Obstetrics and gynecology. Multiple pregnancy (most important)

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Obstetrics and gynecology. Multiple pregnancy (most important)

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55. Multiple pregnancy

Multiple pregnancy - development in the uterus at the same time of two or more fetuses. The reasons for the development of multiple pregnancies have not been elucidated. The hereditary factor plays a certain role in the occurrence of multiple pregnancy. A multiple pregnancy that has developed as a result of the fertilization of two or more simultaneously matured eggs leads to the birth of fraternal (dizygotic) or multi-ovarian twins. With the development of two or more fetuses from one fertilized egg, identical (monozygous) twins are born.

The course of pregnancy with multiple pregnancy differs in a number of features. In the later stages, pregnant women often complain of fatigue, shortness of breath, heartburn, frequent urination, bloating (flatulence), and constipation. Sometimes there is pain in the back, lower back, pelvic bones. Anemia, gestosis often develop, and varicose veins of the lower extremities occur. A complication of such a pregnancy is premature birth. Sometimes there is an excessive accumulation of amniotic fluid in the amnion cavity of one or both fetuses, leading to a sharp increase and hyperextension of the uterus, which is accompanied by the appearance of shortness of breath, tachycardia and other disorders.

Most often, incorrect positions of the fetuses are observed. One fetus may be in the head presentation, the other in the pelvic. In other cases, both fetuses are in a breech presentation, or one fetus is in a longitudinal position, the other is in a transverse position. Diagnosis of multiple pregnancy in early pregnancy is difficult.

It is possible to reliably detect the presence of multiple pregnancy already at very early stages (3-4 weeks) using ultrasound. Signs suggesting the presence of a multiple pregnancy are a rapid increase in the height of the fundus of the uterus and the circumference of the abdomen at the level of the navel over 100 cm, the feeling of fetal movements simultaneously in different localizations. On palpation, small parts of the fetus are determined in different parts of the abdomen, the uterus has a saddle shape, grooves between the fetuses are felt. Of great diagnostic importance are the determination of three (or more) large parts of the fetus, listening to two (or more) distinct heart sounds in different places of the uterus with a difference in frequency of 10 beats per 1 minute or more, as well as the presence of a "zone of silence" between them.

An accurate diagnosis of multiple pregnancy can be established by ultrasound examination of the uterus, electrocardiography, fetal phonocardiography, and radiography. Pregnant women with multiple pregnancies should be under the close dynamic supervision of a antenatal clinic doctor.

In the II trimester of pregnancy, a woman should visit a doctor at least 2 times a month, in the III trimester at least 1 time per week. The diet should contain a sufficient amount of protein (at least 200 g per day), vitamins, iron.

Author: Ivanov A.I.

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