Multiple pregnancy - how does it happen?

How does multiple pregnancy occur?

Many women who have not had twins in their family are surprised when the doctor reports that they will become mothers of several babies at once. But for doctors there is nothing incredible here: although the genetic factor is important, this can happen to any woman, no matter what. Of course, multiple pregnancies are an extremely rare occurrence: there are only 3.5 cases per 1000 births. Among the factors that can increase the likelihood of such a pregnancy, the most often cited is the older age of the expectant mother - over 35 years old. This is also often caused by the IVF procedure (an egg is removed from a woman, fertilized and inserted into the uterus) or hormonal stimulation of ovulation, when several eggs mature in one cycle, and also if you have been taking oral contraceptives for a long time and have stopped doing so. .

Twins (aka twins) can be identical or fraternal.

• Fraternal twins can be formed due to the simultaneous fertilization of two mature eggs by the sperm of one or more men. In this case, eggs can mature in one or both ovaries.
• Interestingly, triplets and quadruplets can consist of identical or fraternal twins - as a rule, until the moment of birth, mom and dad cannot find out whether their babies will look the same or not.
• Identical twins do not always look alike, but they have the same skin color, hair, eyes, blood type, but their fingerprints are different. As a rule, a special emotional connection is established between them; they can simultaneously fall ill and recover, and have similar abilities.

Ifraternal twins may be different genders, just look a little alike, or look almost identical; identical - always only one gender: either girls or boys.

Definition and classification of multiple pregnancy

So, what is multiple pregnancy? This is a phenomenon when two or more fetuses develop in the uterus of a pregnant woman. This phenomenon is quite rare. For example, for every 1,000 pregnancies there are 4 identical multiple pregnancies, which is less than one percent (0.4%). If we talk about non-identical ones, the ratio will look like this: out of 87 pregnant women, one will have twins, and one out of 6,400 expectant mothers will have triplets. But four children at once is generally rare: 1 case in 51,000. It is necessary to take into account the fact that the number of multiple pregnancies has doubled over the past 20 years.

There are two types of multiple pregnancies:

• monozygotic, also known as identical;
• dizygotic, aka heterozygotic.

In a monozygotic pregnancy, twins are produced that have the same set of genes, since they develop from one egg and one sperm. How does this happen? The thing is that after fertilization, cells actively divide. And it happens that after fertilization, the cell divides into two, and each of the cells is capable of turning into an independent living organism. This is how a monozygotic multiple pregnancy results.

But that's not all. There are as many as four options for the development of events after the division of the zygote (fertilized egg) described above, each of which depends on the stage at which the division occurred:

• in the first three days after fertilization, two placentas and two amniotic sacs are formed - then the twins turn out to be dichorionic diamniotic (sometimes they say bichorial, which, in general, is the same thing);
• between the third and eighth days two fetal bladders form, but there is already one placenta for both, and twins are then called monochorionic diamniotic;
• between the eighth and thirteenth days, the formation of two amniotic sacs is impossible, so the twins are in the same bladder and are fed from the same placenta, and such twins are called monochorionic monoamniotic;
• if the division occurred after the thirteenth day, then it is worth waiting for the birth of Siamese twins, that is, those who have fused some part of the body or organ together.

It is clear that the most favorable option for twins is the first, since a separate placenta for each and separate fetal sacs eliminate the possibility of one fetus suppressing the other, which makes them less dependent on each other.

Now about dizygotic pregnancy. Fraternal pregnancy occurs when two or more eggs, fertilized by different sperm, end up in a woman’s uterus. There are two explanations for this phenomenon. The first option involves two sexual acts, the difference between which is no more than a week. The second option is based on one sexual intercourse and two eggs that have matured at that moment.

Such a pregnancy is the safest, since only dichorionic diamniotic twins are possible here. That is, each baby will have its own placenta and, accordingly, a nutrient medium, and its own amniotic sac, which will protect them from the influence of each other and from such a misfortune as a tangled umbilical cord.

Photo source: shutterstock.com

What tests should you undergo if you are expecting twins?

As a rule, the doctor tells you that you will have twins at one of the first examinations: the uterus in this case is larger in size than during a normal pregnancy and grows faster. Sometimes a specialist is not immediately able to determine that a woman is expecting twins: they can “hide” behind each other. In other cases, the second egg dies in the first trimester, and the pregnancy becomes singleton. You need to prepare for more frequent examinations, and in this case there are more types of examinations themselves. As a rule, the doctor will wait for you every 10 days, and in the third trimester - every 7 days.

• At 10 weeks, you can do an electrocardiogram so that the doctor can hear the beating of several hearts in the uterus.
• At 8 to 12 weeks, an ultrasound also allows the doctor to detect a multiple pregnancy, although errors do occur. You will need to do this test once a month to monitor the normal function of the placenta.
• Be prepared for an obstetric examination at every visit to the doctor - all this is necessary to monitor the normal course of pregnancy.
• After the 30th week, in addition to ultrasound, Doppler sonography and cardiotocography of the fetus are performed; the regularity of the tests will depend on the course of pregnancy. They often need to be done weekly, and be prudent: if the doctor prescribes a temporary hospital stay for observation, then you need to follow his recommendation. Multiple pregnancy is a serious burden on the mother’s body, and in order for this process to proceed harmoniously, additional attention will clearly not hurt.
• You need to have your blood tested to prevent anemia: during multiple pregnancies, your hemoglobin level often drops.

In general, the health of a mother expecting twins or triplets will be the same. However, morning sickness, back pain, hemorrhoids and other pregnancy complications may appear earlier and be more pronounced.

Carrying several babies at once is a great joy, but a difficult test for the female body. It is very important to learn about complications in a timely manner in order to correct them. What do doctors fear besides miscarriage, genetic disorders and premature birth? Here's what you need to know.

1) Preeclampsia and preeclampsia

In multiple pregnancies, late toxicosis (preeclampsia) may develop, which can lead to increased blood pressure (preeclampsia). This entails a deterioration in the blood supply to both the placenta and the mother’s organs. Symptoms include severe swelling, dizziness and headache, nausea and vomiting, protein in the urine, blurred vision, and weight gain of more than 3.5 kg per week.

How to treat

This condition can only be alleviated until the end of pregnancy. Expectant mothers will have to test urine more often and reduce the amount of physical activity. If necessary, the doctor will admit you to the hospital.

2) Gestational diabetes

It can develop in pregnant women from 16 to 32 weeks (and go away after the end of pregnancy) and lead to preeclampsia. It is very important for mothers with diabetes to maintain normal blood glucose levels (3.5 - 5.5 mmol/l) and to know about the presence or absence of diabetes - after all, the baby’s body does not produce its own insulin until 12 weeks.

That's why your doctor will assess your risk of diabetes at one of your first appointments and prescribe regular blood sugar tests. If this disease is detected, mothers also need to pay attention to their health after childbirth: their risk of developing diabetes increases, regardless of pregnancy.

How to treat

Expectant mothers need to learn to control their diet, and in this case it will be possible to do without taking insulin. As a rule, the doctor recommends eliminating easily digestible sweets, replacing them with fruits, reducing the calorie content of food, as well as the amount of fat, consuming more fiber; the diet should be divided between carbohydrates, fats and proteins in proportions of 35 - 40%, 35 - 40% and 20 - 25%, respectively.

Don't get hung up on this information: every day women give birth to healthy twins. However, doctors must be fully armed.

In the early stages, the symptoms of multiple pregnancy are no different from those of a normal pregnancy, and it can only be suspected by the unusually rapid enlargement of the uterus and the size of the abdomen.

In the second half of pregnancy, signs of multiple pregnancy are: a rapid increase in the height and circumference of the abdomen; sensation of fetal movement in different places at the same time; palpating small parts of the fetus (arms, legs) in different places of the abdomen; palpation of three or more large parts of the fruit (head, pelvis); the appearance of a furrow (a distinct border between the fetuses on the abdomen (anterior abdominal wall)) between the fetuses; the feeling of the fetal heartbeat in two or more different places of the uterus, the presence of a “silent zone” between them (an area where the heartbeat is not heard), the heart rhythm is different at different points.

Also, during multiple pregnancy in later stages, women more often suffer from shortness of breath, tachycardia (rapid heartbeat), increased blood pressure, and edema. Incubation period As a rule, doubtful (feelings that appear in women that are characteristic of pregnancy, but do not guarantee its presence, since they can occur outside of it) signs of pregnancy begin to appear at 3-4 weeks of pregnancy. The first day of delayed menstruation usually corresponds to 4–5 weeks of pregnancy, but sometimes menstruation can occur even after pregnancy has occurred, and a significant decrease in the volume of menstrual flow is usually observed. In rare cases, menstrual function does not stop throughout pregnancy, but this is not the norm, but indicates a hormonal imbalance (disorder). An increase in the level of hCG (chorionic gonadotropin - the “pregnancy hormone”) is observed from the moment of implantation of the fetus, that is, its attachment to the uterine wall (on the 8th to 12th day after conception), and therefore modern highly sensitive tests for determining pregnancy can detect changes in the level of hCG already from the first day of missed menstruation. Reliable signs of pregnancy, with the exception of ultrasound signs, are determined in the second trimester of pregnancy. Ultrasound detection of pregnancy is possible from the 5th week with a transabdominal examination (the sensor is applied to the abdomen), and with a transvaginal examination (the sensor is inserted into the vagina), pregnancy can be detected as early as 4-5 weeks. Sometimes, with an early ultrasound, it is not possible to immediately determine that the pregnancy is multiple, but at 11–12 weeks, ultrasound helps to accurately determine the number of fetuses in the uterus and assess their condition. Forms Pregnancy is conventionally divided into two periods: embryonic (fetal) - up to the 10th obstetric week. During this period, fertilization, cell division, movement of the fertilized egg from the fallopian tube into the uterine cavity, implantation (attachment of the embryo to the wall of the uterus), development of germ layers (buds - building material for future organs) and the formation of organs and systems occurs; fetal (fetus) – from the 11th obstetric week until birth. During this period, the fetus increases in size, develops and improves its organs and systems. Also, pregnancy is usually divided into trimesters (1, 2, 3), respectively, three months each (up to 12 weeks, 13 - 28 weeks, 29 - 40 weeks). In a multiple pregnancy, twins can be identical (occur when a fertilized egg is completely divided into two and have the same genetic data) or fraternal (implantation (attachment to the wall of the uterus) of two or more different fertilized eggs occurs). Depending on how the placenta and decidua are located (the organs responsible for nutrition, functioning and protection of the fetus in the uterine cavity), they distinguish: monochorionic, monoamniotic twins - twins have a common placenta, there is no septum between them (they are in the same amniotic sac ); monochorionic, diamniotic twins - twins have a common placenta, in the fetal bladder there is a septum between them; dichorionic, diamniotic twins - twins have a separate placenta. Causes Pregnancy occurs as a result of fertilization of an egg by a sperm, which occurs in the upper third of the fallopian tube. Next, the fertilized egg moves through the fallopian tube and enters the uterine cavity, where it attaches to the wall of the uterus (this happens on days 20–22 of the cycle). From this moment, changes begin to occur in the woman’s hormonal background: the corpus luteum (temporary formation) in the woman’s ovary, formed during ovulation (the release of an egg from the ovary), begins to produce the hormone progesterone, and the resulting chorion (the organ responsible for attaching the embryo to the wall of the uterus) produces hCG - human chorionic gonadotropin. The woman’s body adjusts to pregnancy, and signs of pregnancy gradually begin to appear. If for some reason implantation (attachment of the embryo to the wall of the uterus) does not occur, then the mechanisms of pregnancy do not start, the fertilized egg dies without nutrition and comes out during menstruation. Multiple pregnancies can occur as a result of two mechanisms: the maturation and fertilization of two or more eggs at once, and in this case a fraternal pregnancy occurs; the division of a fertilized egg (zygote) into two or more parts shortly after fertilization, in which case the pregnancy is identical. Also, multiple pregnancies often occur with artificial insemination, when, to increase the success of the procedure, several embryos are implanted into the uterus at once, and they take root. The most favorable period for conception is the middle of the cycle (2-3 weeks of the menstrual cycle), when ovulation occurs (the release of the egg from the ovary). However, due to the fact that male and female reproductive cells have a certain lifespan (the lifespan of an egg is 24 hours, sperm is 2-5 days), and also due to disruptions in the menstrual cycle, pregnancy can occur at the beginning or end of the menstrual cycle , but less likely. LookMedBook reminds: the sooner you seek help from a specialist, the greater the chance of maintaining health and reducing the risk of complications: Diagnostics A doctor can diagnose pregnancy based on: analysis of a woman’s complaints - delayed menstruation, nausea, vomiting, general malaise, weakness, drowsiness, engorgement and soreness of the mammary glands, etc.; analysis of menstrual function (date of last menstruation, average duration of the menstrual cycle, date of the expected next menstruation, possible conception, etc.); home test results to determine pregnancy. These tests are based on the determination of hCG (human chorionic gonadotropin), which is excreted in the urine after implantation (attachment to the wall of the uterus) of the fertilized egg. These tests, if the technique is followed, are quite accurate and can detect an increase in hCG levels from the first day of missed menstruation (especially in morning urine, which is the most concentrated); gynecological examination data (the gynecologist can detect an enlarged uterus and other gynecological signs of pregnancy); ultrasound data (ultrasound examination) of the pelvic organs. An ultrasound before 10–11 weeks is usually prescribed if the doctor has doubts about the localization (location) of pregnancy (uterine or ectopic) or if a frozen pregnancy is suspected (a condition in which the embryo or fetus in the uterus stops developing and dies ); indicators of the level of hCG (human chorionic gonadotropin) in the blood. When observing a pregnant woman, the doctor may note a more rapid increase in the size of the uterus, in which case an ultrasound is performed at an earlier stage to confirm a multiple pregnancy. The doctor also prescribes a series of tests for the pregnant woman (blood, urine, tests for certain infections - toxoplasmosis, cytomegalovirus, chlamydial, mycoplasma infections, herpes simplex virus type 1, 2, etc.) and consultations with specialists (therapist, dentist, ophthalmologist) to identify concomitant diseases that may complicate the course of pregnancy. Complications and consequences Complications of multiple pregnancy can be: toxicosis of pregnant women - a complication that usually manifests itself in the first half of pregnancy and can be manifested by dyspeptic disorders (nausea, vomiting), salivation, impaired liver function (hepatosis); gestosis is a complication of pregnancy, characterized by dysfunction of vital organs and systems, usually occurring after the 20th week of pregnancy. Preeclampsia can be mild, moderate or severe. Preeclampsia is manifested by increased blood pressure, edema, and the release of protein in the urine (proteinuria); preeclampsia and eclampsia. Preeclampsia is a condition of a pregnant woman’s body that occurs against the background of the development of severe gestosis, which is characterized by increased blood pressure, dizziness, flashing spots before the eyes, and clouding of consciousness. If no measures are taken to help the pregnant woman and lower blood pressure, then preeclampsia can develop into eclampsia - a serious condition that threatens the life of the mother and child. An attack of eclampsia manifests itself in the form of a convulsive attack with loss of consciousness, which lasts from several tens of seconds to several minutes. After the attack, the woman is unconscious or comatose. The development of eclampsia can lead to the death of the mother and fetus, and therefore may require urgent surgical delivery (caesarean section) regardless of the stage of pregnancy; miscarriage – spontaneous termination of pregnancy before 37 weeks. Termination of pregnancy before the 20th week is called a miscarriage, from 20 to 37 weeks - premature birth. If a woman has three or more miscarriages, then in this case they speak of habitual miscarriage; threatened miscarriage (threatened miscarriage) - increased tone (tension) of the uterus, the appearance of nagging, cramping pain in the lower abdomen in a pregnant woman. Bloody or abundant clear vaginal discharge (bleeding, premature rupture of amniotic fluid) may also appear. All these symptoms require immediate hospitalization of the woman; threat of premature birth - the appearance of signs of incipient labor (increased uterine tone, pain in the lower abdomen, contractions, discharge of amniotic fluid) from 28 to 37 weeks of pregnancy; premature pregnancy (premature birth) - the birth of a child for a period of 20 to 37 weeks; post-term pregnancy - birth of a child at 42 weeks or more; non-developing (frozen) pregnancy – cessation of development of the embryo (up to 10 weeks of pregnancy) or fetus and its death; intrauterine fetal death (after 28 weeks of pregnancy); isoserological incompatibility (incompatibility of the blood of mother and fetus according to the Rh factor or blood group, as a result of which the mother’s body begins to produce antibodies (protective substances) that damage the fetus and can cause frozen pregnancy or miscarriage; anemia of pregnant women; gestational diabetes - a disorder in the endocrine system women, similar to diabetes mellitus (increased blood sugar), which occurs during pregnancy in some women and usually goes away after childbirth; placental insufficiency - impaired function of the placenta (the organ that provides nutrients and oxygen from the mother to the fetus), decreased blood flow through placenta and deterioration of nutrition and oxygen supply to the fetus); obstetric hemorrhage; placenta previa; premature detachment of a normally located placenta; ectopic pregnancy - attachment and further development of a fertilized egg not in the uterine cavity, but in the fallopian tube (tubal pregnancy) or in the abdominal cavity (abdominal pregnancy); fetofetal transfusion syndrome is a specific complication of multiple pregnancy in identical twins who share a placenta (an organ that supplies oxygen and nutrients from the mother to the fetus). With this syndrome, there is an excessive supply of blood to one fetus and an insufficient supply to the other, as a result of which the condition of both fetuses is disrupted until the death of one or both of them. Prevention of multiple pregnancy In order for a child to be born healthy, and to prevent the development of complications during pregnancy, a woman must adhere to the following recommendations: planning pregnancy. A planned pregnancy creates the best conditions for the conception and development of a child. A couple planning a pregnancy should consult a gynecologist (urologist), be examined for sexually transmitted infections and, if necessary, treat them. It is also advisable to undergo medical genetic counseling, especially if there are hereditary diseases in relatives. When planning a pregnancy, a couple needs to eat right, quit smoking and alcohol, and take a course of vitamins; examination for TORCH infections. It is advisable for a woman planning a pregnancy to undergo testing for toxoplasmosis (a hidden infectious disease that can be dangerous for the fetus, especially if infected before 12 weeks of pregnancy), the presence of antibodies to the rubella virus (if the woman did not have rubella before pregnancy, she It is necessary to get vaccinated), testing for herpes simplex virus types 1, 2 and cytomegalovirus infection. These infectious diseases (toxoplasmosis, rubella, cytomegalovirus infection, herpes simplex virus type 1, 2) are combined into a single concept of TORCH infection - infections that are most dangerous for a woman if infected during pregnancy, especially in the first trimester; compliance by a pregnant woman with the principles of rational nutrition. During pregnancy, a woman's need for nutrients, vitamins and minerals increases. A pregnant woman's diet should be balanced, varied, providing the woman and child with all the necessary substances. There are two key points to remember: everything the mother eats passes through the bloodstream in the placenta to the baby; If a child needs something, but does not get enough of this substance from food, he can “borrow” the deficient substance from the mother’s body (for example, calcium). Of course, a pregnant woman should exclude alcohol, toxic (poisonous) and psychostimulant substances from her diet; it is advisable to limit substances containing caffeine (coffee, tea, cola) until complete refusal; all medications, herbs, and “folk remedies” can be used only after consulting a doctor; regular observation of a pregnant woman by an obstetrician-gynecologist, timely completion of examinations and tests, strict implementation of all recommendations. If the pregnant woman’s condition worsens or alarming symptoms appear, an unscheduled visit to the doctor; observance of personal hygiene rules by a pregnant woman, avoiding exposure to toxic and strong-smelling substances. It is advisable for a pregnant woman to avoid hair coloring and perm. Cosmetics for pregnant women should be hypoallergenic (not cause allergic reactions); wearing comfortable clothes and shoes. Clothes for pregnant women should preferably be made from natural fabrics, do not compress the stomach, are comfortable and functional. Shoes should be comfortable, loose, stable and non-slip. During pregnancy, a woman should avoid shoes with heels or platforms, as they increase the load on the spine; maintaining the physical shape of a pregnant woman. Pregnancy, if it proceeds without complications, is not a disease, and therefore does not serve as a contraindication for moderate physical activity or doing housework. It is only necessary to exclude heavy lifting, excessive stress on the abdominal muscles and situations that create a risk of injury to the woman. In late pregnancy, women's physical activity decreases somewhat. To prepare the body for childbirth and maintain muscle tone for a pregnant woman from an early stage, it is recommended to perform gymnastics for pregnant women, which can be recommended by a antenatal clinic doctor. Daily walks in the fresh air are also recommended. A woman with a multiple pregnancy is advised to rest on her side more often to reduce compression of the internal organs by the uterus; psychological preparation for childbirth and support. A woman during pregnancy is very vulnerable, susceptible to stress and negative emotions, and needs support and protection. It is necessary to exclude stressful situations and postpone the resolution of all conflicts and problems indefinitely. It is important to receive positive emotions, enjoy your condition, and drive away anxious thoughts that are typical for pregnant women, especially if this is your first pregnancy. If you have a difficult family situation or are unable to cope with anxiety on your own, you should seek help from a psychologist or psychotherapist. Additionally, planning your pregnancy is the key to its successful course. If for any reason pregnancy is currently undesirable, there are various methods of preventing unwanted pregnancy (contraception). These include: biological method: calendar method (exclusion of sexual intercourse or protection during the period of ovulation); interruption of sexual intercourse; barrier method: mechanical (condoms, vaginal rings, caps and diaphragms); chemical (spermicidal suppositories, gels and tablets); hormonal contraception: combined oral contraceptives (COCs); gestagens (mini-pills); hormonal plasters, rings, subcutaneous implants, hormonal intrauterine spiral; hormone inecations; emergency (postcoite) contraception; Intrauterine contraceptives (spirals).

Premature birth: in what cases should you consult a doctor?

First of all, it is advisable to ask your doctor for a number that you can call at any time for consultations. Here are the sensations when you should consult a doctor or call an ambulance in case of acute symptoms:

• contractions resembling menstrual periods;
• pain in the lower abdomen, possibly with accompanying diarrhea;
• contractions of four or more within 20 minutes or eight or more within an hour;
• a feeling of pressure in the lower back that does not go away;
• unusual discharge;
• bleeding.

Weight during pregnancy with twins

There is a misconception that weight gain during pregnancy with twins is much higher and can reach 30-40 kg. However, this is not true.

The rate of gain depends on the woman’s weight before pregnancy and her height. It is from these data that BMI is calculated - body mass index. To calculate BMI, you divide your weight (in kilograms) by your height squared (in meters). For example, for a girl of 56 kg with a height of 1.6 m, the BMI will be 21.9.

Based on the initial BMI, we can predict how much the expectant mother of twins will gain during a normal pregnancy:

• BMI < 20 – weight gain 16-20 kg
• BMI 20-27 - gain 13-17kg
• BMI > 27 – gain 11-13kg

To determine your ideal weight at different stages of multiple pregnancy, you can use an online calculator.

Weight during multiple pregnancy

How to behave during multiple pregnancy

The most important thing for a mother who is expecting several babies at once is to calm down and not worry about anything. A good mood and a positive attitude are your concern.

• As soon as possible, visit several specialists and choose the one who seems to you to be quite competent, attentive, experienced and at the same time friendly and adequate. Your doctor should make you feel optimistic, and you will have to communicate with him frequently and trust him to manage your pregnancy. Remember that if at any stage you have a desire to change doctors, it is better to do so. We also advise you to write down your questions and feelings so that you can discuss them at your doctor’s appointment, and at the appointment, write down his advice. For forgetful pregnant women, this will help them not to miss anything.
• Form a healthy diet. Oddly enough, the weight gain of the expectant mother of twins is not so great: if during a normal pregnancy it ranges from 9 to 13–15 kg, then in the case of a multiple pregnancy it is 13–15 kg. So you don't have to eat for three or four. But it is very important to eat foods high in folic acid, iron and calcium.
• Do not take vitamins, herbal remedies or dietary supplements without consulting a specialist. Before you start taking any vitamins, tell your doctor thoroughly about your health, especially the medications you are taking (if you are taking them). Remember that a number of vitamins make it difficult to absorb other medications, and some medications, in turn, interfere with the absorption of vitamins, which means they need to be taken at different times of the day - so every nuance is important here.
• Give up bad habits. Avoid overheating whenever possible. Talk to your doctor about what type of physical activity and how much is good for you. Many doctors do not recommend expectant mothers of twins to exercise after the 24th week. Rest more often, monitor your health and remember: the better the mother’s physical condition, the stronger the baby’s health.
• This also applies to psychological health. Don't forget about walks with friends, pleasant conversations and your hobbies. Treat yourself and your well-being with care.

Closer to the due date, prepare to become a mother of twins: organize help with the babies after they are born - it is worth remembering that the emotional support of loved ones is also important. Don't try to embrace the immensity - don't hesitate to ask for help.

First trimester: signs and development of twin pregnancy

When the first signs appear, it is recommended to take a pregnancy test at home. However, only a doctor can confirm that you are having twins. Most often this is noticeable on an ultrasound at the 12th week of pregnancy. If you recently found out that you are expecting twins, we recommend reading the article with tips for multiple pregnancies.

Twins pregnancy: 1–4 weeks

What signs of twin pregnancy can you notice?

• Implantation bleeding.

  When the fertilized egg attaches to the mucous wall of the uterus, slight bleeding from the vagina is possible - as a rule, this occurs two weeks after fertilization.

• Breast tenderness.

  Due to changes in hormonal levels, the breasts become more sensitive and swell. During a twin pregnancy, the body produces even more of the hormone hCG (human chorionic gonadotropin) than during a singleton pregnancy, so these sensations may be more pronounced.

Development of twins

• How multiple fetuses are formed during pregnancy:

  Fraternal twins.

  When two eggs are fertilized by different sperm, two zygotes are formed, each of which develops into an embryo. Fraternal twins are not identical. They can also be either same-sex or different-sex.

• Identical twins.

  When only one egg is fertilized early in pregnancy, the zygote sometimes divides into two embryos. Identical twins are always the same sex, have the same number of chromosomes, and look alike.

Twins pregnancy: 5–8 weeks

What signs of twin pregnancy can you notice?

• Frequent urination. During pregnancy, the volume of circulating blood already increases, and if you are expecting twins, it increases even more. Your kidneys need to process more fluid, which means your bladder fills faster and you have to go to the toilet more often. But you shouldn’t limit yourself to water, because maintaining water balance during pregnancy is very important.
• Fatigue. As your blood levels of the hormones hCG and progesterone rise, you may feel tired. Try to get plenty of rest.
• Nausea and vomiting.

  Nausea is not typical for this stage of pregnancy, but for some mothers it occurs within a month after conception, and sometimes earlier. For expectant mothers of twins, nausea can sometimes be more severe than for mothers with a singleton pregnancy.

Development of twins

• The brain and spinal cord are formed.

  Somewhere in the sixth week, the spinal cord and brain are formed from the neural tubes of the embryo.

• Hands and legs appear.

  By the eighth week, the twins have rudimentary limbs that look like oar blades.

• Double heartbeat.

  Babies' hearts are forming, and in some cases they are already starting to work.

• All major organs are being formed.

  By the end of the eighth week, all major organs of the embryo begin to form, including the lungs and genitals.

Twins pregnancy: 9–13 weeks

What signs of twin pregnancy can you notice?

• Breasts are growing.

  Breasts grow due to the enlargement of the mammary glands and fatty tissue, because if you choose breastfeeding, you will have to feed not one baby, but two! Soon you will need a bra that is looser and more comfortable.

• More vaginal discharge.

  As we have already said, during pregnancy with twins, the level of hormones increases and the volume of circulating blood increases. This also causes an increase in the volume of secretions. There is no need to worry if this discharge is white or clear and does not have a distinct odor. And if the discharge is accompanied by itching, burning or an unpleasant odor, an infection may have entered your body.

Development of twins

• Fingers and toes appear, as well as nails.

  Babies develop fingers, then toes, and by the 12th week, nails will probably appear.

  Read also:  Breastfeeding, please: a big educational program about human milk
• Facial features are drawn.

  By this time, the faces of the embryos narrow and characteristic features appear on them. Each person has eyelids, the profile becomes clearer, and the nose, eyes and upper lip can be seen on the face.

• The rudiments of teeth appear.

  From the gums emerge tooth germs, from which teeth are subsequently formed.

• Urine is produced.

  The embryo's body begins to produce urine and excrete it into the amniotic fluid.

How should a mother of future twins eat?

The expectant mother of twins needs to increase the number of calories in her diet by only 500 per day. What might they contain? For example, in one cheese sandwich and two glasses of low-fat milk or in a large orange and a handful of nuts. It's time to get acquainted with the table of calorie content of foods, which can be found on the Internet. If before pregnancy your diet was not the healthiest, don’t worry, but now you will eat right.

• The main thing is variety. Different foods provide different vitamins and minerals.
• Eat complex carbohydrates: vegetables, fruits, whole grains (pasta, brown rice, whole grain bread, oatmeal and other foods).
• Don't forget about protein and iron. It is better, if possible, to choose foods from which these elements are easily absorbed: dietary meat, chicken, tofu and other soy products, legumes, nuts, egg whites. If you don't eat meat, consult your doctor about your diet.
• Make sure you have enough calcium in your diet. Remember that for its absorption the body needs vitamin K2, which is found in Agusha curds, and vitamin D. Milk, cheese and yogurt are the best sources of calcium.
• Don't forget about healthy fats - vegetable oil, especially olive oil. There is also a lot of fat in nuts.

Pregnancy with twins - sensations

During a multiple pregnancy, a woman’s well-being and sensations are somewhat different from being pregnant with one child. What the expectant mother may face:

• Severe long-term toxicosis
• Varicose veins due to weight gain
• Shortness of breath due to excessive enlargement of the uterus, resulting in displacement of the fundus diaphragm
• Heartburn
• Increased fatigue, drowsiness
• Edema
• Back pain
• Dark spots
• Anemia, dizziness, fainting

A pregnant woman begins to feel fetal movements a couple of weeks earlier than during normal pregnancy; they are more intense and numerous. This is explained by the fact that babies are cramped and lie closer to the wall of the uterus.

Toxicosis

What to expect after childbirth

Many mothers are scared that they will have to cope with several children at once. The main enemy of mothers with many children is perfectionism. Don't try to do everything - this can only lead to depression. Be sure to use the help of loved ones and a nanny, if you think this is possible, and devote time not only to your children and family, but also to yourself. Psychologists advise monitoring your mood very carefully to avoid the consequences of excessive stress. By the way, many people find it helpful to meet “lucky friends” - other mothers of twins with whom they can exchange experiences. Here's what they note:

• It is necessary to establish a feeding and sleeping schedule as soon as possible, otherwise you will not be able to cope with twins. Of course, a perfectly synchronized routine only happens in fairy tales, but you can try to get closer to such a situation;
• If you want, you can breastfeed two babies at the same time - this is possible. But some mothers prefer to feed their babies in turns. Remember that there are professional lactation consultants - make an appointment with one;
• When raising, support differences between children, especially identical ones, so that they feel like separate individuals. It is advisable to encourage them to have different friends, hobbies and social circles.

Good news: the older the kids, the easier it is with them. By age 2, you will find that they sleep better in the same room and enjoy playing with each other.

When can you find out about twins?

Fifteen to twenty years ago, people learned about twins only during childbirth or not earlier than the 20th week of pregnancy. When recognizing a multiple pregnancy, the following signs were taken into account.

The enlargement of the uterus during multiple pregnancy occurs faster than during pregnancy with one fetus, so the size of the uterus does not correspond to the duration of pregnancy. At the same time, the significant volume of the pregnant uterus does not correspond to the small size of the presenting fetal head. In addition, with twins, a deepening of the area of ​​the uterine fundus (saddle-shaped uterus) can be detected, the formation of which is associated with protrusion of the corners of the uterus by large parts of the fetus; as well as a longitudinal depression on the anterior wall of the uterus if the twins are in a longitudinal position, or the presence of a horizontal groove on the anterior wall of the uterus if the twins are in a transverse position. For a long time, it was important for the diagnosis of twins to clearly identify three or more large parts of the fetus in the uterus during an obstetric examination (two heads and one pelvic end or two pelvic ends and one head). Of equal importance was the presence of two distinct heartbeat points in different places of the uterus.

Today, an ultrasound examination as early as the 5th week of pregnancy can tell the expectant mother how many babies she can expect. At the same time, the doctor on the screen identifies two “bubbles” of nascent life. It is interesting that such a finding for a woman who was hesitant between whether or not to have an abortion, in almost 100% of cases, inclines the expectant mother to continue the pregnancy. An experienced doctor up to 14 weeks of pregnancy can determine the type of twins (monozygotic or dizygotic) by the thickness of the septum between the “bubbles”.

To diagnose multiple pregnancies, phonocardiography is also used, with which it is possible to record the heart sounds of twins not only in the last months of pregnancy, but also at 20-22 weeks and earlier.

What purchases will parents of twins have to make?

According to the experience of parents, twins do not need many identical things; some things can be bought in one copy.

• Children only need one crib, one changing table, one bathtub, one comb and nail clippers, as well as one baby monitor and other similar items.
• If you want to buy two developmental mats, two mobiles or two walkers at once, it’s better not to do this. One of the kids may not like the toy, so it is better to buy such things, at least at first, in one copy. If children cannot share a toy, then you can buy a second one of the same kind.
• Children need different car seats, high chairs and stroller seats.
• Buy diapers, wipes and baby food in one place and make sure you get a discount card.
• Remember that you don’t need to buy a lot of clothes for newborns: babies quickly outgrow them.

Is it possible to plan the birth of twins?

Naturally - practically not.
If pregnancy has already occurred and the woman knows about it, then in any case it is impossible to change the course of events by any means, because in the process of fertilization information about the future child is laid down, including whether there will be one or two. But some factors still increase the likelihood of conceiving fraternal twins, while the likelihood of having identical twins is not associated with any hereditary or external factors and is constant - on average 3 per 1000 pregnancies, that is, 0.3%.

So, in women aged 35-39 years, the likelihood of such conception increases. The fact is that during the late childbearing period, the concentration of a hormone in the female body increases, which stimulates the maturation of the egg. Thus, several eggs ready for fertilization can mature at once. It is also known that the production of this hormone is influenced by the length of daylight hours. Therefore, you are more likely to conceive twins in the spring, when the sun begins to warm up noticeably.

If there were already twins in the family, then the probability of giving birth to fraternal twins is higher, the closer the generation in which this happened. The tendency to give birth to fraternal twins occurs only in women. Men from such families can pass this property on to their daughters, although an increased incidence of twin births is not observed in the offspring of these men themselves.

More often, several eggs mature in women who have a short menstrual cycle - 20-21 days, as well as in women with abnormalities in the development of the uterus, for example, in the presence of a septum in the uterine cavity or a bicornuate uterus (a pathology of the development of the uterus in which the organ is not pear-shaped, but as if bifurcated).

In recent years, hormonal drugs that stimulate egg maturation and ovulation have become widely used to treat infertility and other gynecological diseases. As a result, a long-awaited pregnancy after many years of infertility often turns out to be twins or triplets! Successfully developing technologies of in vitro fertilization (IVF) have also led to the fact that pregnancy with twins or triplets is no longer a rarity. Twins after IVF are always fraternal, often of different sexes, each with their own appearance and character.

The frequency of twin births is significantly higher during various social upheavals and wars.

Belly during pregnancy with twins

• During a multiple pregnancy, the belly begins to grow earlier than during a normal pregnancy. By the 12th week it can be quite noticeable due to the increase in the size of the uterus
• Starting from the 17th week, it becomes quite difficult to sleep. It is recommended to lie or sleep on your left side with your knees slightly bent. A special pillow for pregnant women or simply a rolled blanket placed under the stomach and between the legs helps reduce pain.
• In the third trimester, the belly begins to grow very actively, which leads to the appearance of stretch marks. It is recommended to use moisturizing creams or oils from the beginning of the second trimester to increase skin elasticity. For example, wheat germ oil or baby oil
• Around week 20, your doctor may recommend wearing a back and abdominal support band.

Belly during multiple pregnancy