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Multiple Gestation

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Introduction

Multiple Gestations are a type of high-risk pregnancy and require extra care during delivery. It has become common over the past few years. As per the US Department of Health and Human Services, the rates of twin birth have increased by more than 85 percent since 1980. The rates of triplets, quadruplets and other high-order multiple births have increased as well.

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What is Multiple Gestation?

Multiple Gestations are the presence of two or more embryos in the uterus. Nowadays, about three per cent of all pregnancies result in multiple gestations.

Multiple Gestations can be a result of:

  • ● One ovum (fertilised egg) splits into two or more cells before implantation, or
  • ● More than two eggs get fertilised by two sperms at the same time.

These two types of Multiple Gestation pregnancies can lead to fraternal or identical babies.

  • ● Fraternal babies are a result of two eggs that get fertilised by two sperms. The genetic material of the babies is different as two different sperms fertilise the eggs.
  • ● Identical babies result from the fertilisation of one egg that splits into two or more cells before implantation. The genetic material of the babies is identical. They are of the same sex.

In cases of triplets, quadruplets, and high-order multiple gestations, the babies can be identical, fraternal, or a combination of both.

What are the Causes of Multiple Gestation?

Several factors have been linked with Multiple Gestation. The common ones include:

  • Heredity: If you have a family history of multiple gestations, your chances of having twins, triplets, or high-order Multiple Gestations increases.
  • Age: With age, the chances of having Multiple Gestations increases. Women who are 30 years or above have a greater chance of having Multiple Gestations.
  • Race: Asian and Native American women have the lowest multiple gestations rates, whereas African-American women are at an increased chance of having multiple gestations.

 

Other factors that may cause Multiple Gestations are:

  • Ovulation-stimulating medicines: Certain medications, such as clomiphene citrate, help in the production of multiple eggs. If fertilised, it may result in multiple gestations.
  • Assisted reproductive techniques: Assisted reproductive techniques such as in-vitro fertilisation (IVF) help couples get pregnant. These techniques use ovulation-stimulating medicines for the production of multiple eggs to increase the success rate of fertilisation.

What are the Symptoms of Multiple Gestations?

A routine prenatal ultrasound during your first trimester will tell whether you are having multiple gestations or not. You may also experience exaggerated symptoms of your pregnancy. For example, if you have Multiple Gestations, you may experience extreme fatigue and nausea.

Some of the other common symptoms of Multiple Gestations include:

  • ● Greater appetite
  • ● Bigger belly
  • ● Faster than usual weight gain
  • ● Extreme morning sickness
  • ● Fetal movements in different parts of the abdomen at the same time
  • ● Higher levels of pregnancy hormones

How is Multiple Gestations Diagnosed?

To diagnose Multiple Gestations, your healthcare provider may run the following tests and examinations:

  • Pregnancy blood test: During multiple gestations, the levels of human chorionic gonadotropin (hCG) hormones in the blood may be high. A blood test will help determine the levels of hCG hormones.
  • Imaging test: An imaging test, such as an ultrasound creates images of tissues, organs, and blood vessels using high-frequency sound waves. It will help determine the size and number of the fetuses. During early pregnancy, an ultrasound can be done using a vaginal transducer. In later pregnancy, an abdominal transducer can be used.
  • Alpha-fetoprotein: During pregnancy, the fetal liver releases a protein that is present in the mother’s blood. In multiple gestations, the levels of this protein are higher as two or more fetuses produce it.

How can Multiple Gestations managed?

Your doctor may prescribe specific management and care for the Multiple Gestations based on:

  • ● Your overall health and medical history
  • ● The number of fetuses
  • ● Your due date for the delivery
  • ● Your preference and opinion on the management and care options

Management of Multiple Gestations includes:

  • Increased nutrition: If you are carrying multiple fetuses, you may require extra calories, nutrients, and proteins. Your doctor may also recommend you gain weight to support your pregnancy. As per the Institute of Medicine, women having normal body mass index are to gain 37-54 pounds, women who are overweight should gain 31-50 pounds, and those who are obese should gain 25-42 pounds.
  • Frequent prenatal visits: The risk of complications increases with multiple gestations. Regular prenatal visits can help detect complications early.
  • Maternal and fetal testing: In case of complications, testing may be done to keep an eye on the mother and fetus’s health.
  • Medications: A common problem with Multiple Gestations is the development of the lungs in fetuses. If this is the case, the doctor may prescribe corticosteroid medications.

In case preterm labour occurs, the doctor may prescribe tocolytic medications to slow down or stop contractions. These medications can be taken orally, intravenously, or through injections.

How are Multiple Gestations Delivered?

The delivery of multiple fetuses depends on the gestational age, fetal position, and mother and fetus’s health. Usually, the vaginal delivery for multiple fetuses is done in an operating room because of the increased risk for complications and the potential need for an emergency C-section.

In twins, if both the fetuses are in the head-down position, and there are no chances of complications or infections, a vaginal delivery is possible. If the first fetus is in a head-down position and the second fetus is not, the first one is delivered vaginally. The second will either be rotated to the head-down position or delivered breech (the buttocks are presented first). In some cases, an emergency C-section of the second fetus may be needed.

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FAQ's

Can Twins be Conceived on Different Days?

Yes, it happens when a sperm fertilises egg days or weeks later than the first one.

What is Fetus-in-Fetu?

It is a condition where a baby is born pregnant with its twin. It is extremely rare and occurs in 1 in every 500,000 births.

Does Two Amniotic Sacs Always Mean Twins?

Pregnancy with two amniotic sacs is the optimal twin pregnancy. Each twin gets its protective membrane.

Do you Spot More with Multiple Gestations?

Yes, mothers carrying two or more fetuses may spot more. If you spot more in the first trimester, you could be undergoing a miscarriage as miscarriages are more common with Multiple Gestations.

Which Parent Carries the Gene for Twins?

The mother carries the gene for twins. Having a family history of twins matters only if it on the mother’s side.

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