Added: Mily Dressler - Date: 02.03.2022 08:41 - Views: 17204 - Clicks: 2456
A Guide for Patients. Multiple births are much more common today than they were in the past. There are more multiple births today in part because more women are receiving infertility treatment, which carries a risk of multiple pregnancy. Also, more women are waiting until later in life to attempt pregnancy, and older women are more likely than younger women to get pregnant with multiples, especially with fertility treatment. Although major medical advances have improved the outcomes of multiple births, multiple births still are associated with ificant medical risks and complications for the mother and children.
If you are at risk for a multiple pregnancy, this booklet will help you learn how and why multiple pregnancies occur and the unique issues associated with carrying and delivering a multiple pregnancy. You may know someone who has twins, but do you know how twins occur and how they develop? There are two types of twins: identical and fraternal non-identical. Identical twins occur when a single embryo, created by the union of a sperm and an egg, divides into two embryos. Each embryo is monozygotic, genetically identical, Number twins 10 both will be the same sex.
Depending on when the division occurs, identical twins may have separate placentas and gestational sacs, or they may share a single placenta but have separate sacs. In rare cases, identical twins may be in the same amniotic sac. Non-identical twins occur when two separate eggs are each fertilized by a separate sperm. The two embryos that result are dizygotic, not genetically identical, and can be the same or different sex. Most of the time, this is the type of twinning that occurs from assisted reproduction procedures. Spontaneous losses are even higher in triplet and quadruplet pregnancies.
When a fetus is lost in the first trimester, the remaining fetus or fetuses generally continue to develop normally, although vaginal bleeding may occur. Ultrasound examinations performed early in the 5th week of pregnancy occasionally may fail to identify all fetuses. After 6 to 8 weeks, ultrasound should provide an accurate assessment of the of fetuses. Naturally, twins occur in about one in pregnancies, triplets in about one in 10, pregnancies, and quadruplets in about one inpregnancies. The main factor that increases your chances of having a multiple pregnancy is the use of infertility treatment, but there are other factors.
Your race, age, heredity, or history Number twins 10 prior pregnancy does not increase your chance of having identical twins but does increase your chance of having fraternal twins. Infertility treatment increases your risk of having twins, both identical and fraternal.
The overall rate of twins for all races in the United Statees is around 33 per 1, live births. Black and non-Hispanic white women have similar rates of twinning, while Hispanic women are less likely. Non-identical twin women give birth to twins at the rate of 1 set per 60 births. However, non-identical male twins father twins at a rate of 1 set per births. Maternal age and prior pregnancy history. The frequency of twins increases with maternal age and of pregnancies. Women between 35 to 40 years of age with 4 or more children are 3 times more likely to have twins than a woman under 20 without children.
Maternal height and weight. Non-identical twins are more common in large and tall women than in small women. This may be related more to nutrition than to body size alone. During World War Number twins 10, the incidence of non-identical twinning decreased in Europe when food was not readily available.
Fertility Drugs and Assisted Reproductive Technology. Multiple pregnancy is more common in women who utilize fertility medications to undergo ovulation induction or superovulation. Use of drugs to cause superovulation has caused the vast majority of the increase in the multiples. Assisted reproductive technology ART procedures such as in vitro fertilization IVF also contribute to the increase in the multiple birth rate. The risk of multiple pregnancy increases as the of embryos transferred increases. The duration of a normal Number twins 10 pregnancy ranges from 37 weeks to 42 weeks from the time of the last menstrual period.
Twin pregnancies occasionally progress to 40 weeks but almost always deliver early. As the of fetuses increases, the expected duration of the pregnancy decreases. The average duration is 35 weeks for twins, 33 weeks for triplets, and 30 weeks for quadruplets. Complications increase with each additional fetus in a multiple pregnancy and include many medical issues that will be discussed below. In addition to these, there is a higher incidence of severe nausea and vomiting, cesarean section, or forceps delivery.
If you are pregnant with twins or more, or if you are at risk for a multiple pregnancy, you should be aware of these and other potential problems you might experience. Preterm labor and birth pose the greatest risk to a multiple pregnancy. Cesarean section is often needed for twin pregnancies and is expected for delivery of triplets. Since preterm labor and birth present such serious risks, the pregnant mother must understand the warning s of early labor. Sometimes, preterm delivery can be delayed by a few days or more if it is detected early. Each day gained provides valuable fetal growth and development.
Once a woman is in advanced labor, delivery cannot be stopped. In rare instances, delivery of a second twin can be delayed. This delay, when possible, allows for continued growth in the protective environment of the uterus. Currently, there are no effective treatments to prevent preterm birth of multiples.
The placenta is attached to the wall of the uterus, and the fetus is attached to the placenta by the umbilical cord. The placenta provides blood, oxygen, and nutrition to the fetus through the umbilical cord. Placental function is more likely to be abnormal in a multiple pregnancy.
If the placenta is unable to provide adequate oxygen or nutrients to the fetus, the fetus cannot grow properly. The placenta ages prematurely and may slow fetal growth, especially late in the third trimester. Another placental problem is twin-twin transfusion, a life-threatening condition in identical twins. This transfusion occurs when blood flows from one fetus to the other through a connection in a shared placenta. Therapeutic amniocentesis and laser coagulation of blood vessels that link circulation to the twins in the placenta s may reduce complications of twin-twin transfusion.
Preeclampsia, also known as toxemia, occurs 2 to 5 times more often in multiple pregnancies. The condition may progress and threaten the health of the mother and baby. When severe, the mother may have seizures, and stroke or other life-threatening complications are possible. Women with multiple pregnancies are more likely to develop gestational diabetes during pregnancy.
Babies of diabetic mothers are more likely to experience respiratory distress and other newborn complications. However, gestational diabetes is common even in singleton pregnancies, and treatment is well established and effective. Preterm delivery places an infant at increased risk for severe complications or early death. Prematurity also may result in visual impairment or blindness.
Neonatal intensive care unit admission is required for one-fourth of twin and three-fourths of triplet deliveries. Despite these s, it is important to note that the vast majority of multiple-birth infants do survive. Fetal death occurs in about 1. Furthermore, compared to singleton pregnancies of the same birth weight, there is no ificant increase in the incidence of chronic lung disease or brain, eye, or gastrointestinal problems in multiple-birth infants.
Low birth weight of less than 5. The average birth weight is approximately 4 lb. As a result of prematurity, the risk for cerebral palsy is 4 times more likely to occur in twins. The rates are even greater for triplets and high-order multiple births. Birth weight also Number twins 10 closely Number twins 10 the severity of disability throughout the childhood years.
As noted above, the average birth weight even for quadruplets is well above this. Prevention during infertility treatment is the best approach to avoiding a multiple pregnancy. In ART cycles, limiting the of embryos transferred is an effective approach. Consult the ASRM Practice Committee Report titled Guidelines on of Embryos Transferred for recommendations regarding the optimal of embryos to transfer based on patient age, embryo quality, and other criteria.
In the United States, physicians and patients tly decide how many embryos to transfer. However, in England, no more than two embryos may be transferred in most cases. In Canada, a maximum of three embryos are recommended for transfer. The ultimate goal of ART is to achieve a high pregnancy rate while transferring a single embryo. While physicians can transfer two embryos and still maintain acceptable pregnancy rates, the transfer of one embryo is associated with good pregnancy rates in certain patient groups, thereby resolving the problem of multiple pregnancies caused by multiple embryo transfer.
Multiple pregnancies are a known complication of ovulation stimulation drugs. Most physicians monitor patients with ultrasound examinations and blood tests.
A woman with a large of ovarian follicles or high hormone levels has an increased risk of a multiple pregnancy, and the cycle may be canceled to avoid the risk. No proven way of reducing multiple pregnancies with superovulation has been identified, although preventing fertilization with development of more than three follicles is helpful in reducing high-order multiples. When a triplet or high-order multiple pregnancy occurs, multifetal pregnancy reduction may be considered to improve the chance for survival of the fetuses.
While multifetal pregnancy reduction carries some risk of a complete miscarriage, it also reduces the chances of extreme premature birth.
In order to achieve the best outcome with a multiple pregnancy, the expectant mother must work as part of the health care team. A nearly total change in lifestyle can be expected, especially after about 20 weeks into the pregnancy. There is an increased need for maternal nutrition in multiple pregnancies.
An expectant mother needs to gain more weight in a multiple pregnancy, especially if she begins the pregnancy underweight. With multiples, weight gain of approximately lb.
The pattern of weight gain is important too. Healthy birth weights are most likely achieved when the mother gains nearly one pound per week in the first 20 weeks. The increase in fetal growth with appropriate nutrition and weight gain may greatly improve pregnancy outcome at a minimum of cost. Many physicians who manage multiple pregnancies believe that a reduction in activities and increased rest prolongs these pregnancies and improves outcomes.
However, routine hospitalization for bed rest in multiple pregnancy has not been shown to prevent preterm birth. Women with high-order multiple pregnancies usually are advised to avoid strenuous activity and employment at some time between 20 and 24 weeks. Bed rest improves uterine blood flow and may be helpful for fetal growth problems. Intercourse generally is discouraged when bed rest is recommended.
Since preterm birth and growth disturbances are the major contributors to newborn death and disability in multiples, frequent obstetric visits and close monitoring of the pregnancy are needed. Prenatal diagnosis using a variety of new techniques can be done near the end of the first trimester to screen for Down syndrome and other genetic abnormalities. Amniocentesis may be performed between 16 and 20 weeks.Number twins 10
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