1. Etiology of multiple pregnancy.
2. Diagnosis of multiple pregnancy during pregnancy.
3. Clinical study.
4. Treatment of multiple pregnancy.
The introduction of pregnancy is a happiness for multiple babies, and a woman’s pregnancy is a double happiness. Undoubtedly, the birth of two children at once is wonderful, but not a multiple pregnancy, pregnancy always proceeds smoothly and without such.
Complications of pregnancy makes increased demands on the body, so the expectant mother must be with particular attention to her condition. Special nutrition, prevention, mode of possible complications – this is an incomplete list of conditions for the safe flow of multiple pregnancies.
Pregnancy Multiple fetuses can occur: as a result of fertilization or two more simultaneously ripened poliovuli (eggs), as well as with the development of two more or embryos from one fertilized egg (Gemini).
polyembryony, formed from two (three, etc.) ovules, are called dvuayaytsem (multi-ovum), arising from one – identical.
objectives and purpose of the essay:
– consider the causes of multiple fetuses;
– pregnancy on the diagnosis, clinical research and treatment of multiple pregnancy.
1. Etiology of multiple pregnancy
definition According to the medical dictionary, twins and twins are one and the same. But colloquially, twins are called dizygotic twins, who developed from two fertilized eggs. But identical twins are obtained if the fertilized egg cell completely divides, forming two identical completely embryos.
The separation of a fertilized egg by unknown causes occurs and the nascent monozygous twins of the same sex are the same, have the same set of blood genes and resemble each other like drops of water. But dizygotic ones that are close to each other can be both surprisingly similar, and not so similar to each other – after all, they have a different set of genes. Fraternal twins are heterosexual and blood group they may also differ.
Gemini already conceiving is a small theory and a miracle to explain a multiple pregnancy can be found very much, but from these explanations it will not be a miracle to be a miracle. And yet these most theories talk about the causes of pregnancy dizygotic twins.
is the hereditary ability of a woman to produce two eggs at once. It should be noted that in the female body ovulation can occur simultaneously in two and one, in the ovaries of the ovary can grow two more and follicles, and in one follicle there can be several eggs. Multiple ovulation 10 times increases the birth probability of twins. The other side of the hereditary birth to the predisposition of twins – if in your family family or husband has already happened multiple If. pregnancy you or your spouse from twins, what, the chance your kids will also be very twin. But it will be even higher for your daughter, because after a generation of occurrence the probability of multiple pregnancy increases.
Frequently, for a long time when being treated for infertility, the couple becomes the parents of unexpectedly twins. It was not – was not, and here are two at once. When this happens at the stage of artificially preparing for fertilization, it is doubly unexpected. it would have already seemed to go to the last step – in vitro fertilization and suddenly you realize that in the first second, and in pregnant expecting twins. This is due to the fact that hormonal therapy stimulates the middle exit in the egg cell cycle, but when the drug is too high a dose, not even one but two or more eggs come out of the follicle. 35% of all multiple pregnancies are caused precisely by the administration of drugs, the work of stimulating ovaries.
or IVF fertilization in vitro and in general often induced pregnancy is the cause of multiple pregnancies. artificially When fertilized, 3 to 6 previously fertilized in vitro embryos are placed in the mother’s uterus. Depending on the health and the mother’s body, pregnancy occurs with a probability of 40%, and almost everyone can take root. In the future, doctors will offer to make a reduction – remove one or several embryos, especially if there is a development in the lag of the fetus. However, often the fading occurs in the development of a “non-viable” embryo at the earliest gestational age, and the rest survive and are born completely healthy twins.
pregnancy assumptions about the possibility of re-conception already at the onset of pregnancy. As a rule, with pregnancy, ovulation stops. But in the event that this is not the case, conception is possible on the background of a recent pregnancy, including from various partners. This assumption suggests that the conception of the fruits of two can occur with a difference of several Question. The days of re-conception and fertilization at the onset of pregnancy, occurs when an ultrasound scan shows the age of dysygotic fetuses. And all the more likely it is only in this situation that we are simultaneously talking about the fertilization of two eggs and the possible development of a violation of one of the fruits. The smaller fetus will catch up and the second fetus may then develop normally in pregnancy. In the case of intrauterine death from the fetus in early pregnancy, the second fetus is able to survive and develop without a situation. In pathologies, when the age of dysygotic fruits is differently set, a clear control of the doctors and repeated timely ultrasound are needed. It is also possible that the doctor will insist on abortion if the second fetus is dramatically lagging behind in development. And still it’s possible to draw any conclusions on this, only considering the dynamics of the development of both embryos.
A bamniotic (diamniotic) is called a monozygous (twins) identical in which the embryos are located at some distance from each other and each form an amnion, a water membrane, that is separate for itself. They have a common placenta and a common chorial membrane, they are also called the surrounding monochorial. In case both of the embryo are located closely, they form one amniotic common sheath and it is called monoaminiotic Everyone. twins from dizygotic (dvuayaytsevyh) baby forms itself for a separate amniotic bladder and has its placenta. Sometimes both placenta are located and this confuses a number of specialists and ultrasound mothers. However, as we have already noted, identical twins are identical and always of the same sex.
2. Diagnosis of multiple pregnancy during pregnancy
Before the introduction of the ultrasound study into a wide clinical practice, in most cases the diagnosis of multiple pregnancy was made only in accordance with. According to M. Faroogui et al., who analyzed all cases of multiple pregnancies in 1953 from 1973, almost 60% of non-birth twins were diagnosed, and in 31% of cases, the presence of a second fetus was found in birth after the ultrasound.
The first study allows not only to carry out the diagnosis of early multiple pregnancy, but also to determine:
position and fruit of breeze;
the nature of the development of the fruit;
localization, amount and structure of the placenta;
the number of amniotic cavities;
amniotic fluid volume;
congenital malformations and death of antenatal fetuses;
the state of the fruit from the functional point of view;
the nature of the IPC and FPC using trimester.
In Doppler ultrasound I, the diagnosis of multiple pregnancy is based on two identifying and more ultrasound contours of fetal starting eggs from the 4th-5th week of pregnancy.
After a broad ultrasound study in the second trimester, the percentage of accurate multiple pregnancy diagnosis of pregnancy has increased significantly. According to P. et al. And Persson., After the introduction of the routine ultrasound trimester in study II, an accurate diagnosis of multiple pregnancy was made in 98% of cases. The same perinatal authors compared the outcomes in cases where the multiple pregnancy diagnosis was made before delivery and in cases. In the birth of early diagnosis of twins, low more perinatal mortality, a later term of delivery, fewer babies with a low body weight, and no births of children with bodies weighing less than 1500 g were noted.
Ultrasound examination, trimester in I carried out pregnancy, is of great importance to multiple pregnancy during pregnancy. Its tasks are: 1) the number of definition of fruits; 2) determination of the type of placentation and establishment; 3) amnionality of the development of the fruit; 4) diagnosis of congenital malformations and markers of chromosomal abnormalities.
As an ultrasound, the rule in the first trimester is carried out with the use of transvaginal access, which allows visualization of the fetal egg already at 4-5 weeks of gestation. The number of fetal allows bags to establish chorinity already from the 5th week.
pregnancy from 6 weeks can be clearly visualized and count the number of yolk sacs. The size of the yolk is in the bag time is 2-4 mm. The yolk sac itself is a rounded thin-walled formation located in the choriological cavity and communicating with the embryo through the yolk beginning. the channel from 6 weeks can also count the number of embryos with the assessment of their cardiac activity.
Amniotic number of cavities is determined from the 8th week of pregnancy: a) each if the ovum contains one yolk sac and one fetus, the amnionality corresponds to the placenta type,
b) if the egg contains two yolk sacs and two fetuses with cardiac activity, then the amniotic number of cavities may be greater, the number of placentas (monochorial diamniotic) or monochorial (same monoamniotic). In this case, it is possible to determine precisely the amnionality after 8 weeks, when the amniotic membranes begin to be clearly visualized;
c) if the egg contains one yolk sac and two fetuses with cardiac activity, the number of amniotic cavities will correspond to the type of placentation (monoamniotic monochorial).
From 9 to 10 weeks, fast obliteration of the extra-embryonic space begins due to an increase in the amniotic cavity. When diaminotic double amniotic septum between the sacs thick, contains choriological, the tissue is located between the shells in the form of echographic. wedge this symptom is described as a form of lambda shaped placental tissue in the amniotic region.
The septa of a monochorial diamnotic pregnancy, as the egg grows and the obliteration of the extraembryonic space proceeds, the amniotic cavities begin to come into contact with each other, forming a thin separating membrane. The separating membrane fits the wall of the uterus at an angle of 90 °, which is indicated by the T-shaped connection.
Traditionally, for many years, SFGH was diagnosed retrospectively on a neonatal basis on the period of difference in Hb content (50 g / l and more) in peripheral blood twins and differences in the mass of newborns (20% and However). a more significant difference in Hb level and mass is characteristic of newborns and for some bihorial twins, which, in connection with recent years, these indicators are no longer considered as signs of SPFG.
On the basis of the ultrasound criteria, the stages of SPFG (Quintero R. et al, which), 1999 are used in practice to determine the management of pregnancy tactics:
Stage I: the bladder is determined by feradonor;