregnancy with one child. But since the norms of this hormone are very wide, it is better to show the result of the analysis to the doctor, he, by virtue of experience, will help determine the pregnancy of twins.

1. There is a popular sign, unfortunately, it does not always work, but it is believed that twins can be identified by severe toxicosis. In some cases, this really coincided, because now two fetuses affect the body, more toxin is produced. But early toxicosis is not a guarantee of twin pregnancy.

1. A reliable method of how to identify twins without ultrasound is to palpate the doctor and listen to the heart sounds of the fetuses. What does it mean? The heart begins to beat already from the 6th week of pregnancy, but you can listen to it only on an ultrasound. You can listen to it through the abdominal wall of a woman only by a doctor at 22 weeks of pregnancy. If heart tones are heard in different places of the uterus, while: between these places there is an area where the heartbeat is not heard, and the heartbeats have an unequal frequency, then this means that the pregnancy is multiple.

1. The gynecologist, even without ultrasound, determines twins by palpation. The abdomen is palpable, more than two large parts are determined. Large parts are the head and pelvis. If two heads and two pelvises are clearly palpable, then twins are identified.

How to determine the pregnancy of twins? It is worth watching the growth of your abdomen, if it is growing rapidly, looks longer than it really is, then this may indicate twins. It is possible for the woman herself to calculate the size of the uterus during pregnancy, if the height of the uterine fundus is higher than the gestational age, twins are likely.

At what time it is better to determine the twins, the gynecologist knows better, the above are ways to determine the twins themselves. But 100% can be seen on ultrasound and can be felt well at the end.

One of the wonderful moments in the life of every woman is the news of pregnancy, ahead of several months of expectations, excitement and, finally, a joyful meeting at the end of the journey. However, the news that two “bubblers” “settled” in the stomach at once does not lead every mother to indescribable delight, because in such a situation a woman becomes afraid for the successful course of pregnancy. But do not worry too much, because now medicine has stepped far forward and, under the close supervision of qualified gynecologists, the expectant mother will be able to safely endure her babies. The most important thing is to recognize the signs of twins in the early stages of pregnancy as early as possible in order to timely begin to control the process of fetal development and monitor the well-being of the mother. So what are these signs?

• Inheritance above all

If a young mother has already experienced such a happy phenomenon in her family, then one must be prepared for the fact that the birth of twins will be repeated in a young family. Such a phenomenon is not always natural, and does not mean at all that it will be observed in all relatives. Most often, twins by heredity are born in a generation.

• We fall into hibernation

Many pregnant women in the early stages of pregnancy experience increased drowsiness, but, of course, all this is individual. As for future mothers who are expecting twins, many of them noted increased sleepiness in the first couple of months, yes, such that they literally fell asleep on the go.

• Oh, this toxicosis

Toxicosis delivers a lot of trouble to expectant mothers. In those women who still do not know they have two babies in their tummy, toxicosis can be very strong. Needless to say, it all depends individual characteristics body and this is not a 100% guarantee that there are two fetuses in your tummy at once.

• very bright

How, most often, a woman finds out about an interesting situation? The absence of menstruation on time pushes her to take a test and, two strips indicate that in 9 months a new man will appear in the family. A sign of early twin pregnancy is two brightly colored stripes on the test, most often for mothers expecting one baby, the second stripe is too pale or invisible.

• What about appearance

Any woman with the onset of pregnancy undergoes a global restructuring of the body, a real hormonal "explosion", which naturally affects her appearance. Being pregnant with two children at once, such changes in appearance can be even more pronounced, these include:
— dark spots on the face;

1. acne and pimples on the skin of the face and back;
2. change in skin color;
3. hair loss;
4. in rare cases, papillomas appear on the body.

• Belly like a watermelon

The belly of a mother who carries twins in the last stages is simply huge and it seems that there really is such a huge watermelon. What about in the early stages? Women who carry twins at once notice that their stomach, which is flat up to this point, begins to grow by leaps and bounds.

In addition, they note that they begin to feel movements much earlier than the deadline. This happens because two fetuses take up much more space and, of course, the stomach has to increase. As for the movements, two children create twice as many movements and, willy-nilly, you will feel them much sooner than if there was one baby.

• Why so much

It is quite natural that a mother who carries two children under her heart will gain more kilograms than a woman who is expecting one baby. According to average norms, in the first three months a woman gains weight from one and a half to 2.5 kilograms. For those lucky women who are expecting twins, these weight indicators can be safely multiplied by two!

• The older, the more!

It is so inherent in nature that the older a woman becomes, the more likely it is to receive double joy at conception. If you are over 35 years old, then the probability of being a “mother squared” in one birth is great for you!

• What will the doctors say?

Doctors, for their part, can also determine a two-fetal pregnancy quite early.

Distinctive signs of multiple pregnancy

Signs of twin pregnancies in early pregnancy, which can be pronounced, are:

• The belly will tell

On the belly of a pregnant woman with twins, doctors always note the appearance of a characteristic horizontal stripe.

The first ultrasound most often dispels all the guesses and doubts of both mothers and doctors. Although there are cases of errors when the uzist simply did not notice the second fetus.

• When two hearts beat together

Experienced doctors, listening to the belly of the future mother, clearly distinguish the beating of two small hearts at once.

• Skillful hands

The obstetrician-gynecologist leading the pregnancy can feel two heads and two pelvises of developing fetuses during palpation.

• Strange word - Fano electrocardiography

A similar procedure is carried out closer to the 20th week of pregnancy, and thanks to it, doctors clearly distinguish the sound of two hearts, which certainly confirms a multiple pregnancy.

• Test - alphafetoprotein

A similar test is performed during the transition from the 1st to the 2nd trimester of pregnancy and is done in order to identify possible abnormalities in the fetus. When pregnant with two fetuses, the test result will be very high.

• Stimulation

If the pregnancy did not occur for a long time, and the doctors took any measures to stimulate it, then in most cases, several eggs are ovulated at once, which subsequently leads to multiple pregnancy.

• Stopping contraceptives

Protection with hormonal oral contraceptives for a long period of time - suppress the work of the ovaries. After stopping their intake, the ovaries begin to work at full capacity, making up for lost time, and often produce several eggs at once.

As you can see dear readers, signs of twins in early pregnancy are quite diverse, they are both medical and household. It is important for a future mother to listen to her own feelings, visit an obstetrician-gynecologist and an ultrasound room in order to find out for sure how many babies are in her growing belly. Good luck with your pregnancy and safe delivery! See you soon for new articles!

Every woman who finds out about her pregnancy wants to be aware of who and when she will be born. And if there are usually no special problems with, then the sex can only be determined by ultrasound, and even then it is not always correct. And what to do in the case when a woman expects not one, but several children. How can you suspect that you have a multiple pregnancy? Signs exist, but they differ in different girls and are not always reliable, but still we will try to describe them.

Multiple pregnancy: signs

Most often, women bearing two children or more note very rapid fatigue. This is understandable, because the body is under heavy stress, and therefore fatigue occurs much faster. At the same time, it happens that a woman does not pay attention to this, because she believes that she has become older and has more responsibilities than during her first pregnancy. Some do not notice this sign at all.

What else can indicate a multiple pregnancy? Toxicosis that manifests itself much earlier and is stronger: more sick, more ailments, and more often there may be vomiting. If you are very worried about toxicosis, you should complain to the doctor.

Rapid weight gain, especially in the first trimester, may indicate that a woman is expecting more than one child. This happens due to the rapid increase in the uterus and the amount of blood. True, sometimes even when carrying a singleton pregnancy, women quickly gain weight, especially when taking hormonal drugs.

Another difference that can tell a pregnant woman that she will have not one baby, but two or three is a large belly size. At the same time, you need to know that during the time the stomach grows faster compared to the first and may not always indicate multiple pregnancy.

It should also be said that the movement of the fetus in the stomach of a woman begins to feel earlier if they are carrying twins. Although this is very individual.

How to identify multiple pregnancy

During an examination by a gynecologist, he can determine a multiple pregnancy due to a discrepancy between the size of the uterus and the expected period - it will be larger. But the doctor will not be able to say for sure, since the same picture is observed with uterine myoma, or polyhydramnios.

A survey of the expectant mother in the antenatal clinic is mandatory, and if she or her husband has twins in the family, this may indicate the development of a multiple pregnancy. Also, a hint may be information about or stimulation of ovulation.

An elevated level of hormones also indicates a multiple pregnancy: ά-fetoprotein and human chorionic gonadotropin.

The most accurate way to confirm that you have a multiple pregnancy is ultrasound diagnostics. This method allows you to determine the number of embryos at an early stage with an accuracy of 99.3%.

In the second half of a multiple pregnancy, the signs are clearer and it is easier to determine its presence from them. significantly exceed the prescribed time, the abdominal circumference can be more than 110 cm.

The uterus can have a specific shape - saddle-shaped, since its corners protrude due to the position of the fetus. On the front wall there is a horizontal or longitudinal groove, depending on the transverse or longitudinal groove, respectively.

A distinct definition of three parts of the fetus on palpation: two heads and a pelvis, or two basins and a head.

When listening, the presence of two heartbeat points is revealed, there should be a difference of 10 beats / minute.

It turns out that multiple pregnancy has signs, and can be determined on different terms with varying degrees of certainty.