Multiple pregnancy by week fetal development. Pregnancy with twins: from the first signs to birth

Today we will discuss all the issues of the development of twin pregnancy, features of the course of pregnancy itself and childbirth. As a pediatrician, I will even say a few words about my observations of the development of twins and pairs of twins after birth in my area.

So, a pregnancy is usually called multiple when two or more fetuses develop. But, since triplets and even more multiple pregnancies are not so common, today we will talk only about twins. If the problem of triplets is relevant for some of you, then I will say that everything works out in approximately the same way.

Twins and twins: what's the difference?

Twins develop when not one egg, but two, matures in a woman’s body. These germ cells can develop both in one ovary and in different ones at the same time. Of course, the obligatory condition is that both of them will be fertilized by two sperm (different ones, of course).

This results in two organisms with different genetic material. They can be the same or different gender. There is no particular similarity in their appearance; they look just like brothers and sisters.

Since children develop from different eggs, they may be called fraternal twins. Touching upon medical details, let me explain that each baby has its own fetal sac, its own placenta.

Twins are babies who develop from one egg fertilized by one sperm, which at a certain time divided into two parts, and from each part the development of a separate organism began. One egg, one sperm, same genetic material. Thus, twins are always the same sex, have an identical set of genes and the same appearance.

Twins can also have their own two sacs and two placentas. Doctors call such twins bichorionic and biamnionic. The earlier the egg is separated, the greater the likelihood of a separate placenta and separate amnion (fetal sac) forming. So, for example, the above-described version of twins will occur if the separation of the egg occurred on the 3rd day from the moment of fertilization.

But more common are twins with one placenta and two separate membranes (biamnic monochorionic twins). This scenario is possible if the fertilized egg decides to give two lives 3-8 days after meeting the sperm.

The third option for the development of twins is also common. This is when one amnion and a single placenta are formed (monochorionic monoamnionic twins). Usually this option is possible when the egg divides quite late - 9-10 days after conception.

Why does multiple pregnancy develop?

Not everyone can experience double happiness. The incidence of twin births in the human population is approximately 1.5%.

The main reasons for the development of twins and in general multiple pregnancy, are:

• hyperstimulation of the ovaries by hormones. It is used in medicine as an auxiliary technique for conceiving a child as quickly as possible. Hyperstimulation is indicated for a woman whose cause of infertility has been identified, and it consists of impaired maturation of female germ cells in the ovary;
• Twins are often born after in vitro fertilization. To increase the likelihood of pregnancy during IVF, several embryos are simultaneously fertilized and implanted into the expectant mother's uterus (in Russia, up to three embryos are possible at once). On early stages embryo death may occur, so doctors count on the successful consolidation of at least one of the implanted embryos.
• Of course, at the request of the parents, embryo reduction is possible if two have implanted. But this is a rather risky step, not to mention a sin. Reduction of an implanted embryo at the request of the parents after unsuccessful attempts to become pregnant is uncommon;
• recent cessation of oral contraceptives after long-term ovarian rest also increases the likelihood of multiple eggs maturing at the same time;
• hereditary factor. Heredity plays an important role in this phenomenon. Moreover, this feature is transmitted more through the female line, and more often through a generation. That is, for a woman who has given birth to twins, her granddaughter is more likely to give birth to twins, not her daughter. Although this is not a fact. For example, my mother never had twins in her family. But in my father’s family, after delving into the pedigree, we finally found a case of twins. Few people remembered this case, since out of two children there, only one survived after birth. And the fact that the possibility of multiple pregnancies was transmitted through the paternal line does not in any way contradict genetic laws.

Are there early signs of multiple pregnancy?

It is practically impossible for a woman to find out about her multiple pregnancy on her own. More often, pregnant women with twins note the appearance of early toxicosis. Moreover, the pregnancy test can be with the usual color intensity of the indicator strip. Only at the appointment can the doctor note too big sizes uterus and their discrepancy with the calculated gestational age.

It is not always possible to recognize two embryos at the first ultrasound confirming the fact of pregnancy. But at 8-10 weeks of pregnancy, when it is possible to determine the heartbeat using Dopplerometry, it is already possible to accurately say about the beating of two hearts. And at the mandatory first screening ultrasound, which is carried out up to 12 weeks, the specialist will always notice the development of two babies, since their size at this stage is no longer tiny.

For more later women with twins report more severe heartburn, shortness of breath, and swelling of the lower extremities. A pregnant woman gains weight more rapidly. Normally, during a multiple pregnancy, a woman can gain 20-22 kg.

After 18-20 weeks, a woman may feel tremors simultaneously in different parts belly. And the doctor can feel several large parts, for example, two heads and two butts of babies.

Features of multiple pregnancy

About more early appearance and I already wrote about more pronounced toxicosis above. It is understandable that pregnancy with one child puts a colossal load on all the systems and organs of a woman, and with twins it is even more difficult for the body to withstand the load.

Women pregnant with twins more often suffer from iron deficiency anemia, since it is incredibly difficult to provide oxygen and iron for the synthesis of red blood cells to two babies.

During pregnancy with twins, the volume of circulating blood increases. Since the mother's blood performs the function of providing the embryos with nutrients, the blood in the mother's body must circulate more intensively than during a normal pregnancy in order to provide nutrition to two babies.

Placental insufficiency is a fairly common occurrence during pregnancy with two babies, since two embryos require a more intense metabolism in the placenta. Because of this, changes inevitably appear in the structure of the placenta, leading to disruption of the blood supply and nutrition of the babies.

More often, this malnutrition occurs in one of the babies, which can lead to fetal fading in the early stages. There is another option that often occurs - one baby develops more intensively and is born with a noticeably greater weight than the second.

As a rule, during pregnancy with twins, the size of the placenta is more impressive than during pregnancy with one fetus. That is, it is often partially or completely attached to the baby’s path at the time of birth. This phenomenon is called placenta previa. With this development of events, childbirth through the birth canal is contraindicated. Placenta previa is one of the absolute indications for surgical delivery.

Since a double load falls on the kidneys of a pregnant woman with twins, very often edema in such women appears earlier and manifests itself to a greater extent than during pregnancy with one baby.

An excessively enlarged uterus forces a change in location internal organs– stomach, intestines, ureters. In this regard, such women have more severe heartburn, constipation, and a greater risk of disease urinary tract during pregnancy.

The expectant mother can hear the babies moving as early as the 15th - 16th week. The intrauterine development of children in both singleton and multiple pregnancies is the same. However, during pregnancy with twins, due to the close location of the enlarged uterus to the surface of the skin, the woman notices the first movements earlier.

The intensity of fetal movements also differs from their intensity during a more common singleton pregnancy. In the later stages, babies push very intensely, trying to compete for a more comfortable position in the cramped space of the uterus.

Watch in antenatal clinic a woman with a multiple pregnancy is examined more carefully and more often. Until the 30th week, an appointment is scheduled every 10 days, and after the 30th week of pregnancy - once a week.

The condition of the cervix is ​​carefully monitored, since isthmic-cervical insufficiency (prenatal dilatation of the cervix) due to overdistension of the uterus is a fairly common occurrence in multiple pregnancies.

A woman with twins can receive maternity leave and sick leave two weeks earlier than with a singleton pregnancy. That is, at 28 weeks, and not at the required 30 weeks of pregnancy. Payments of benefits after the birth of babies do not differ in terms. But they are charged for each of the kids.

Twin pregnancy calendar

Obstetricians-gynecologists count the first week of pregnancy from the first day of the last menstruation, when, in fact, menstruation is still ongoing and the egg is not fertilized. That is why, with the arrival of a delay in regular menstruation, a woman learns about the existence of pregnancy with a fairly decent period of 3-4 weeks.

Let's look week by week at what happens to babies and mothers at different stages of pregnancy.

First trimester

• 1-4 week

As a rule, a woman does not even suspect she is pregnant yet.

After the fusion of the egg and sperm into fallopian tube a zygote is formed. This is a single cell from which a multicellular organism will subsequently be formed. If there were initially two eggs, and they are fertilized by two different sperm, then two zygotes will be formed, and fraternal twins will develop.

During the process of cleavage, the zygote turns into a morula. First there are 2 cells (one cell is divided in half), then 4, then successively 8, 16 and 32 cells, located in a dense cluster in the shape of a raspberry. It is at the morula stage of 32 cells that the proembryo enters the uterine cavity. It may not be implanted into the wall of the uterus immediately, but after 2-3 days.

I will dwell in more detail on the moment when one fertilized egg gives two lives. This happens if, during crushing, the morula at some point suddenly “falls apart” into two parts, and each part begins to develop further independently, forming a separate organism.

If the division of a single fertilized egg occurs in the first three days after meeting the sperm, twins develop with separate membranes and separate placentas (second column in the figure).

If this division of the egg occurs between the 3rd and 8th days after conception, the twins will have separate membranes and one placenta (third column in the figure).

If the egg decides to divide later than 8 days, but before the 13th day from the moment of fertilization, twins will develop with a single membrane and a single placenta (fourth column in the figure).

Late division of the egg (after 13 days of life) threatens the development of undivided twins (Siamese).

Before implantation, a cavity is formed between the morula cells, and it turns into a blastocyst - a hollow vesicle filled with liquid contents.

Implantation occurs approximately on the 7th day after conception. At this stage, the process of cell division is only progressing. The process of implantation of the embryo into the wall of the uterus can take a couple of days. This is considered the first critical period in the development of pregnancy.

In the second week, the formation of primary and secondary chorionic villi (the future placenta) and differentiation of the germ layers, which will subsequently give rise to all the organs and systems of the baby, occur. This is considered the second critical period in obstetrics.

Up to 14 days, the embryo looks like a vesicle consisting of three germ layers. From the third week, blood vessels form and grow into the chorionic villi. Thanks to this, when the chorionic villi come into direct contact with the mother’s blood, the fetus receives nutrients. Thus, the type of nutrition of the embryo changes to hematotrophic (through blood).

With the beginning of the third week, the formation of all organs begins (organogenesis). First, the neural tube, heart and gonads are formed, then the liver, lungs, primary intestine and primary kidney. Starting from the 3rd week, you can determine the fetal heartbeat on an ultrasound, if the permission of the device and the qualifications of the doctor allow this to be done.

At the 4th week, the nervous system continues to develop, the rudiment of the brain and spinal cord is formed. At this time, the rudiments of the upper and lower limbs are already visible in the embryo.

By the end of the 4th week, the embryos will be no larger than 2 cm in size.

• 5-8 week

During this period, organogenesis continues, that is, the formation of organs and body systems of developing children. The structure of all previously laid down organs and systems becomes more complex. Nerve fibers are formed that connect organs with the central nervous system, that is, with the brain and spinal cord. The head of the embryos at this time is disproportionately large.

At the sixth week of pregnancy, embryos can already bend and straighten their necks, changing the position of the head. Gradually, facial features emerge, eyes, ears, and mouth are formed. There is a clear difference between the upper and lower extremities, and the fingers are different.

At this stage, gender has already been formed, but gender cannot yet be determined. The genitals visible on ultrasound have yet to form.

Blood flow in the uterus and placental bed becomes more intense to ensure such intensive growth and development of embryos.

The eighth week marks the end of the embryonic period of baby development. At this time, the embryos are usually 4.5-6 cm long and weigh about 15-20 g.

• 9-12 weeks

By the ninth week, babies are fully formed to be called not embryos, but fruits. Your own blood type and Rh factor appear. With the end of the embryonic period, complete differentiation of the brain and spinal cord, central and peripheral nervous systems is observed.

The fruits swallow amniotic fluid. Their bladder and kidneys function. The movements of the fetuses become more varied - they can cover their faces with their hands, suck thumb, move to the sides. The external genitalia are formed. The structure of the placenta becomes more complex. It begins to perform more and more functions (respiratory, protective, metabolic, hormonal).

At 12 weeks, the length of the babies is approximately 85-90 mm, the babies weigh up to 30 g each.

The first trimester of pregnancy has come to an end.

What changes await the expectant mother of twins in the first trimester?

The expectant mother of twins in the first trimester may experience earlier and more severe toxicosis, which may also make itself felt in the second trimester.

The uterus quickly increases in size. By the end of the first trimester, it often extends beyond the pelvis, therefore putting pressure on adjacent organs and can disrupt their normal functioning. Thus, pregnant women with twins feel a frequent urge to urinate already in the first trimester. Constipation is also a frequent (but not obligatory) companion to multiple pregnancies.

In women during this period, the mammary gland actively enlarges and becomes moderately painful and sensitive. But this symptom is characteristic not only of twin pregnancy, but of any pregnancy.

A woman should visit her doctor once a month. The gynecologist, at his discretion, can set you an individual schedule of visits. Up to 12 weeks, women must undergo an ultrasound, during which all disorders and malformations of the babies are excluded.

Second trimester

• 13-16 weeks

Actively developing skeletal system kids. The rudiments of the ribs are formed. The bones of the skull become smooth and denser. Shallow breathing movements can already be observed. It's more like training your chest muscles. The digestive system begins to function. Peristaltic waves of the intestine appear. Bile production begins in the baby's liver. Interestingly, it is at this time that babies develop their sense of taste.

The movements of developing children in the uterus become increasingly active. They already have quite rich facial expressions, but so far they remain involuntary (children frown, smile, open their mouths, perform sucking movements).

The skin of babies is quite thin, blood vessels are clearly visible through it. There is practically no subcutaneous fat tissue. The scalp is gradually covered with the first vellus hairs.

The approximate size of 16-week-old babies is about 12 cm from rump to crown, and they weigh approximately 90 g each.

• 17-20 weeks

Children are growing actively. The growth of the body of children at this stage prevails over the growth rate of the head.

At the seventeenth week of pregnancy, the size of the babies from the sacrum to the crown is approximately 14-15 cm, each already weighs approximately 130-140 g.

Children at this stage of intrauterine development already hear and distinguish sounds and respond to them with certain movements. With loud, sharp sounds, babies move more intensely. Their eyes are still closed, but they can already distinguish between light and darkness. On an ultrasound, you can observe that the baby, in response to some external influences, tries to cover his face with his hands, bring his chin to his chest, that is, bend his head.

It has been proven that twins sense each other's presence.

As a rule, women carrying twins hear the first movements of the fetuses earlier than usual (16 weeks for first-time mothers, 18 weeks for repeat pregnant women). Since babies are cramped in the uterus, they push away from its walls more actively. At this stage, a woman can feel up to ten baby movements per day. At this stage, babies develop the blink reflex.

The fetal heartbeat can already be clearly heard with a phonendoscope or obstetric stethoscope. The rudiments of teeth, including permanent ones, are intensively formed. During this period, a cheese-like protective lubricant is formed on the fetal body. Subcutaneous fat tissue is formed.

Babies' bodies are already producing immune cells. Fetal hemoglobin is gradually replaced by adult hemoglobin.

By the end of the fifth month, the coccygeal-parietal size of the babies reaches 21-24 cm, and the weight is already quite decent - 320-340 g.

• 21-24 weeks

During this period, all pregnant women already felt the first movements of their babies. Baby's sleep time gradually decreases, and the time of wakefulness and active movements increases.

Active strengthening of bones is underway. The skin is still wrinkled and has many folds; in large folds, especially a lot of cheese-like lubricant of the fetus accumulates.

The child actively swallows amniotic fluid containing particles of lubricant and desquamated epithelium, and dark green feces already accumulate in his intestines. In a normal pregnancy, bowel movements of babies can occur only after birth.

At this time, the amount of subcutaneous adipose tissue increases, including brown fatty tissue, which will protect babies from hypothermia after birth.

Babies are already very good at distinguishing sounds. It is noticeable that for themselves they identify sounds that are sharp, loud, pleasant or unpleasant, and react to them in a certain way (with excitement or freezing).

By the end of this period, the babies reach a height of 26-28 cm, their weight increases to 450-550 g.

• 25-28 weeks

The children’s facial features are becoming more and more clearly visible; they already have eyelashes and eyebrows. The curves of the ears gradually form.

The lungs are actively developing, so-called air sacs (alveoli) are formed. They are not yet filled with air, but at the 25th week a substance called surfactant begins to be produced, which will prevent these sacs from collapsing after birth, when they are filled with air.

Babies are actively gaining weight due to an increase in the amount of adipose tissue, muscle growth, growth and strengthening of bones.

During this period, boys' testicles begin to descend into the scrotum, and girls' genitals continue to form.

By the 28th week, as a rule, the final presentation of the fetuses is established, since they are already cramped in the uterus, they cannot turn over from the cephalic presentation to the pelvic presentation or vice versa.

By this period, babies are practically formed. When premature birth with proper care, they are quite capable of surviving.

By the end of this period, the weight of the babies is approximately 800-900 g, height up to 35 cm.

Changes in the body of the expectant mother of twins in the second trimester of pregnancy

The uterus has already grown enough, the tummy is noticeably rounded. At this stage, it is already more difficult for a pregnant woman to lead her usual active lifestyle. But proper alternation of periods of rest and activity will help avoid problems with constipation, varicose veins, and swelling.

During this period, the expectant mother should pay special attention to the diet, namely the sufficient content of protein and calcium in it. It is worth enriching the diet as much as possible with products containing calcium and phosphorus, vitamin D 3 (fish, canned fish, eggs, nuts, hard cheeses, dairy products), since the skeletal system in children is actively developing. At this stage, the expectant mother may already be bothered by heartburn.

It's time to use a support bandage, since during this period most often the woman still has to work, and lower back pain and heaviness in her legs are already bothering her. The very physiologically changing gait (swinging) contributes to less strain on the back and pressure from the uterus on the pelvic bones. But in case of multiple pregnancy, it is difficult to do without additional support of the bandage.

Pregnant women often complain that it is difficult for them to find a comfortable position while sleeping. Experts recommend sleeping on your left side, with your upper leg bent at the knee and your lower leg straightened. Specially designed pillows for pregnant women are designed to relieve the pelvic bones and lower back and support a woman’s already enlarged belly.

Actively in the mammary gland, adipose tissue is replaced by glandular tissue. To the touch, the mammary gland has a fine-meshed structure.

Pigmentation of the parapapillary region on the chest and midline on the abdomen becomes more and more apparent. May appear on the body dark spots and freckles. This is due to an increase in melanin content in the skin of a pregnant woman.

Before the 22nd week of pregnancy, women undergo a second mandatory (screening) ultrasound. During this study, they may already be told the sex of the babies, if, of course, the position of twins allows them to consider their gender.

Third trimester

• 29-32 weeks

In children, the brain and cerebral cortex are actively developing, and the number of its convolutions is increasing. The brain mass of babies is 25% of the mass of an adult.

Now one of the cerebral hemispheres is beginning to function more actively, which determines whether the child will be left-handed or right-handed, and whether left-hemisphere or right-hemisphere activity will predominate.

The endocrine glands that produce hormones (thyroid and parathyroid glands, pancreas, pituitary gland) are actively working.

Surfactant already accumulates in large quantities in the lungs, and they begin test mode of operation.

By the end of this period, the weight of the babies is 1500-1600 g, length - about 40 cm.

• 33-37 weeks

The skin of babies becomes lighter as subcutaneous fatty tissue accumulates (about 10-15 g per day). The vellus hair is gradually wiped off. By birth, they may remain on the shoulders and back. There is more and more cheese-like lubricant on the body.

During sleep, babies' eyes are closed, and during periods of wakefulness, the eyelids are open. The color of the iris of all children's eyes is the same (deep dark blue) and only after birth it can change. The pupil already reflexively reacts by narrowing or dilating to the intensity of the penetrating light.

The pulmonary and digestive systems are fully formed. The kidneys are functioning fully, excreting up to 500 ml of urine per day. Amniotic fluid is renewed approximately eight times per day (every three hours). The bones of the skull are denser, but mobile and pliable, which is so important for the normal passage of the head through the birth canal.

The babies are fully formed and ready to meet their mother. By the end of this period, the weight of babies can fluctuate significantly - from 2200 to 3000 g, height - approximately 43-46 cm.

A pregnancy at 37 weeks is already considered full-term, and a woman pregnant with twins is being prepared for a planned delivery.

Changes in the condition of the mother of twins in the third trimester

Future mothers of twins have the right to finish work early and retire. For them, maternity leave starts from the 28th week. In the third trimester until the 30th week, gynecologists prescribe a visit to a pregnant woman every 10 days, and after the 30th week of pregnancy - once a week.

During this period, the intensity of the babies' movements decreases (they are cramped), but the force of the shocks increases. A greatly enlarged uterus can compress the inferior vena cava when a woman is lying on her back. Therefore, in this position, pregnant women often experience weakness, dizziness, and lightheadedness.

Constipation, incessant heartburn, hemorrhoids are frequent (but I repeat again - not at all necessary!) companions of the third trimester of multiple pregnancy. During this period, women may notice the first drops of colostrum released from the mammary gland. This is fine. The mother's body is preparing for the birth of babies. The reproductive tract and mammary gland are prepared for childbirth and functioning after childbirth, hormonal levels change.

At 32 weeks, women undergo a third screening ultrasound. Here you can finally see the position of the babies, their presentation, which fetus is closer to the womb. You can evaluate the condition of the placenta, since when twins develop, it often shows signs of aging prematurely (fast and intense metabolism through the placenta quickly wears it out). This is another reason for earlier delivery of multiple pregnancies.

The expectant mother of twins is hospitalized in advance in an obstetric hospital. This occurs approximately 3-4 weeks before the expected due date. This is done to finalize the method and timing of delivery.

In just the third trimester, a mother of twins can gain up to 6-7 kg. In the last weeks of pregnancy before giving birth, a woman can lose from 500 to 1.5 kg. The body gets rid of excess fluid, the mother’s blood thickens, and swelling decreases.

Peculiarities of childbirth when carrying twins

A woman with twins should be prepared for early hospitalization before birth. This situation requires more careful monitoring of the pregnant woman in the later stages.

Premature birth in such women is very common. This is due to overstretching of the uterine muscles, which can serve as one of the triggers for the onset of labor. As a rule, if surgical delivery of a multiple pregnancy is required, it is planned for 36-37 weeks.

If there are problems with carrying twins and it is difficult to safely bring intrauterine development to 36-37 weeks, doctors try to maintain and bring the pregnancy to at least 32-34 weeks.

During this period of children's development, surfactant is already produced in their lungs. This is a substance that prevents the air sacs of the lungs (alveoli) from collapsing, and the lungs become more or less prepared to perform their function after the birth of babies.

But more often a different picture is observed - when one child is in a cephalic position and the other is in a pelvic presentation. It happens less often when one child is located in the cephalic or pelvic position, and the other in a transverse presentation.

Natural childbirth with a single placenta of twins is dangerous because at the birth of one of the babies, placental abruption may occur and, accordingly, the nutrition of the other child may be disrupted. In this regard, you will still have to resort to an emergency caesarean section in order to save the second baby.

Thus, preliminary hospitalization of a woman with twins 3-4 weeks before the expected date of birth is necessary to clarify the obstetric status and additional examination of the expectant mother, as well as to resolve the issue of the method of delivery. More often, the issue is resolved in favor of a planned cesarean section, since natural births of twins much more often end in complications for both the fetus and the mother.

My observations on the development of twins and twins after birth

As a pediatrician, observing the development of twins and twins after natural birth, I always note that the first born child of twins is larger and healthier for health reasons. It is he who endures the adaptation period after birth more easily.

In children, first born, transient (borderline) conditions occur less frequently after birth (toxic erythema, physiological jaundice, transient neurological disorders: depression or excitation syndrome).

And development in the first year of life, as a rule, shows that the first child of twins develops faster than the second born.

These observations are confirmed by my family of twins. The twin sister was born larger and 5 minutes earlier than her twin brother. So, let's say, brother, how a true gentleman, let the lady go ahead.

And throughout life, my sister quickly acquired new skills. She sat up faster and crawled. I learned to walk much earlier than my brother.

Now I am the mother of two children, the youngest of whom has just learned to walk. It so happened that at different times I had to lead both of them by the hand for a long time before the children walked on their own. The little man wants to walk, but he still doesn’t have enough strength. So he demands: “Lead me, Mom, by the hand!” Although there is still a question of who is driving whom)) J More likely, the baby is driving his mother. He also shows with a demanding hand: “Take me there!”

I asked my mother how she coped with twins in such a difficult time. You need to drive and hold two people. But here nature itself probably took care that the twins did not simultaneously enter a new period of development. One is still crawling - the other is learning to walk.

So it’s possible to cope with twins, although it’s not easy. If, having learned about your double joy, you doubt and are full of fear about the upcoming birth and the future in general, then do not doubt it.

Not everyone can experience double happiness, which means you are a special person. Your pregnancy time will fly by. Another positive thing is that instead of 18 months in a pregnant state, you will only have 9 months. The result will be two babies, two of your wonderful little bloodies. Double positive emotions and double your difficult happiness await you.

Health and happiness to you and your children!

A practicing pediatrician and twice-mother, Elena Borisova-Tsarenok, told you about pregnancy with twins.

Pregnancy with twins is a real miracle that does not happen to every mother, while those who want to have two similar friends There are plenty of kids for each other.

Twins birth process
in ultrasound fluid
what do the photo weight look like
features in the situation of what should happen

According to statistics that vary from country to country, the proportion of new mothers who give birth to two or more babies at a time is about 1 percent of the total. Depending on the country, it can either be slightly lower or reach up to one and a half percent.

An interesting fact is that twin pregnancies reach 70% of the total, and the higher the number of fetuses, the lower the already tiny chances of raising two identical babies in the future.
Getting acquainted with this topic is worth starting with the basics, since often people simply do not understand who are twins and who are twins.

Difference between twins and twins

Twins are any children whose conception occurred at a close time. At the same time, the conception of both babies does not always occur at the same time; there are often cases when the second egg is fertilized within a week after the first, which does not prevent, in exceptional cases, two or even three babies from developing at once. Twins, triplets - this is just a clarification of the number of brothers and sisters.

Pregnancy with twins

However, twins are divided into identical and fraternal - here the difference is quite serious:

1. Identical twins are the result of one fertilized cell dividing into two, which must subsequently separate before attaching to the mother's uterus. If this happens in the first three weeks after conception, both fetuses will receive their own placenta for nutrition, but if this happens later, then there will be one placenta. In this case, both babies will receive the necessary nutrients through one placenta, to which two umbilical cords will be attached at once.
2. Fraternal twins always develop separately, have their own placenta, and are less similar to each other, while the bond between identical relatives is extremely strong. The reason, according to scientists, lies in an absolutely identical set of genes, since both babies, in fact, come from the same cell. Fraternal twins are no more similar to each other than ordinary brother and sister.

Signs of this feature

Pregnancy with twins has a slightly different course compared to normal pregnancy. Thus, during pregnancy with twins, the belly grows more intensively, and, often, quite quickly begins to advance beyond its due date, compared to a normal pregnancy. This may be one of the signs of twin pregnancy.

However, this largely includes rapid enlargement of the uterus, which, when observed by a doctor, becomes noticeable in the early weeks, at about 6-8. Agree, if at 6 weeks your beloved’s belly is 3 centimeters larger than what happens during a singleton pregnancy, you are unlikely to notice it, and neither will she, especially if this is the first pregnancy with twins.

Expectant mother of twins

In terms of size, it is better to judge at a later date, when at 10 weeks your chosen one becomes the owner of a beautiful tummy, more typical for the 14th week of pregnancy. However, at this stage it is always known for certain that there are at least two babies, and, in principle, it is not uncommon for a competent doctor to notice signs of a twin pregnancy a little later than the fifth week.

He sends the mother for examination to monitor the pregnancy of twins with an ultrasound, since this is the most reliable way to determine this interesting, rare fact. It is also possible to diagnose this trait using a blood test, but this is not as accurate and is not used often.

Positive aspects of the feature

If we talk about the benefits of pregnancy with twins, just look at the photos of happy mothers and fathers hugging their identical children. Yes, you shouldn’t expect any global list of advantages: there is only one plus, but what is it:

• babies, be they twins or twins, will always get along well with each other, nipping all possible quarrels in the bud. Such kids also do not have jealousy towards each other, which is often found in other children of different ages, when an older child is jealous of a younger one because he receives a little more attention from his parents;
• later, when the kids grow up, there will be no rivalry between them either, this is understandable - why compete with someone who was always there, with whom you shared everything, including mother's love during the first 9 months of life in mom’s tummy?
• All these related feelings are especially strongly expressed, of course, in identical twins, who often feel the state of their other half even at a distance;
• and, of course, the most pleasant moment for parents will be watching how two identical children with their eyes frolic and play together.

According to statistics, a pregnancy after twins has a much greater chance of becoming multiple births again, and this time it may not be limited to twins. Of course, this does not mean that the second pregnancy will certainly end in twins, but the chances of this will be much higher than the first time, since the body begins to adapt to bearing two fetuses at the same time.

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 you take pregnancy tests and go to an ultrasound to see for the first time in ultrasound photographs a twin pregnancy.

As already mentioned, pregnancy with twins is a more complex process that is more difficult for both the baby and the mother. Let's look at the weekly changes in the body that will be most noticeable to the expectant mother during pregnancy by weeks of twins, accompanied by a photo of the belly:

• from 1 to 5 weeks;

Usually everything goes smoothly and unnoticed. Often during this period the pregnancy itself is not yet known.

• 6 week;

Possible onset of toxicosis. This unpleasant phenomenon is especially common in pregnant women with twins, and very often lasts longer than usual. In terms of its intensity, toxicosis is mother of many children usually stronger.

• from 7 to 10 weeks;

The uterus becomes enlarged expectant mother, and by the 10th week its dimensions become identical to the 14-week uterus of a singleton pregnancy.

• from 11 to 13 weeks;

It goes on as usual, until the 13th week, when pain makes itself felt, but it is in no way related to the proximity of labor, since there is no pressure in the lower part. Most often, discomfort appears in the so-called iliac region.

• from 14 to 25 weeks;

A gradual increase in the abdomen, to a size that is usually not found in mothers of one baby. During this period, you need to be attentive to your health, and if you have the slightest pain in the abdomen or even the head, consult a doctor. And in general, it is simply necessary to contact an antenatal clinic when you are pregnant with twins or triplets earlier than ordinary pregnant girls visit.

• 26 – 30 weeks;

Shortness of breath appears, since the size of the uterus does not allow the lungs to expand sufficiently. After the thirtieth week, babies are usually no longer in danger, and they can completely calm down.

• 31-36 weeks.

There may be unpleasant sensations in the rib area associated with an impressive tummy. It’s time to switch to constant monitoring with a doctor, and everything will end with the birth of the long-awaited twins.

Healthy kids

How does childbirth go?

Childbirth, like pregnancy with twins, is more difficult than for others, and there are a number of reasons for this.

1. Firstly, the position of two or more fetuses is often unpredictable, so natural childbirth is not always successful, although such cases do occur. But even with the apparent absence of alarming facts during pregnancy, in the end you still have to do C-section. However, today it is not so scary, and there is no need to be afraid of it.
2. Possible complications during childbirth also include tangling of the umbilical cords, which often causes additional troubles for doctors. All this serves as a reason for mothers carrying twins to be hospitalized in advance, most often 3-4 weeks before delivery, in order to carefully study the mother’s body and prepare for all possible developments of the situation.

However, the general positive impression Giving birth to twins cannot be overshadowed by any of the problems that new mothers have to go through. We have not yet examined in detail the general discomfort, fatigue, etc. from carrying several babies at once. But reviews about twin pregnancy are extremely positive.

Pregnancy with two future babies at once is not only double joy and a huge responsibility, because inside the fair sex two people live and develop at once.

Twin pregnancy refers to the specification of multiple pregnancy - the process of carrying more than one fetus at the same time. Children born from this condition are called twins.

According to official statistics, before the era of in vitro fertilization, every eightieth woman gave birth to twins. The development and mass introduction of reproductive technologies has increased the incidence of multiple pregnancies several times.

Multiple pregnancy

Multiple pregnancy is a general concept and usually defines the presence of more than one fetus in a pregnant woman. Depending on their number, it can be twins, triplets, and so on.

Common reasons

There are only two basic reasons for multiple pregnancy:

1. Maturation of several eggs at once in one uterus.
2. The division of the zygote into several parts after fertilization.

In the first case, on ultrasound there is no septum between the twins, in the second there is one, but the degree of separation of the embryos may differ. If the zygote splits in the first days, then the degree of isolation of future children will be high. If this process drags on for several weeks, then the likelihood of conjoined twins becoming very high becomes very high.

There are a number of indirect and direct signs indicating a multiple pregnancy.

Medical signs

1. Ultrasound results.
2. Abnormally high AFP blood test results.
3. The sound of two hearts, diagnosed by the Doppler system.
4. Significant expansion of the uterus, determined when diagnosing the height of the uterine fundus.

Early signs of twin pregnancy

1. A very bright and saturated stripe on an express test to determine pregnancy, caused by a significant increase in the blood hormone HcG.
2. The presence in the family of women who previously carried multiple pregnancies.
3. Earlier onset of toxicosis, which is more difficult to tolerate than during normal pregnancy. In this case, it forms faster acne and signs extreme fatigue, characteristic of the middle, and not the early stages of gestation.
4. Earlier (from the fifteenth week) the babies move due to the close presentation to the walls of the uterus.
5. Large belly.

Fetal development in twins

The development of two babies at once during pregnancy is quite similar to classic singleton pregnancy, however, for the mother this process is more problematic, primarily due to possible additional complications.

In the first trimester, twins each grow in a separate zygote. By the end of the first month, the zygote is implanted into the endometrium. In the second trimester, children have their own fingerprints, begin to drink amniotic fluid and even squint, ultrasound already shows their exact gender. The third trimester is the final formation of children.

Representatives of the fair sex will have to visit the doctor more often for additional monitoring of the condition of the body and fruits, rest more, and consume the required amount of vitamins and fruits. Often, from the beginning of the third trimester, she will be offered to be kept in storage until 36 weeks and the onset of labor.

Possible complications

Multiple pregnancy implies possible additional complications for both the mother and future children. The most common of them:

1. Incorrect position of the fruits.
2. Polyhydramnios.
3. Previa of placental structures.
4. Severe fatigue, shortness of breath and palpitations.
5. Anemia.
6. Prematurity and fetal development disorders.
7. Intrauterine growth retardation and, accordingly, very low birth weight of babies.

1–10 weeks

Your body is actively reacting to pregnancy. The mammary glands swell and increase. By the eighth week, the embryos are already about three centimeters long and can already be detected using ultrasound.

The symptoms of sensations coincide with classic singleton pregnancy, only toxicosis and other negative sensations appear earlier. After the eighth week, future babies complete embryonic development, and by the 10th–11th week the hearts are formed, and the voice-producing apparatus begins to form. The weight of your babies is about five grams.

10–20 week

The uterus with two future babies is actively expanding, you start wearing clothes big size. Twins are actively growing at a rapid pace; from the 16th week, their gender can be determined by ultrasound. Their movements become more and more active (from the twentieth week they are clearly noticeable), while the coordination of the hands and head is poorly expressed. The main organ of exchange is still the placenta, however, the rudiments of the excretory and digestive system are already present: future children swallow amniotic fluid and at the same time expel decay products through urination.

By the sixteenth week, the body length of twins is about 17 centimeters, weight up to two hundred grams. In the twentieth, they gain another 100 grams and up to ten centimeters in height, while they can respond to sounds.

20–30 week

A rapidly growing uterus provokes the appearance of stretch marks; the metabolism in women during this period is significantly accelerated. Future babies literally compete for the best position in the womb; the result of the struggle is constant tremors.

By 24–25 weeks, the growth of the fetus is already about thirty centimeters, the weight reaches 700 grams. Appearance babies are almost close to newborns, their noses are finally formed, and the formation of facial features is completed.

The woman gradually returns to frequent urination, extensive swelling occurs, and fatigue becomes more profound. By the 28th week, future children will reach the threshold of viability and, in the event of premature birth, will most likely be saved. By the thirtieth week, each baby weighs about a kilogram, height up to 35 centimeters. The formation of the body is 95 percent complete.

30–40 week

Calm and only calm - for mothers, one of the most important phases begins, namely, the final third trimester. Babies are almost ready to see the world, their bone skeleton is formed, calcium and iron are gradually accumulating, and the pancreas is developing. The size of the bodies has almost caught up with the head and now, in general, the body looks familiar.

From the 32nd week, false contractions may appear, not exceeding a few minutes. Due to a large belly and other negative factors, it is very uncomfortable for mothers to sleep; in addition, representatives of the fair sex suffer from heartburn. From the 36th week, the pregnant woman is scheduled to be hospitalized in the maternity hospital.

By 37 weeks, future babies are considered fully term and ready to be born. The sucking apparatus is formed, the height of the child reaches 55 centimeters, and the weight is about 2.3–3 kg, which is slightly lower than in a singleton pregnancy.

Pregnancy with twins, as mentioned above, has some features - in particular, this is a larger list of possible complications for the mother and future children, a more active manifestation of symptoms of toxicosis and other negative factors, lower weight and height of individual fetuses, as well as a high probability of premature birth.

Pregnancy with twins after cesarean section

Caesarean section is a rather complex operation, which significantly increases the risks for the mother and fetus in subsequent pregnancies, especially if the patient has a multiple pregnancy.

In case of twins and a normally unhealed scar on the uterus, doctors often recommend terminating the pregnancy even with normal metabolic processes and the absence of other negative factors. If a woman who has previously undergone a cesarean section carries twins until the thirtieth week, in any situation the attending physician performs a repeat operation - this will partially remove the risk of uterine rupture and other processes that can even lead to death.

Second pregnancy with twins

A second multiple pregnancy is very rare. Partially, the low probability of such an event is increased by IVF, but the process of pregnancy and childbirth in this situation significantly overloads the body. In any case, the pregnant woman is placed under very strict registration in the antenatal clinic. At the same time, it is recommended to go into confinement from the second trimester in order to monitor the condition of the body of future babies and the fair sex in a hospital setting.

Childbirth during a multiple pregnancy usually occurs earlier than 40–42 weeks, closer to 36–38. Future children are fully formed, although their weight and height are below the classical norm, so to prevent possible consequences, the babies are immediately sent to intensive care.

Unfortunately, even qualified specialists cannot always predict the exact course of such childbirth due to a number of features, in particular.

1. Features of the behavior of babies, each of which can interfere with the birth of another.
2. Possible monoplacental structure, often leading to the death of one of the newborns due to oxygen starvation.
3. Asynchronous collision of fetal position: one of the babies may have breech presentation, the second one has a headache. During the birth process, sometimes there is a catch and simultaneous exit of both into the pelvic opening. Which is fraught with serious consequences for the mother and future children.

Nowadays, with multiple pregnancies and the absence of direct contraindications, doctors often recommend natural childbirth, albeit under the strict supervision of a doctor. If the mother has a narrow pelvis, polyhydramnios, breech presentation of one of the fetuses, large weight of future babies, anomalies in intrauterine development(one placenta, hypoxia, breech presentation, etc.), then the specialist will probably prescribe a caesarean section.

Useful video

Multiple pregnancy: identical twins

How is twin pregnancy going? Tips and tricks

Doctor Elena Berezovskaya - About multiple pregnancy

Purposefully getting pregnant with twins

Ultrasound of twins in 3D

Ultrasound of twins - 10 weeks

Ultrasound of twins - 15 weeks (twins)

Ultrasound of twins - 16 weeks

Ultrasound of twins - 20 weeks (twins)

Ultrasound of twins - 22 weeks

Question answer

What is the probability of pregnancy with twins after IVF?

IVF significantly increases this likelihood, since several embryos are implanted into the uterus: if more than one takes root, a multiple pregnancy is formed.

What size is the belly when pregnant with twins? What is the normal weight?

During the development of a multiple pregnancy, the belly of the fair sex is larger in size than that of women with one unborn child. However, its exact dimensions depend on the type of attachment of the fetus to the uterus (anterior or back wall), the size of the future children themselves and other factors.

The mother's weight standards during pregnancy with twins differ from the standards for weight gain during a singleton pregnancy. To do this, you need to make a simple calculation and calculate your body mass index (BMI).

IDMT = weight in kilograms / current height in meters squared

If your BMI during pregnancy was less than 18.5, then weight gain of 13–18 kilograms is considered normal. With an IDMI of 18.5 to 25, the norm is 11–16 kg. From 25 to 39 - 7–11 kg and the body mass index was more than thirty - from 5 to 9 kg.

Are there any peculiarities in the movement of twins during pregnancy?

Twins subjectively begin to move faster than one child. In fact, both types of pregnancy develop approximately the same, it’s just that in the case of twins, the fetuses take up more space and are located closer to the upper edges of the woman’s epithelium, which feels the movements more clearly and strongly.

It is also worth noting that from the second trimester of pregnancy, both future children move more actively together than one, essentially “fighting” with each other for free space in the mother’s belly.

Is it possible to have a second pregnancy with twins after a previous twin pregnancy?

If you have not used IVF, then the chance of a repeat multiple pregnancy in a woman who has already given birth is negligible. However, if it did happen or reproductive technologies were involved, the next birth and, accordingly, gestation is carried out under the strict supervision of doctors, who often prescribe a cesarean section to minimize risks for the newborn and the mother.

One of the most intelligent twin pregnancy calendars, I used it quite often. Pulled from some site.

From 1 to 4 weeks of pregnancy
These four weeks will pass unnoticed for you; you will not even know about the upcoming event. However, these weeks determine whether you will have one heir or several. If you are reading this article, they are most likely already behind you, because the signs of pregnancy with twins, like the signs of any other pregnancy, are not determined until the delay.

5 weeks pregnant
The beginning of the 5th week of pregnancy is the same delay in menstruation, others usually appear early signs multiple pregnancy, in principle, they are indistinguishable from those with normal pregnancy one fruit.

It must be said that two children means twice as much human chorionic gonadotropin secreted by their future placentas, which means that a multiple pregnancy in the early stages means the appearance of symptoms very early, earlier than with a normal one, and if you have twins, a pregnancy test will show bright two strips already on the first day of the delay.

This pregnancy calendar by week, twins in it main character, it starts for you right now, but you still cannot know that you are expecting twins, although by the end of the 5th week the ultrasound will already show twins. If this is a multiple pregnancy after IVF, you will be sent for it now to make sure of success; for most of our other visitors, this week is either a time of hope for twins, or this week is already over.

Pregnancy 6 weeks twins
Signs of twin pregnancy will appear later.

Your babies are now getting better and better every day, and it is already clear where their head is, you can see the rudiments of their eyes, their hearts are beating, they can be seen during an ultrasound examination, and in the place of future arms and legs, flipper-like outgrowths have appeared.

Determining a multiple pregnancy at this stage is quite possible using an ultrasound, and the doctor will see two fertilized eggs or one, but it has two beating hearts. They can already tell you what type of twin you are carrying.

You most likely already know the fact of pregnancy. The delay occurred 2 weeks ago, and if you regular cycle, you probably took a pregnancy test.

You've probably already felt the toxicity coming. If you are having twins, your pregnancy will have more severe symptoms of early toxicosis and it will last longer than usual. And in general, there are slightly more dangers awaiting you than when carrying one child.

Pregnancy 7 weeks twins
7 weeks of pregnancy with twins is the time when most women have already managed to contact an antenatal clinic.

The babies are a little less than a centimeter long each, their arms and legs are gradually acquiring familiar features, but their fingers have not yet separated.

Their heads occupy almost half the length of the body, and although the neural tube has already closed and the rudiment of the brain has formed, there is no skin sensitivity over most of the surface of the body, only areas sensitive to touch appear near the mouth.

It must be said that the babies’ faces have not yet taken shape, but you can already understand where the mouth, nose, ears and eyes will be.

Now babies are also called embryos, and this is the most dangerous period of their development, it will last until 12 weeks of pregnancy. Miscarriage and developmental defects are quite possible.

If a frozen pregnancy occurs, not all of the twins may die, but only one of the embryos. The second one will then continue to develop further and only one child will be born.

Pregnancy 8 weeks twins
The doctor may suspect symptoms of multiple pregnancy starting this week when gynecological examination. Your uterus is growing too fast for your pregnancy. However, in case of multiple pregnancy, early diagnosis during examination by a gynecologist is difficult. overweight women, since it can be difficult to estimate the size of the uterus in this way.

In any case, at 8 weeks there is only one the right way how to determine a multiple pregnancy is an ultrasound of the uterus, everything else is just assumptions and suspicions.

Meanwhile, your kids are actively developing, they don’t care about your desire to find out how many there are and what gender they are, their task is to grow. In a week they have doubled in size each, and now the body length is 2 cm, the heart has formed and hid in chest, now the twins look more complete.

An embryonic hernia of the umbilical cord may be visible on an ultrasound in a child; at this stage this is normal; soon the intestines will return back to the tummy. The fingers on the arms have separated, but on the legs they are still connected by membranes. The umbilical cord is formed, the placenta is actively forming, the villous chorion is gradually destroying the endometrium, and the connection that will connect mother and babies throughout pregnancy is being actively formed.

And you, most likely, are now suffering from toxicosis. With twins, almost all women have it, with rare exceptions; you may now even lose weight due to a complete lack of appetite, nausea and vomiting. Don't worry, it will pass soon, just be patient... a couple of months. With twins, toxicosis often continues until the 16th week of pregnancy.

9 weeks pregnant twins
At week 9, twins cross a peculiar milestone; they now become completely dependent on the newly formed placenta. It is this period that is most dangerous for miscarriage.

If you are expecting twins, the danger increases. Mothers of twins should give up sex during pregnancy, the stakes in this game are too big.

10th week of pregnancy twins
The 10th week is the usual period for a doctor to determine a multiple pregnancy; as a rule, by this time the uterus has enlarged so much that it is simply impossible to ignore its discrepancy with the gestational age. It may already be 13-14 weeks old, that is, it may leave the pelvis. This saves you from such troubles as frequent urination and a tendency to constipation.

However, the course of multiple pregnancy has its own characteristics. Your rapidly growing belly means your uterus will soon be stretched beyond its limits, which is the main reason babies are born earlier. due date. But don’t worry, nature made sure that they come into the world mature, ready to live independently; after 35 weeks, twins most often require almost no medical support after birth.

At 10 weeks of pregnancy, twins enter their fetal period of development. The time of organogenesis, when there was a risk of major malformations, is already behind us.

The babies are about 4.5 cm in size, they are fully formed, can actively move, and although their bodies are not yet proportional, they already have all the organs. The faces of the children are quite distinguishable, the arms seem long, and the legs are a little behind, there are no more tails, and the organs have returned to abdominal cavity, the head still seems too big...

11 weeks pregnant with twins
You feel a little better, toxicosis loosens its grip, but it won’t let you go completely for a long time. Your twins no longer want to be invisible, you can already see your growing belly, although clothes still allow you to hide it.

Your twins have now straightened their backs a little, their heads have gained freedom. The chins separated from the chest, the neck formed. The toes are still connected by a membrane, but the hands are fully formed.

The heart has completed its development, now it has four chambers and there will definitely be no major defects.

Your twins can move, but only with monoamniotic twins can they touch each other. Baby teeth are being laid. The gender of the twins can already be discerned, but they won’t be able to tell you on an ultrasound; the babies are still very small, each weighing no more than 4 grams.

12 weeks pregnant with twins
At 12 weeks, a multiple pregnancy is rarely not yet diagnosed. The period when a multiple pregnancy can be determined with a simple gynecological examination is 9-10 weeks. If twins are discovered later, this means that either the woman was registered late at the consultation, or she was examined too early and was not examined again (this often happens, because gynecologists try not to disturb pregnant women too much in the early stages).

Miscarriage is now less likely during multiple pregnancies, and your twins are less vulnerable. You're on the verge of the second trimester, your babies are now about 6 cm long each.

You've probably already had your first ultrasound and met your twins. This is an incredibly touching moment; few women can resist tears when they first see tiny babies on the monitor screen.

Pregnancy 13 weeks twins
The development of multiple pregnancy creates a large burden on the pregnant woman’s body.

Now your uterus is growing very quickly, and you may experience pain due to the stretching of the uterine ligaments. This unpleasant feeling on the sides of the uterus, which releases when changing position.

These pains differ from the symptoms of a threat in that the uterus remains relaxed, and the pain is localized in the iliac region, and there is no downward pressure. When there is a threat, you feel pain similar to menstrual pain, but this pain is dull or sharp, and is not at all similar to what happens during menstruation.

Managing a multiple pregnancy requires special consideration in the antenatal clinic; you will have to go to appointments more often and take more tests. What can you do, this is a high-risk pregnancy.

Your babies are now moving a lot, but it is not yet noticeable to you. Fetuses at the 13th week of pregnancy already weigh about 14 grams, their skin is thin and translucent, appearing red due to clearly translucent vessels.

And by this time the children are completely covered with soft fluff. Their eyes are closed, and their hearing is not yet functioning, but now the entire skin of the babies is very sensitive, they have a sucking reflex, they have learned to coordinate their movements, and can clench their hands into tiny fists.

Twins 14 weeks pregnant
Your tummy has risen almost to the middle of the distance between the navel and the pubis, the fundus of the uterus is about 3 cm higher than during normal pregnancy.

Twins at 14 weeks weigh about 35 grams each and have a body length of 12 cm.

Finally, early toxicosis is a thing of the past, you feel great. In your case, the wonderful feeling will not last long, your children are growing very quickly, and for this reason you will very soon experience all the delights of a big belly.

Gynecologists usually prohibit sex during multiple pregnancies, but no one prohibits mutual affection and alternative relationships.

Features of multiple pregnancy are such that you have an increased risk of vitamin deficiency, anemia, and late toxicosis. You will now have to go to see a gynecologist 2 times a month, because you need more careful monitoring.

15 weeks pregnant with twins
Your twins at the 15th week of pregnancy weigh about 60 grams, and have a length of 10 cm from the top of the head to the butt. They are already training their lungs, these are breathing movements with a closed glottis. At the same time, the muscles necessary for breathing are trained, and amniotic fluid does not enter the lungs.

The babies are forced to take the fetal position in the uterus, curled up in a ball, but there is still enough space and they move a lot.

Your belly is like that of other mothers at 17 weeks, but you cannot feel any movement, because despite such a large belly, there are babies there that are normal for the period of pregnancy, they are no larger or stronger than other children at this stage.

The kids look very thin now. Facial expressions have appeared, they can wince and frown. The corpuscles are covered with delicate down, lanugo. Legs and arms are proportional, movements are coordinated. Children suck fingers and generally anything that comes to hand, even their own umbilical cord, and they have formed their own rhythm of sleep and wakefulness. They sleep almost all the time and wake up about once an hour. The secretion of the glands, a kind of lubricant (the so-called cheese-like lubricant), accumulates in the folds; it protects the skin from moisture and is needed to facilitate childbirth.

Pregnancy 16 weeks twins
The time has come for the triple test, this is a second trimester screening for chromosomal abnormalities and developmental defects. The result may confuse you; there will be deviations from the norm in the tests. AFP is always elevated in multiple pregnancies, but the babies are fine, don’t worry.

HCG norms during multiple pregnancies are also higher, which in fact only means that everything is fine with the twins. HCG level in case of multiple pregnancy, it is increased due to the fact that there is not one placenta, but two, or one, but larger in size and provides two children. Only a low hCG level can cause concern.

It's time for the second ultrasound. If the first ultrasound was genetic and targeted major abnormalities, this will detect almost all malformations and abnormalities in children. It is carried out from 16 to 22 weeks of pregnancy.

You are already wearing maternity clothes, your pregnancy is noticeable to others. Sometimes women feel the first movement at this stage of pregnancy...

17th week of pregnancy twins
During pregnancy with twins at 17 weeks, the belly begins to seriously interfere. It is difficult for you to choose a sleeping position, get used to sleeping on your left side, this will improve blood circulation in the twins’ placentas. Try adding pillows.

The fundus of the uterus is at the level of the navel; many have a dark stripe in the middle of the tummy; this will go away after childbirth.

The skin of the abdomen stretches quickly; stretch marks can be prevented with special care. Don't forget about the hip area and your beautiful, enlarged breasts. It needs special care, maternity underwear and special creams - reliable protection against stretch marks. Be sure to use them.

During pregnancy with twins, weight is gained faster than during normal pregnancy, and from this period you will feel it in full. Try not to overeat and eat right, your appetite is enviable now.

Your twins are about 12 cm long and weigh about 100 grams. At this stage, they acquire the ability to hear, which means it’s time for prenatal education. Talk to them, sing them songs, tell them stories, read books to them, play classical music.

Have you already signed up for childbirth preparation courses?

Pregnancy 18 weeks twins
Women feel movements during a multiple pregnancy at the same time as during a single pregnancy.

If this is your first pregnancy and you don’t feel the babies yet, this is normal; some expectant mothers feel them only at 20-21 weeks, don’t worry.

The belly with twins grows very quickly, pain in the lower back and back can become a constant companion. Wear a prenatal bandage, it relieves pain, choose comfortable shoes and rest more often. Gymnastics for pregnant women also helps.

Often from this period misadventures begin with constant hospitalizations in the maternity hospital for preservation. Be philosophical about it, at least get some rest. Before maternity leave There are still 10 weeks, and a couple of weeks in the maternity hospital is just an opportunity to take a break, giving the babies all the time.

Pregnancy 19 weeks twins
The 19th week of pregnancy is the time when babies gain half their height at birth (almost 25 cm), and 300 grams of weight, this is 1/10 of how much they will gain by birth. Further they will actively grow, the organs are all already developed and functioning.

The central nervous system and lungs begin to develop most actively, and the twins are preparing for birth. They are still very thin, the skin is thin and red, covered with fuzz and a layer of grease. While weight is gained through the development of organs and muscle tissue, the time for fat accumulation will come later.

Although children's eyes are still closed, they are already able to distinguish between light and dark. The sensitivity of the skin is well developed, the fingers have an individual pattern, and the fluff gradually begins to fade, remaining thick on the shoulders and back.

Vegetation appears on the head, the first head of hair appears, babies have eyebrows and eyelashes.

Twins sense each other’s presence, and an attachment is formed in utero that will last a lifetime. If the pregnancy is monoamniotic, the twins have the opportunity to touch each other, which they do, feeling not only themselves, but also their neighbor. With diamniotic twins, the babies are isolated by the membranes, but this does not mean that they do not feel each other’s movements and do not interact in any way in utero.

After giving birth, the twins will still be attached to each other, and you will find nothing better than keeping them in the same crib for the first months, because this way they will behave more calmly.

It is interesting that the biological rhythms of children are synchronized in utero; they move at the same time and sleep at the same time. And these rhythms may not coincide at all with my mother’s.

Pregnancy 20 weeks twins
We're halfway through the pregnancy. For you, perhaps even more, because few pregnant women carry twins to term until 40 weeks; in most cases, twins are born before 37 weeks.

The twins have now grown even more, and you can feel their movements. Children spend most of their time sleeping, and when they wake up, they exercise, as space allows, and swallow the surrounding amniotic fluid.

Their intestines are already working, digesting desquamated skin cells from amniotic fluid, but nothing is excreted anywhere, all waste products accumulate in the large intestine, children will get rid of them after childbirth. This original stool is dark olive in color, almost black, and is called meconium.

Babies also urinate in the amniotic fluid, which is part of their renewal cycle. During the day, amniotic fluid changes its composition several times.

It must be said that with twins, a problem such as polyhydramnios occurs in one of the fetuses. How does this happen?
If there is a connection between the placentas, a vessel, the so-called shunt, blood can be discharged in larger quantities to one child. This leads to the fact that he urinates more and... grows faster. As a result, a difference in weight between children and moderate polyhydramnios occurs in one of them. This cannot be cured, but this situation does not pose any particular danger; the second baby will certainly gain weight after birth.

21 weeks pregnant twins
There are only 7 weeks left until maternity leave, but you already want to get everything done. You are now looking for baby things, the family is preparing for the arrival of two babies.

Your tummy no longer allows you to even bend over to fasten your shoes, and you have adapted to putting on your shoes while sitting.

Your babies have gained almost 400 grams each and are now very active. At this stage, almost all pregnant women feel movements. The child’s strengthened bones and rapidly maturing nervous system allow him to perfectly coordinate movements, and the first reflexes work. If you touch the baby’s foot, he will pull back his foot and clench his toes; if you touch his cheek, he will reach out and try to grab with his mouth what touched him.

Kids now not only hear well, their eyes have begun to open. Of course, there is still a problem with vision, they can only distinguish vague shadows, but there is nothing to look at yet.

22 weeks pregnant twins
The weight of twins at the 22nd week of pregnancy is already 400 grams, length 27 cm; an ultrasound may reveal a difference in weight and height; often one of the twins is larger than the other. This is normal and there is no reason to worry.

It’s already quite difficult for you, your stomach has risen 25 cm above the level of your pubis and is beginning to limit your breathing. You quickly gain weight, children grow - you inevitably get fat.

If you have more than two children, it is even harder for you. But let's digress a little. The most multiple pregnancy occurred in 1971, 15 babies were born! And if their mother managed it, can’t you handle it?

23 weeks pregnant twins
Your babies have gained almost half a kilogram of weight. They still have very little chance of surviving premature birth, but in a month they will be quite viable.

You look good now, pregnancy makes you look good. Under the influence of pregnancy hormones better hair and skin, but now you have many risks associated with the fact that you are carrying twins.

How long have you been to the dentist? Often women do not have enough calcium, and this affects their dental health. Your back and legs may be bothering you. Back pain is common due to load redistribution, and the legs may even swell. You may now be diagnosed with anemia.

Follow all your doctor's orders.

Pregnancy 24 weeks twins
At 24 weeks of pregnancy, twins weigh about 600 grams each.

The maturation of the lungs has begun, they have formed most of the alveoli, air sacs, and now the production of surfactant, the substance responsible for their expansion after childbirth, has begun.

Your body is now being tested to its strength. Pyelonephritis, varicose veins, anemia, gestosis and many other troubles occur more often and are more severe with twins.

Often babies never choose the correct position before birth, and placenta previa and associated bleeding are very common.

Your belly is growing, growing very quickly, and every day it becomes more difficult for you to walk and more difficult to breathe. Heartburn and nausea, constipation are also a consequence of uterine pressure, try to eat more often and in small portions.

Complications of multiple pregnancy are varied and dangerous, try to think less about them. Remember only the symptoms that require immediate medical attention:

If your stomach hurts or even just pulls, this pain does not go away when you lie down, and happens more than 5 times per hour,
- if any unusual discharge from the genital tract appears,
- if you have a fever or pain when urinating,
- if you notice swelling or too rapid weight gain,
- if you have a headache, there is a feeling of irritation from light.

Twins 25 weeks pregnant
There are 3 weeks left before maternity leave, but most pregnant women last weeks are tracked for storage. You also have the opportunity to free yourself from getting up for work in the morning by taking advantage of your right to take another vacation immediately before maternity leave.
Your babies have begun to accumulate fat; they will need it immediately after birth to maintain warmth. This is a special, brown fat that will burn, providing energy, in the first days after birth, meeting the child’s needs during the period when nutrition has not yet improved. This fat is deposited on the tummy and between the shoulder blades, the arms and legs are still thin, and the skin is wrinkled and red.

Soon the time will come to bulk up and accumulate white, real fat.

Nerve connections are now being formed; the twins are developing their nervous system. The organ of balance matures and sense organs are formed, vision and hearing become more and more perfect.

The twins are now beginning to produce their own antibodies for the first time, and their immune system has started working. Important has the nutrition of the expectant mother, because right now the origins of future allergies in children may be laid.

26 weeks pregnant twins
At the 26th week of pregnancy, the fundus of the uterus with twins rises 30 cm or more from the pubis. This means that it has practically filled the abdominal cavity, shifting and squeezing the digestive and respiratory organs, which causes natural discomfort.

Your heart is now working overtime, your blood volume has increased by 60%, and your lungs have nowhere to expand, which may cause shortness of breath. You find it difficult to find a sleeping position, and even pillows are of little help. Be patient, most of the journey is over.

Your twins now weigh 800-850 grams, they are already quite cramped, although for now they can change presentation by turning around in the uterus. Often with twins, children are not lying correctly, and because of this they have to have a caesarean section. Special gymnastics can partly influence the situation of children, but there is little hope for it.

27 weeks pregnant with twins
It’s hard for you to walk and breathe hard, the kicks of babies are sensitive, your uterus is actually already resting on your ribs. What can you do, two kids are double the weight, and they have gained almost a kilogram each.

More than half of twins are born prematurely, and from this time onwards the chances for health and well-being become great.

Despite the fact that you have a multiple pregnancy, the signs of a threat of premature birth are the same as with a normal one. These are regular pains in the abdomen of a girdle nature.

Very often, labor begins with premature rupture of amniotic fluid and proceeds rapidly. We advise you not to leave home without an exchange card and to avoid walking alone.

Next week you go on maternity leave.

Do you already have your emergency suitcase ready? Is everything ready for the arrival of babies into your life? Has the dowry been collected?

28 weeks pregnant with twins
Maternity leave for multiple pregnancies begins earlier; you will be given sick leave 84 calendar days before the expected date of birth, in addition, you are entitled to 110 days of postpartum leave. Add up these numbers; if you give birth early, your postpartum leave will be extended by the unused number of days.

28 weeks is a kind of milestone, from which you can calm down a little regarding the risk of premature birth. Your babies are already viable, although you need to be aware that they will spend many days in the hospital before you can take them home if labor starts now.

Geminis weigh more than a kilogram each, and now it's time for you to rest.

Any woman is afraid of childbirth, and a woman pregnant with twins is even more afraid, and this is not surprising, because it is obvious that such a birth will not be easy. Be prepared for the possibility that you will most likely be offered a caesarean section.

29 weeks pregnant with twins
Now your twins will gain weight every week.

Now the children are already 37 cm tall from head to toe, and the weight of each of them reaches 1200 grams. Nowadays the difference in the weight of babies can be increasingly significant; one can weigh 1000 grams, and the second 1300.

You are now experiencing all the same sensations that women experience during full-term pregnancy. And the weight gained was about the same, 10-11 kg, if not more. The back and pelvic bones, especially in the symphysis area, can be very painful; the body is preparing for childbirth.

30 weeks pregnant with twins
Your twin babies are fully formed. The boys' testicles are in the scrotum, the children began to actively become rounder, and their length growth slowed down. This normal phenomenon that they now move less and less, it’s just that the uterus is becoming quite crowded.

The weight of children reaches 1350-1400 grams, the amount of amniotic fluid is approximately about a liter for each, and now it will decrease every day.

The brains of twins are developed enough to provide spontaneous breathing and maintaining body temperature, and the gastrointestinal tract is now ready to digest food on its own. The babies' arms and legs no longer seem as thin as before, now they have begun to actively store fat, and the first thing that has become rounder is... the twins' cheeks. The fact is that the fat pad in the cheek area is vital for sucking, which means it must be created first.

31 weeks pregnant twins
The children's weight reached approximately one and a half kilograms. Most likely, your twins have already chosen a position for birth, but they are still squirming and kicking a lot, although their activity has already subsided. Every day they get stronger, and these pokes and kicks are quite painful.

You seem simply huge to yourself. During a multiple pregnancy, the belly reaches its maximum size by 31-32 weeks, and is very disturbing. It’s hard to breathe, you feel pain under your ribs, and you can’t lie quietly on your back for even five minutes, you feel faint. But soon it will become easier, the stomach will drop before childbirth.

You'll have your last ultrasound next week if you haven't had one yet. If you found out the sex of the children at the last ultrasound, they will tell you whether spontaneous childbirth is possible. There are situations when a planned caesarean section is the only option correct solution. For example, when the placenta is previa or one of the fetuses occupies a transverse position in the uterus.

32 weeks pregnant twins
The time has come for the last ultrasound during pregnancy; twins will now be assessed not only from the point of view of development and presence possible deviations and diseases, but also as an object of future childbirth. Usually, by this time, children are determined to be breech and lie with their heads down. The condition of the placentas and their location are assessed, and childbirth is predicted.

It should be noted that in case of twins, upon admission to the maternity hospital for the birth itself, as a rule, an ultrasound is also performed, based on the results of which the final decision on the tactics of childbirth is made.

Children weigh approximately 1600 grams each. Now the uterus is so crowded that a natural protective mechanism is activated, and weight gain becomes slower than during normal pregnancy. Your twins will weigh less than the average child during a normal pregnancy, and at the same time, the maturation of all organs and systems of babies is accelerated; twins can be born prematurely and they are preparing for this.

33 weeks pregnant twins
Your doctor now wants to see you every week, and that's no surprise. Childbirth may begin unexpectedly, now you have a high risk of gestosis and other complications, your health needs constant monitoring.

Your children could have gained up to 1800 grams, their height is approximately 43 cm. They now look approximately like ordinary newborns, differing only in their thinness. The skin has smoothed out, nails are growing on the fingers and toes, the fluff on the body has almost disappeared, and hairs on the head are growing back.

Geminis actively develop their senses. They can see and react to bright light directed at the anterior abdominal wall, they are frightened by sharp sounds and taste amniotic fluid. Their main occupation, as before, is to suck whatever they have to.

Sleep and wakefulness alternate, and brain activity is clearly recorded on the electroencephalogram. Your children are already dreaming...

34 weeks pregnant with twins
You're probably already tired. Tired of a big belly, of waiting, of pain in the back and legs, in the pelvic bones... You are tired of endless tests and visits to the doctor, you are tired of the walls of maternity hospitals. It is quite possible that your stomach has already dropped. The head of one of the twins drops into the pelvis, it becomes easier to breathe, but at the same time the problem of constipation appears, or gets worse if it already existed before.
Your twins are training their respiratory system through breathing-like movements. The fetal heart rate is approximately 120 beats per minute. Sometimes babies hiccup, you feel it as a rhythmic shaking in the stomach.

They move less and less every day, their weight can already reach 2 kg, and of course, they are very cramped. If they are born this week, you will most likely be able to take them home quickly. In most cases, at this stage, twins no longer even need an incubator.

35 weeks pregnant twins
That's all. You can consider your mission completed and calmly wait for the birth. As a fact, from this week of pregnancy, in the absence of other diseases, all newborns survive and have no health problems. If the birth is without injuries and hypoxia, you will take them home straight from the maternity hospital.

We hope that you have already prepared everything you need for your twins and for yourself in the maternity hospital.

36 weeks pregnant twins
The 36th week of pregnancy and beyond, for those who have not yet given birth, is the time of waiting for the onset of labor.

During a multiple pregnancy, your weight could increase by 15-17 kg by the end of it, and of course, these weeks are very difficult.

Childbirth during a multiple pregnancy is usually planned, which means that by now you should already be in the maternity hospital under the supervision of doctors.

We can only be glad that you made it through and reached the end, very soon you will be able to take your babies in your arms.

Pregnancy and childbirth with twins is not an easy experience for any woman, and if you have a multiple pregnancy, a cesarean section can be the method of choice for childbirth with about a 70% chance. If you are planning more pregnancies, do not worry about this, pregnancy after twins is quite possible, and it does not matter whether you gave birth yourself or had a cesarean section, you will just need rest to regain strength and health.

A typical gestation (pregnancy) is characterized by the gestation of one fetus, while a multiple pregnancy is characterized by two or more fetuses. According to the number of developing embryos, we can talk about twins, triplets, etc. The relevance of issues related to polyembryonic pregnancy is explained by the fact that its course is fraught with the development of various complications, prematurity of newborns, premature birth and other features. In addition, perinatal mortality during polyembryonic gestation is about 10%, fetal malformations are recorded twice as often. These and other features are prerequisites for studying the causes of multiple pregnancy and proper management of pregnancy and childbirth.

Causes of multiple pregnancy

The issues related to the emergence of polyembryonicity have not been fully studied. Many factors are involved in its development:

• Heredity. A predisposition to multiple births is noted if one of the spouses is a twin or twins and female relatives tend to develop multiple births.
• A woman has a high amount of follicle-stimulating hormone in her blood. It stimulates the maturation and development of two or more eggs at once.
• Stimulation therapy for infertility.
• Performing IVF (in vitro fertilization), during which ovarian hyperstimulation is used.
• Malformations of the uterus.
• Number of gestations (with each repeated case, the likelihood of polyembryony increases).
• Hormonal changes in a woman over 35 years of age. As a result of hormonal accumulation, two or more eggs may ovulate.
• Fertilization of eggs of different ovulation periods, when new pregnancy superimposed on an existing one.

Classification

The classification of polyembryony is quite complex and is explained by the many reasons for its occurrence. Determining its type is important for proper management of pregnancy and childbirth. In solving these issues, zygosity, chorionicity and the number of amniotic cavities are of great importance. The classification of multiple births is associated with such concepts as:

• Monozygotic, or pregnancy with twins, triplets, etc. It develops from a single fertilized egg, the division of which produces similar embryonic structures that develop independently under favorable conditions. As a result, identical twins are born, having the same gender and similar external features, as well as the same blood type, dental structure, etc.
• Bizygotic gestation, which develops when two or more eggs mature in both ovaries. Their fertilization leads to the development of dizygotic embryos. They can be variable: same-sex and heterosexual, with different group blood and have other differences. If there are more than two embryos, then there may be options for the development of monozygotic and dizygotic fetuses. The peculiarity of dizygotic embryos is that they have their own membranes - chorionic, placental and amniotic. Each has its own placenta; they are separated from each other by a multilayer membrane septum.

Features of the development of multiple pregnancy

Gestation with two or more fetuses puts a greater burden on a woman’s body and affects the development of embryos. Features of the course of multiple pregnancy are manifested in the following:

• Gestation period has been reduced to 35-37 weeks.
• Changes occur in the functioning of systems and organs. The volume of circulating blood increases up to 50%, which causes additional stress on the cardiovascular system, respiratory system, and urinary system. Toxicosis and gestosis occur (loss of protein in the urine, resulting in the development of a serious complication - eclampsia, which threatens the life of the woman and the fetus).
• Polyhydramnios can cause hypofunction of the kidneys.
• Isthmic-cervical insufficiency (ICI) is a softening of the cervix that rapidly progresses and requires surgical intervention. Treatment consists of suturing the cervix and inserting a pessary.

There are other risks of polyembryony that threaten the life and health of the woman and fetus:

• Development of gestational diabetes.
• Impaired blood circulation of the placenta, placenta previa, early abruption.
• Threat of miscarriage.
• Delay and malformations of fetuses.

Signs of multiple pregnancy and its management

Signs of polyembryonic gestation in the early stages do not differ from normal pregnancy. The woman experiences fatigue, shortness of breath, frequent urination. It is quite difficult to recognize multiple pregnancies in the early stages, and women with a history or relatives of multiple pregnancies should be under special control.

The main visual sign of multiple pregnancy in the early stages is the rapid growth of the uterus and an increase in the pregnant woman's abdomen.

Ultrasound allows diagnosis of multiple pregnancy. The accuracy of this method is 99%. Also used in making a diagnosis is the determination of the concentration in a woman’s blood. hCG hormone and placental lactogen. Their indicators significantly exceed the norm for a singleton pregnancy.

Features of management

Gestation with multiple fetuses carries many risks, even if it is normal. Therefore, its management is mandatory from the moment of diagnosis. A woman must strictly follow the recommendations of specialists:

• Visit your obstetrician-gynecologist twice a month before 30 weeks and every week after 30 weeks.
• Carry out weight control (recommended weight gain is 20-22 kg).
• Take preventive medications prescribed by your doctor.
• Undergo an ultrasound scan within the specified time frame.
• Visit specialists to monitor the condition of the cervix, organs and systems.
• Undergo laboratory blood tests and the necessary control hardware studies (CTG, Dopplerography, echography of the fetoplacental system).

If necessary, the pregnant woman is prescribed additional studies. Her hospitalization in the maternity hospital is necessary from the 36th week, and in some cases even earlier.

Childbirth with multiple births

Childbirth during multiple gestation is a crucial moment for both the mother and doctors. This is explained by frequent complications associated with the condition of both the mother and the fetus:

• 30% of women in labor with multiple births experience early or premature rupture of amniotic fluid and premature birth.
• Due to overstretched uterine muscles, labor contractions become weak and the cervix does not dilate. As a result, the expulsion of the first fetus from the uterus is delayed.
• The second fetus often tends to enter the pelvis at the same time as the first, which is fraught with serious complications.

All this leads to protracted labor, there is a threat of infection of the uterus and the development of fetal hypoxia. There are cases of rapid labor with perineal ruptures. During the period of expulsion of the fetus, there is a risk of developing a serious complication - premature placental abruption and severe bleeding. If this happens while the second fetus is in the uterine cavity, it is a threat to its life.

Proper management of multiple births means minimizing the risk of complications.

It is necessary to constantly monitor the cardiac activity of the fetus and the condition of the woman in labor. It is advisable to give birth in the first stage on the left side. With weak labor activity stimulation and anesthesia are performed.

If necessary, during the expulsion period, obstetric surgical procedures are performed to extract the fetus using instruments. The umbilical cord is tied not only at the fetal site, but also at the maternal site. If this is not done, then the death of the fetus in the uterus is possible. The second child passes into the birth canal 10-15 minutes after the first. If there is a delay, the doctor breaks the amniotic sac to drain the amniotic fluid and the baby comes out of the pelvis on its own.

If the child is in a transverse position or his head is not inserted correctly into the small pelvis, then the woman is given general anesthesia and the child is mechanically rotated and removed. In complicated cases, delivery is carried out by caesarean section.

Women with polyembryonic pregnancies are provided with increased postpartum leave. They are recommended to use high-quality contraception for three months and plan subsequent pregnancies only after two to three years. Newborns also need special attention and, in accordance with the degree of their maturity and maturity, require a certain amount of nursing.