Multiple pregnancy. Pregnancy with twins: weight and belly, sensations

Twins are born one after another in the same birth. The time interval between the birth of twins is short.

If both fetuses are formed from one fertilized egg, then they are mono- or homozygous, identical, identical. Such twins have the same sex, the same genotype, external similarity, similar character and habits. Many monozygotic babies are mirrored. For example, one is right-handed, the other is left-handed, there are moles on different sides of the body. Sometimes even organs are located in a mirror image. Fingerprints match certain characteristics. The acquisition of specularity depends on when the division of the zygote occurred: the later, the greater the probability.

Heterozygous twins occur when two female gametes are fertilized by two male gametes. Rarely, fraternal twins can be born from different men. Children have different genotypes, different appearances, and can be of any gender. Pregnancies with heterozygous twins are registered more often.

Difference between identical and fraternal twins

Predisposition factors

The occurrence of twin pregnancy can be facilitated by:

• heredity - the presence of twins in relatives of partners or one of them. More common across generations. Moreover, the relatives may not be close - first cousins ​​or second cousins;
• during pregnancy occurring after 35 years of age - the older the woman giving birth, the higher the chances;
• at the end of taking COCs, the ovaries begin to actively produce hormones, which is why several zygotes can form;
• hormonal stimulation during IVF - more than one artificially grown embryo is transported into the uterus. If two eggs are detected during pregnancy, then one can be removed if desired (resorption);
• history of several births. According to statistics, during the fourth pregnancy, every third woman in labor is diagnosed with multiple births (the so-called parity of pregnancy).

Options for the development of monozygotic twins

Polyzygous

If two eggs are fertilized at once, these are fraternal (dizygotic) twins. Each fetus has a separate placenta and amniotic sac. Twins can be of the same or different sexes and are twice as common as identical twins.

Differences between twins:

• children of different sexes may be born;
• blood type is not always the same;
• outwardly they may look the same, or differ significantly, since they have a different set of chromosomes.

Scientists have proven a genetic predisposition to this type of pregnancy. If there have been cases in the family, then the likelihood of having dizygotic twins in the next generation increases significantly.

Signs

Twin pregnancies are a little more difficult than singleton pregnancies.

Manifestations may be:

• psycho-emotional instability, severe nervousness, irritability due to rapid hormonal changes;
• slight dizziness;
• hypersalivation;
• drowsiness, fatigue;
• nausea and a gag reflex can be observed from the first days of pregnancy - one of the main signs that a woman is pregnant with twins;
• later manifestations: the belly grows faster, it is clearly visible already at 14 weeks;
• movements occur earlier;
• severe shortness of breath. When the first baby is placed head down, the mother's stomach drops and breathing becomes easier;
• rashes, acne, age spots;
• bulging veins (varicose veins);
• fluctuations in blood pressure. If it is consistently high, you should immediately visit or call a doctor;
• problems with gums, teeth, hair due to a deficiency of vitamins and microelements.

In the first trimester, when carrying one baby, up to two kilograms are added, and when pregnant with twins - about four. This occurs not only due to increased appetite, but also due to a significant increase in the amount of circulating blood. In the final stages, the difference should be no more than 3.5 kg. Much depends on your initial physical characteristics, nutrition and activity during pregnancy.

The higher the initial BMI, the less the total weight gain should be by the end of the twin pregnancy:

• index less than 20 - 16-20 kg;
• 20-27 — 13-18;
• over 27 - 12-13.

For calculations, you can use the weight calculator, where you can enter your indicators and the presence of twins.

Monozygotic

If several fetuses are born due to the division of one egg, the twins are identical (monozygotic). Moreover, the gestational age at the time of fetal separation plays a significant role.

When separated from days 1 to 3 after fertilization, each twin has a separate placenta and membranes. Separation at a later date deprives the fruit of this advantage; there are also cases when there is not even a partition between the fruits. If the zygote divides two weeks after conception, conjoined twins are formed with a frequency of 1:200,000 cases.

Identical twins have the same DNA and genotype, but the phenotype is different. Experts believe that such a pregnancy is not natural and is not related to age, race or genetics.

Characteristics:

• all children are of the same sex,
• same blood type
• very similar body type, skin, hair and eye color.

But the twins will not necessarily look completely identical. Fingerprints are also different.

An ultrasound can definitely determine a monozygotic pregnancy only if there is no septum between the fetuses.

Survey

Pregnancy with twins is confirmed using ultrasound examination already at 5-7 weeks of gestation. Fraternal fruits are usually identified earlier than identical fruits. Doctors should warn the couple that it is extremely rare, but still there is a phenomenon called hidden twin syndrome (ischiopagus) - one more developed embryo absorbs the other. Then, during the following diagnostic procedures, a singleton pregnancy is displayed on the ultrasound monitor screens. Also, with incomplete separation, it is possible for twin organisms to join each other (Siamese twins). Modern diagnostic methods make it possible to establish as accurately as possible the fact of twin pregnancy. But the expectant mother should be aware of the risks associated with such a gestation. Thanks to the Doppler system that studies blood flow, an experienced diagnostician can determine the beating of two hearts at once.

A blood test shows an elevated level of an embryo-specific marker - alpha-fetoprotein (AFP), and a reduced iron concentration. Chorionic gonadotropin is higher during pregnancy with twins, and sharp jumps are observed. If a test system is used to determine pregnancy, then due to the concentrated hCG, the control strip will be richer in color. A medical examination and measurements of the uterine fundus show significant expansion of the uterus, which is not typical for normal pregnancy. An obstetrician-gynecologist can palpate two heads.

Reasons for giving birth to twins

Researchers have identified a number of factors that increase the likelihood of conceiving two babies:

• Maturity - in a woman aged 35-40, the level of gonadotropin increases, it increases the chances of becoming a mother twice in one pregnancy;
• Heredity - women on the side of the expectant mother had twins. She is also at risk;
• Genetics - the IGF-1 gene is responsible for tissue development and cell division. There is a direct connection between his promotion and the conception of twins;
• High levels of IGF-1 protein are observed in overweight women who consume a lot of dairy products. Therefore, vegan women are much less likely to have two babies;
• Hormonal therapy - for example, treatment of infertility with gonadotropic drugs;
• IVF is a procedure that involves stimulation of the ovaries, which leads to the fertilization of two eggs.
• Nationality - African women are more likely than any other woman on the planet to give birth to two or more children in one pregnancy.

Scientists from Amsterdam have identified another factor - 2 genes (one or a combination of them). The first is associated with an increase in the hormone FSH, a natural stimulator of the ovaries for the release of an egg. If the hormone level is high, 2 eggs may be released.

The second one is SMAD3. It is responsible for the woman’s body’s response to the FSH hormone. If the ovaries are sensitive to it, two eggs can be fertilized. In this case, the FSH level is not important.

The first gene variant increases the chance of bearing and giving birth to two children by 18%, the second by 9%, and their combination by 29%.

Features of obstetrics

In half of the cases, births with twin pregnancies occur prematurely, approximately 3-6 weeks earlier than the expected date. There is no need to worry about this. At this intrauterine age, children are mature, ready for life outside the womb, and adapt normally to the external environment. The average birth date is 35-36 weeks, very rarely mothers reach 38-40 weeks. Pregnant women with twins require early hospitalization, at least 14 days in advance. Children born prematurely require intensive care and professional care. The method of delivery is chosen by the obstetrician depending on the presentation, the amount of amniotic fluid, and possible hypoxia.

Doctor's opinion

70% of two pregnancies end in caesarean section.
It is indicated in the pelvic or transverse position. Sometimes the doctor decides to perform surgery to avoid existing risks. Unforeseen consequences can occur even with a normal pregnancy and correct presentation. If a woman has already had a cesarean section before, some gynecologists argue that pregnancy with twins can pose a danger to life or health. But practice does not confirm this opinion. — Andamova Elena Viktorovna Obstetrician-gynecologist, Ph.D.

During pregnancy with twins, giving birth on your own is allowed if the gestation proceeded satisfactorily, the woman in labor is healthy, the onset of labor is regular, and both babies have a cephalic presentation.

Diagnosis of an interesting situation

You can usually find out for sure that you are having twins fairly quickly. An ultrasound can accurately answer your question already at 5-6 weeks - usually at this point the babies already reach several centimeters in size, and they can be examined.

Birth of boys

It is noteworthy that, in principle, few people do an ultrasound before 4 weeks, since girls often find out about their pregnancy after a delay, which occurs four weeks after intimacy with a man. Only after this should pregnancy tests and ultrasound visits be performed in order to see a twin pregnancy in ultrasound photographs for the first time.

Complications

To avoid possible unpleasant consequences during pregnancy with twins, you need to be attentive to sensations, changes in psychological and physical state, visit a gynecologist on time, and listen to his advice.

Possible complications of multiple pregnancy:

• one fertilized egg stops developing (anembryony);
• intrauterine death of one embryo;
• chromosomal abnormalities;
• the connection of organisms when twins transform into Siamese twins;
• disturbance of placental circulation, in which blood is distributed disproportionately between children (feto-fetal transfusion syndrome). This is typical for monochorionic pregnancy, when the embryos have a common bladder and placenta;
• congenital diseases;
• early severe toxicosis, lasting longer than in a singleton pregnancy;
• miscarriage;
• Iron-deficiency anemia;
• severe swelling;
• excessive shortness of breath caused by displacement of the uterus, compression of the stomach, diaphragm, and lungs;
• tooth loss, alopecia;
• gestosis occurs in the third trimester of pregnancy. Characterized by dysfunction of the brain, kidneys, and blood supply system. Main symptoms: high blood pressure, protein in urine.

There is a danger to the health of the mother herself, since she has to withstand double loads.

Twins development week by week

During pregnancy with twins, children develop more intensively in utero:

weeks	Characteristics
4-6	Internal organs and the brain are formed. The mother has the first symptoms of pregnancy (weakness, nausea, dizziness). Diagnosis of twins using ultrasonography
7-8	Embryo growth is up to 40 mm. An ultrasound visualizes the head, arms, and legs. Increased risk of miscarriage. A pregnant woman has frequent urination and a tendency to constipation
9-10	The organs are formed, but the proportions of the body are still missing (large head, small body). You can see the faces. At this stage of pregnancy, the expectant mother needs to minimize sexual activity. Improves urination and defecation
11-12	The fruits have grown to 6 cm, teeth and nails are visible on ultrasound. Twins have four-chambered hearts. The risk of interruption is reduced.
12-14	Babies weigh up to 35 grams, the skin is transparent, covered with primordial fluff. Appearance of reflexes: sucking, squeezing. Rapid enlargement of the uterus, possible pain.
15-16	Fetal position, almost constant sleep. Facial expressions and proportionality of the limbs appear. Routine ultrasound diagnostics of pregnancy in the second trimester (16-22 weeks)
17-18	Movements. A growing belly, discomfort when choosing a position, the appearance of stretch marks, increased appetite. When pregnant with twins at this stage, it is advisable to wear a bandage to prevent stretching of the skin and ease of walking.
19-20	Weight 300 g, height up to 25 cm. The urinary system and intestines are functioning. Reaction to sound stimuli. The tremors are pronounced.
21-22	Weight up to 400 grams, length about 27 cm. Twins open their eyes well and hear perfectly. A pregnant woman quickly puts on weight.
23-24	The noses, the outlines of eyelashes and eyebrows, and body hair are formed. The lungs have matured. The woman has swelling of the legs, lower back pain, varicose veins, and tooth decay.
25-26	The twins are viable, have grown to 35 cm, weigh about a kilogram.
31-32	The twins grew to 40 cm, weighed about one and a half kg, and took a prenatal position. Bodies are aligned in proportion. Sleep is cyclical, everyone has their own cycle. The pancreas started working. The last planned prenatal ultrasonography is performed.
33-34	Pregnancy with twins involves increased stress, especially on the legs. Since by this period each child reaches approximately 2 kg, and in length - up to 43-45 cm, it takes on the appearance of a newborn.
35-36	Each of the twins is smaller in size than the only child. Throughout pregnancy, a woman gains up to 20 kg; a lack of weight can negatively affect intrauterine development. At this stage you need to prepare for childbirth.

Recommendations

During pregnancy, you need to be sensitive to all manifestations, and especially with twins. But there is no need to strain too much, otherwise you can “earn” neurosis, and stress and negative emotions have a bad effect on the course of pregnancy. If fatigue and anxiety are more pronounced than usual, bed rest may be necessary. If there are threats of interruption, you will be asked to lie down for “save.”

What the doctor recommends cannot be ignored during pregnancy, especially if twins are expected:

• stay in nature. But if you are prone to allergic reactions, then it is better to choose open places to relax. Do not forget about protection against ticks, wear clothes made of natural fabric with long sleeves;
• walking in the fresh air, especially in the evening;
• You can’t sunbathe in the sun, but you shouldn’t completely isolate yourself from ultraviolet radiation. You need to dose out sunbathing, go outside in the morning or evening;
• walk or travel far from home only with a guide, especially in the late stages of pregnancy, because labor can begin at any moment. It is recommended to take personal and medical documents with you;
• visiting the pool will reduce the load on the pubic area. Don't swim alone;
• do not lift weights, this can cause a miscarriage;
• posture control. The doctor will teach you how to bend over correctly to avoid curvature of the spine. The spinal column is already overloaded during pregnancy, and even more so with twins. This will help relieve lower back pain, and after delivery, avoid problems with the musculoskeletal system;
• get a good night's sleep. Be sure to lie down during the day, but maintain relative physical activity, unless there are contraindications and bed rest is not prescribed;
• You should not steam in baths, saunas, or take thermal procedures;
• swimming in open water can lead to infection of the genital organs and complications of pregnancy;
• monitor weight gain, control blood pressure, swelling;
• seek help at the slightest suspicion or the appearance of unpleasant or unusual symptoms that were not warned about.

Particular attention should be paid to nutrition. When carrying twins, the female body needs more nutrients, proteins, fats, carbohydrates. But this does not mean that you need to consume double the amount of food, it just needs to be of better quality and a regimen will be required.

The daily calorie requirement when carrying twins is up to 3500. To compare, a pregnant woman with an only child needs 3000 kcal, with triplets - about 4500. To make it easier to breathe and an overfilled stomach does not prop up the diaphragm, portions should be small, but the frequency of intake should be increased so that sufficient minerals were supplied.

Where does it start to grow from?

Those who become pregnant for the first time do not always know where the belly begins to grow during pregnancy. The most reliable answers to all your questions can be obtained from a doctor who monitors the condition of the expectant mother and baby.

The gynecologist should tell you that first the volume of the bottom part of the uterus increases. It is located above the pubis, so the first bulge can be noticed there.

During the first examination of a pregnant woman, the doctor determines where the abdomen begins to grow, while palpating the enlarged organ. Its size helps the doctor understand how long ago the conception occurred. A more accurate period can be determined by ultrasound examination.

During each examination, the doctor measures the longitudinal and transverse dimensions of the abdomen and compares the data obtained with the result of the previous measurement. If all is well, you should see an increase each time.

Medical advice on nutrition during pregnancy

• a minimum of fried, pickled, spicy, fatty foods;
• to prevent anemia, eat beef liver, pomegranates, parsley;
• to replenish ascorbic acid: grapefruit (if there is no allergy), tomatoes, cauliflower;
• It is better to boil, bake, stew, cook in a double boiler, but not fry. Serve warm;
• A mixture of vegetable and fruit juices is useful.

Poor quality food can complicate pregnancy, even lead to miscarriage. Therefore, doctors additionally prescribe multivitamins. 2-3 months after conception, folic acid and preparations containing iron are prescribed. At the AltraVita reproduction clinic, gynecologists have extensive experience in successfully managing multiple pregnancies. Women carrying twins can undergo comprehensive diagnostics at the medical center and consult with a therapist, endocrinologist, nutritionist, and psychologist. A pregnant woman can contact her doctor at any time and receive highly qualified assistance.

Birth of twins: understanding the terminology

Carrying 2 or more children is a multiple pregnancy.
It happens rarely - in a maximum of 1.6% of expectant mothers. Now there is a tendency to increase the indicator. Twins are dizygotic twins. They appear when two eggs fertilize two sperm. Such brothers and sisters are not alike. You can tell by their appearance that they are relatives, but the children are not the same.

Twins can be different-sex or same-sex. Their character and temperament may be radically different.