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Multiple Pregnancy

Multiple Pregnancy

The incidence of multiple pregnancies was 1/85 for twin, 1/85² (1/7225) for triplets, and 1/85³ (1/614,125) for quadruplets in the period before the widespread use of in vitro fertilization methods. Later, these rates increased, and now they have decreased to the old rates as a result of the application restrictions on in vitro fertilization methods. Due to the problems encountered, the follow-up of multiple pregnancies has gained importance.

2/3 of twin pregnancies are fraternal and 1/3 are identical twins. The risks are much higher for identical twins. For this reason, it is necessary to make a distinction in early pregnancy. After the diagnosis of twins is made by ultrasound at the 6th week of pregnancy, gestational sacs and placentas are examined to determine whether they are identical or fraternal twins.

A twin pregnancy is more risky for both mother and babies than a singleton pregnancy. During pregnancy, there is a need to follow up more strictly and every two weeks.

The risk of miscarriage is higher in the first 3 months of pregnancy. Nausea and vomiting are more common. Complaints such as dizziness and fainting have increased. During these weeks, the same routine examinations in singleton pregnancy are performed. As soon as the nausea is over, the blood pill is started. Anemia is more common.

11-14 to understand Down Syndrome in babies in twin pregnancy. Double testing is done weekly. Triple testing is not used. In single pregnancies, amniocentesis is performed after the age of 35, while amniocentesis is performed at the age of 32 in twins. Urine culture is performed with it.

From the 4th month, called the second trimester, it is seen that the mother’s womb grows faster. The calorie requirement of the mother increased by 300 kcal/day compared to the singleton pregnancy. Nutritional supplements are provided. If necessary, it is taken under dietitian follow-up. The onset of edema and high blood pressure in this early period, especially during the hot season, are important alarms.

Blood pill support is increased to prevent anemia. Calcium is started. Since the rate of anomalies is high in multiple pregnancies, routine ultrasound and level 2 examination at 21 weeks are carefully performed. By the way, since gestational diabetes, which we call gestational diabetes, is more common in twins, latent sugar is checked at the 25th week.

Attention after 30 weeks!

         Twins show the same development as singleton pregnancies until the 30th week. However, after the 30th week, it is normal for the weight to start to fall back compared to the singleton. After 30 weeks, follow-up should be more frequent. Because weight gain is rapid in pregnant women, and preeclampsia and blood pressure problems are more common. It is necessary to keep weight gain under control by eating a diet low in salt, low in fat and carbohydrates, walking as much as possible and doing sports as much as possible. The sport should not be anaerobic. The size of it; is that the intensity of sports never leaves the pregnant woman out of breath. What we call a pregnant “talk test” is the ability to talk without difficulty while doing sports.

Anterior or dislocated placenta is more common. Infants may experience growth retardation, and one infant may receive the blood supply of another. Amniotic fluid may increase a lot. The way babies enter the birth canal can be problematic. For all these reasons, the risk of premature birth has increased 10 times. The mean week of delivery is 36:37 weeks, and the risk of operative delivery and postpartum hemorrhage is also increased. For these reasons, the clinic where the delivery will take place must be determined at the 30th week, this clinic should have the equipment and experience to follow up high-risk pregnancies, and the standards of the neonatal intensive care unit (NICU) should be high.

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