Templates for presentations on the theme of multiple pregnancy. Multiple pregnancy. twin types. The reasons for their occurrence

Multiple pregnancy The likelihood of twins increases: History of twins (belonging to twins) Maternal age from 35 to 39 years Number of births Belonging to the black race Use of assisted reproductive technologies Conception after taking COCs High secretion of pituitary gonadotropins

Multiple pregnancy Classification By zygosity: Dizygous (twin, non-identical) Monozygous (identical, identical) By chorion (placentation): Bichorionic - biamniotic Monochorionic - biamniotic Monochorionic - monoamniotic

Multiple pregnancy Multiple pregnancy Fertilization of two or more oocytes Simultaneous ovulation followed by fertilization of two or more eggs matured in different follicles of the same ovary Simultaneous ovulation followed by fertilization of two or more eggs matured in different follicles in both ovaries Ovulation and fertilization of two or more eggs, matured in one follicle Superfertilization - fertilization of two or more simultaneously ovulated eggs by spermatozoa different men Fertilization of an egg that ovulated against the background of an existing pregnancy

Multiple pregnancy Early division of a fertilized egg (depending on the time from fertilization to zygote splitting, one of 4 twin options): 0-72 hours - bichorionic - biamniotic monozygotic twins 25% 4-8 days - monochorionic - biamniotic monozygotic twins 70% 9-13 day - monochorionic - monoamniotic monozygotic twins 5% After 13 days - fused (Siamese) twins

Multiple pregnancy Diagnosis Clinical and anamnestic signs: Excessive weight gain The height of the fundus of the uterus is 4 cm or more more than is typical for this period, an increase in the circumference of the abdomen. Palpation of parts of the fetus, the size of the fetal head, not corresponding to the size of the uterus. Auscultation at two or more sites of fetal heartbeat

Multiple pregnancy Ultrasound - the gold standard in the diagnosis of multiple pregnancy Accuracy - 99.3% Possible from 6-7 weeks of gestation When using a vaginal probe from 4-5 weeks of gestation Allows you to determine the number of fetuses, amnions, or reality (especially in the first 14 weeks) Differential diagnosis of bichorial from monochorionic twins is easier in the first trimester and can be performed with transvaginal ultrasound at 5 weeks

Multiple pregnancy Complications in the mother: Anemia (2 times more common than in singleton pregnancies) Spontaneous abortions (2 times more common than in singleton pregnancies) in 50% - fetuses were resorbed - anembryony - death of the embryo "vanishing twin" - phenomenon "disappeared twin" no later than 14 weeks

Multiple pregnancy Complications in the mother during pregnancy: Early toxicosis (nausea and vomiting are more severe) Pregnancy-induced hypertension (3 times more common than in singleton pregnancy) Preeclampsia (in 20-40% of pregnant women with multiple pregnancies) Threatened preterm birth, preterm birth (36 .6%-50%)

Multiple pregnancy Complications in the mother during pregnancy: Premature discharge of amniotic fluid (25% of cases) which is twice the frequency in singleton pregnancies Polyhydramnios occurs in 5-8% of twin pregnancies, especially in monochorionic twins. Acute polyhydramnios before 28 weeks of gestation occurs in 1.7% of twins. Impaired glucose tolerance Cholestasis of pregnancy

Multiple pregnancy Complications in the fetus: High perinatal mortality of 15% increases in direct proportion to the number of fetuses - increases in direct proportion to the number of fetuses - per 1000 births in twins per 1000 births in triplets per 1000 births in triplets

Multiple pregnancy Fetal complications: Prematurity - low birth weight (55% weight less than 2500) - respiratory distress syndrome - intracranial hemorrhage - sepsis - necrotizing enterocolitis Average duration of pregnancy: Twins - 35 weeks Triplets - 33 weeks Quadruples - 29 weeks

Multiple pregnancy Complications in the fetus: Congenital malformations Observed 2-3 times more often than during pregnancy with one fetus Observed 2-3 times more often than during pregnancy with one fetus In monochorionic anomalies, twice as often as in bichorial ones The frequency ranges from 2 to 10 % The frequency ranges from 2 to 10% The most common: cleft lip non-occlusion of the hard palate non-occlusion of the hard palate CNS defects CNS defects heart defects

Multiple pregnancy Complications in the fetus: United twins Frequency - 1: 900 twin pregnancies Classification based on the area of the body by which they are connected to each other: thoracopagi - fused in the chest area (40%) omphalopagic - fused in the anterior abdominal wall (35%) pygopagi - fused in the sacrum (18%) ischiopagi - fused in the perineum (6%) craniopagi - fused in the head (2%)

Multiple pregnancy Complications in the fetus: Pathology of the umbilical cord and placenta: -placenta previa -placental abruption (more often in the second stage of labor) -sheath attachment of the umbilical cord (7% in twins) -previa of the umbilical cord (8.7% in twins), -prolapse of the umbilical cord in childbirth

Multiple pregnancy Complications in the fetus: Feto-fetal transfusion syndrome (twin transfusion syndrome) complication of monochorionic multiple pregnancy frequency up to 15% frequency up to 15% anastomoses leading to pathological shunting of blood from one fetus to another One fetus becomes a donor and the other recipient

Feto-fetal transfusion syndrome Donor Chronic blood loss Anemia HypovolemiaHypoxia Limited growth Decreased renal blood flow Oliguria Oliguria Amnion compression Recipient Chronic increase in BCC Hypervolemia PolycythemiaHypertension Non-immune dropsy Cardiomegaly Polyuria Polyhydramnios

Multiple pregnancy Complications in the fetus: Malpresentation of the fetus during childbirth (50% - 10 times more often than in singleton pregnancies): -Head-head 50% -Head-pelvic 30% -Pelvic-head 10% two fruits 10%

Multiple pregnancy Complications in the fetus: Collision - Coupling of twins during childbirth Frequency 1: 1000 twins and 1: childbirth Perinatal mortality with this complication reaches 62-84% Diagnosis is made during the period of fetal expulsion Diagnosis is made during the period of fetal expulsion Observed in breech presentation

Multiple pregnancy Complications in the fetus: Various variants of impaired development of one or both twin fetuses - a consequence of placental insufficiency 5 types of prenatal development of twin fetuses (M.A. Fuchs): 5 types of prenatal development of twin fetuses (M.A. Fuchs): physiological development of both fetuses - 17.4% uniform malnutrition of both fetuses - 30.9% uniform malnutrition of both fetuses - 30.9% uneven development of twins - 35.3% congenital pathology of fetal development - 11.5% antenatal death of one fetus - 4 ,1%

Multiple Pregnancy Fetal Complications: Intrauterine fetal growth retardation incidence of 70% compared to 5-10% in singleton pregnancies. Delay in the development of one of the fetuses (differences in size and weight of more than 15-25%) with a frequency of 4-23%. Neurological Disorders: Infantile Paralysis Microcephaly Microcephaly Encephalomalacia Encephalomalacia Premature twins have up to 14% brain tissue necrosis. In children from twins born prematurely, the frequency of brain tissue necrosis reaches 14%.

Multiple pregnancy Pregnancy management: Early diagnosis of multiple pregnancy Dynamic monitoring once every two weeks in the first half of pregnancy, once a week in the second half of pregnancy Good nutrition Bed rest position Prevention iron deficiency anemia

Multiple pregnancy Pregnancy management: ultrasound monitoring of fetal development - Screening (standard) ultrasound per week. to exclude developmental anomalies (taking into account the increased background risk of congenital anomalies) - Dynamic ultrasound starting from 24 weeks. every 3-4 weeks before delivery (to assess fetal growth and timely diagnosis of FTTS)

Pregnancy management: assessment of the state of the fetus according to CTG (non-stress test) should be started at 1 week. and continue weekly until delivery If there is evidence of impaired fetal growth, weekly assessment of the biophysical profile, amniotic fluid index, weekly CTG and umbilical cord blood flow Doppler should be performed from the time this pregnancy complication is diagnosed Multiple pregnancy

Pregnancy management: With diagnosed FTTS syndrome: - Conservative treatment (observation, early delivery of necessity) - Amnioreduction (a series of therapeutic amniocentesis 1-12, removal of 1-7 liters) - Fetoscopic laser coagulation of vascular anastomoses - Septostomy (puncture of the amniotic septum) - Septostomy (puncture of the amniotic septum) - Selective euthanasia of the fetus (donor) embolization, coagulation, ligation

Multiple pregnancy Management of labor: At the beginning of the first period, ultrasound is necessary to clarify the position and presentation of the fetuses (the position may change compared to what it was a few days before the onset of labor) Monitoring of both fetuses by recording CTG is necessary during the first stage of labor

Multiple pregnancy Indications for caesarean section: Monoamniotic fetuses regardless of the position of the fetuses Conjoined twins Transverse position of the first fetus Breech presentation of the first fetus with excessive head tilt Transverse position of the second fetus, which remains unchanged after the birth of the first fetus and an attempt to externally rotate the second More than two fetuses

Multiple pregnancy Management of vaginal delivery: If the second fetus is in a transverse position, ultrasound should be performed to monitor for a possible change in its position. External-internal rotation with subsequent extraction of the fetus by the pelvic end is undesirable due to severe traumatic complications for the fetus. After the birth of the second fetus and placenta, it is necessary to prevent bleeding

The likelihood that it is possible to bear two, three or more babies of any parent can be, to say the least, very surprising. In addition to the physical, it is also a very large psychological burden. Therefore, when the likelihood of multiple pregnancy becomes a reality, future parents need to provide increased psychological support.

Multiple pregnancy, causes

The occurrence of several embryos in a woman's body may be due to various reasons. First of all, this is inheritance from ancestors, if there have already been such cases in the family, then the likelihood of two, three or more embryonic pregnancies is much higher. Also, multiple pregnancy after IVF is even more likely. This is due to the introduction of several fertilized eggs at once. Therefore, considering IVF, multiple pregnancy is practically guaranteed.

Older women tend to be pregnant with multiple embryos. The reason for this is the hormone gonadotropin, which stimulates the development of the egg and its leaving the ovary. Multiple pregnancy, the signs of which may be different, can also be observed after taking hormonal drugs. The occurrence of several embryos can be both after taking fertility drugs, and after contraceptives.

In order to know how to determine a multiple pregnancy, you need to listen to your body even more. If a large fat strip is visible on the test, this is one of the sure signs of multiple pregnancy. Signs of multiple pregnancy before ultrasound are as follows:
Severe toxicosis.
· Severe fatigue.
· Early fetal activity.
Reaction of the skin of the face in the form of acne.

It must be remembered that the dangers in this case are much greater than with one baby. Therefore, multiple pregnancy still carries complications and it is better to be prepared for all possible risks. This will significantly increase the chances of bearing healthy full-fledged babies.

Problems that may arise during the gestation stage

Miscarriage. The development of multiple pregnancy, unfortunately, does not always go well. The most common problem is the inability to bear children. The gestation time in this case varies depending on the number of embryos. A multiple pregnancy with twins lasts about 36-37 weeks, if there are three fetuses, then the period is reduced to 34-35 weeks. Causes premature birth too stretched uterus or amniotic fluid, which accumulates too much.

To resolve this situation, the management of multiple pregnancies should be special. The doctor must constantly monitor the mother. After all, the terms of multiple pregnancy are reduced, in contrast to the time of bearing one baby. From the middle of pregnancy, the expectant mother needs to rest more, and sometimes even adhere to bed rest. In case of shortening of the cervix after 23 weeks, stitches may be applied to it. If this does not stop the activity of the uterus and the stomach also pulls during multiple pregnancy, tocolytics or corticosteroids are prescribed for the fastest maturation internal organs fruits.

The likelihood of complications. Symptoms of multiple pregnancy may be accompanied by anemia and toxicosis, both early and late. To eliminate anemia, pregnant women are prescribed large doses folic acid and iron. If the doctor has determined that this is a multiple pregnancy, ultrasound is done not only to detect it, but also to control the development of babies. You can also observe the amount of amniotic fluid and the placenta.

Problematic fruit development. A fraternal pregnancy is similar in frequency to a pregnancy with a single fetus, and a singleton pregnancy is twice as likely to have such risks. The reason for this is the nutrition of the embryos. Multiple pregnancy in the early stages of this type is complicated by the fact that the nutrition of the embryos goes through the chain. First from the placenta to one baby, and then from the first to the second. This is what can cause the underdevelopment of one of the fetuses. In domestic medicine, nothing but the release of excess amniotic fluid is supposed to simply prolong the gestation period.

Small fetal weight gain. When the birth of a multiple pregnancy occurs, the weight of the babies usually does not exceed 2500 grams. The difference in weight between children is approximately 200-300 grams. To avoid this situation, special attention should be paid proper nutrition especially in the first half of pregnancy. In some cases reduction in multiple pregnancy this is a forced step to preserve the strongest fruits.

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Templates for presentations on the theme of multiple pregnancy. Multiple pregnancy. twin types. The reasons for their occurrence

Multiple pregnancy, causes

Problems that may arise during the gestation stage

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