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more than one fetus. Giving birth to twins is the most common form of multiple pregnancies. In human, multiple pregnancies are very rare. They are more common in the animal kingdom. One, out of 80 women, gives birth to twins. The other forms of multiple pregnancies are too rare, with only one in every 6,400 women giving birth to triplets. Higher order multiple births like quadruples and quintuplets are ever rarer. However, high order multiple pregnancies are not completely unknown. Many times, the babies are safely delivered and they have good chances of survival too. There have been a few cases of octuplets (eight offspring) too. Only one of them died at birth, while the rest are still leading a normal like. Frequencies of multiple pregnancies: Twins are born to one in 80 women. Triplets are born to one in every 6400 women, while the higher order pregnancies happen to one in every 700,000 women. However, in most cases of higher order multiple pregnancies, the babies fail to survive for too long There are three subtypes of multiple pregnancies:
Monozygotic: When one zygote (egg), splits into two or more embryos. Monozygotic pregnancy gives birth to identical twins, of the same sex, as all the embryos are carrying the same genetic material from one single zygote. These twins are maternal twins Dizygotic: When more than one ovum is released during the menstrual cycle, and each one of them are then fertilized by more than one sperm, it gives birth to dizygotic twines. These twins are genetically different from one another, and can also have different sex; they are also caller fraternal twins. Polyzygotic: This case is a combination of monozygotic and dizygotic twins. It is a very rare process. Most multiple pregnancies are a result of polyzygotic phenomenon.
Causes of Multiple pregnancies:
Naturally: Twins, triplets and quadruples may bear naturally, by fertilization of multiple eggs or splitting of the eggs. Fertility treatment: Fertility reproduction and Assisted Reproductive technology (ART) may result in the higher orders of multiple pregnancies. Fertility drugs enable the maturation of more than one egg in one menstrual cycle. As a result, each of these eggs gets fertilized to cause multiple pregnancies. Old age: As women grow old, their hormonal systems start altering. Follicle-stimulating hormones are secreted more in women who are above 35. This may result in multiple pregnancies. Genetic: Multiple pregnancies may be genetic in the woman’s side of the family. Race: Multiple pregnancies are more common amongst the black Africans.
Risks of multiple pregnancies: Incomplete separation: The twins may be physically joined, sharing the same amniotic sac, leading to entanglement and suppression of umbilical cord. Their internal body parts may not be properly functioning. They have low birth weight. The mortality rate of the children is generally very high. Many times it may also lead to prenatal deaths.
especially when they are below one. and your pregnancy week. If possible keep a good certified midwife. . Women cannot opt for normal delivery in case of multiple pregnancies. which you may not be able to handle alone. whether you are having the right weight or not. Also increase your protein intake. neighbors etc. and vulnerable. Listen to all his instructions very carefully. if you are giving birth to more than one baby. 50% of the twins 90% of the triplets are born preterm. including a governess. if you have multiple pregnancies.Most of the multiple pregnancies lead to preterm births. Taking care of multiple babies: It may be very difficult for you to take care of your kids all alone. Multiple babies may be very weak. You too observe the same. who can deal with the occasional complications of pregnancy. and then touch the babies. involving a lot of life risks. They may be born with several problems in their central nervous system. Take more calcium and folic acid. Make regular visits to the doctor. Wash your babies’ and your clothes with a soft antiseptic soap. Clean your nipples with warm water before feeding your kids. chorions. If you are having multiple babies. and placentas (see the image below). you are surrounded with good available doctors. then you are likely to gain more weight. with several physical and immunity problems. So keep them very safe and secured. However. The most common one being cerebral palsy. You can rather consider yourself different. Dizygotic twins have separate amnions. Do not touch them immediately after one comes home from outside. It is very painful and unbearable. Ask the doctor what food would suit you best. away from all infections. you might be asked to visit the doctor more often. considering the number of fetus you are carrying. Do not carry more than two babies with you. or two at a time. So be sure that by third trimester. Eat about 300 calories for each fetus in a day. If a caesarean operation in not done at the right time. each kid will have a different timings and different demands. Do breast feed them regularly. In you are having multiple pregnancies. This is because. Feed the babies one by one. It would be the best source of nutrition for them especially if they are preemies or underweight. How to prepare for multiple pregnancies: Take very hygienic and healthy pregnancy diet. nurse. Diamniotic/dichorionic placentation. Multiple pregnancies can often lead to preterm labor. So take every care and precautions to have an enjoyable motherhood with multiple kids. an old female family member. Pathophysiology The 2 types of twin pregnancies are dizygotic and monozygotic. it may lead to death of the mother too. it involves a lot of risk and so you would be luckier if your babies are bonny and healthy. You need it more. wash the hands properly with antiseptic. Dizygotic twins develop when 2 ovum are fertilized. So try to involve as many people as possible. Ask your doctor. Make the person change the clothes. and some experienced female family members.
Approximately two thirds of twins are dizygotic. then the monozygotic fertilized ovum only partially splits resulting in conjoined twins. Monozygotic twins develop when a single fertilized ovum splits after conception. Trizygotic triplets occur when 3 sperm fertilize 3 ova. and approximately 3 per 1000 in Asians). Birth rates of dizygotic twins vary by race (10-40 per 1000 in blacks. Diamniotic/monochorionic placentation.The placentas in dizygotic twins may fuse if the implantation sites are proximate. These dichorionic twins have different placentas that can be separate or fused. 7-10 per 1000 births in whites. Monoamniotic/monoamniotic placentation. If twinning occurs more than 12 days after fertilization. monochorionic/monoamniotic placentation occurs (see the image below). For example. Approximately 30% of monozygotic twins have dichorionic/diamniotic placentas. . however. only 1% of monozygotic twins have this form of placentation. dizygotic. Finally. The fused placentas can be easily separated after birth. within 2 d after fertilization) of monozygotic twins produces separate chorions and amnions. maternal age (ie. Zygosity in quadruplets and higher order multiples also varies. An early splitting (ie. triplets can be monozygotic. the examination may not always help determine zygosity. These twins can develop twin-to-twin transfusion syndrome (TTTS). increasing frequency with increasing maternal age ≤ 40 y). or trizygotic. Although the evaluation of the placenta or placentas after the birth is important in all multifetal pregnancies. Monochorionic/monoamniotic twins are rare. If splitting occurs later (ie. Epidemiology United States The incidence of monozygotic twins is constant worldwide (approximately 4 per 1000 births). 3-8 d after fertilization) results in monochorionic/diamniotic placentation (see the image below). most artificially conceived twins are dizygotic. and other factors such as parity and mode of fertilization (ie. 6-10% are monozygotic). 912 d after fertilization). Approximately 70% of monozygotic twins are monochorionic/diamniotic. Monochorionic/monoamniotic twins have a common placenta. and development scenarios that involve ovum and sperm. Triplet pregnancies result from various fertilization. splitting. Later splitting (ie. 2 consecutive zygotic splittings with a vanished fetus can also result in monozygotic triplets. Dizygotic triplets develop from one set of monozygotic cotriplets and a third cotriplet derived from a different zygote. with vascular communications between the 2 circulations.
Since 1970. combining for a total preterm delivery rate of 12%. Because of advancements in perinatal and neonatal care. and intrauterine growth retardation. From 2004–2006. 5] The risk of cerebral palsy in multiple fetus pregnancies parallels decreasing gestational age. A second association during the late preterm period (34-37 weeks' gestation) may correlate with the increasing maternal morbidities of multiple fetal pregnancies during this time frame (ie. In the United States.000 births. Divergence from singleton growth curves occurs at approximately 32 weeks' gestation in twins. compared with the decreasing prevalence of higher order multiple deliveries. patent ductus arteriosus.and length of hospital stay. necrotizing enterocolitis. demonstrate no statistical difference between singletons and multiples. and delivery complications (eg. including intraventricular hemorrhage. Other major morbidities. hypertensive disorders. combining for a total low birth rate percentage of 8%. periventricular leukomalacia. and approximately 90% are dizygotic. 11% of singletons were premature (< 37 weeks' gestation) and 61% of multiples were premature. 33 weeks for triplets and 28 weeks for quadruplets.000 births. International The birthrate of monozygotic twins is constant world wide (approximately 4 per 1000 births). the major issues that affect neonatal outcome of multiple fetal pregnancies include preterm delivery. operative delivery. In a prospective cohort study of monochorionic twins followed up from the first trimester until a mean age of 24 months. cord accidents. The highest birth rate of dizygotic twinning occurs in African nations. and 27 weeks' gestation in quadruplets. The mean gestational age at delivery is approximately 37 weeks for twins. retinopathy of prematurity. low birth weight. Neonatal outcomes at specific gestational ages and birth weights are similar to singleton pregnancies. Cesarean delivery.Naturally occurring triplet births occur in approximately 1 per 7000-10. naturally occurring quadruplet births occur in approximately 1 per 600. the prevalence of multiple births has been increasing. placenta previa. premature rupture of membranes. a plateau in the prevalence of multiple births has been observed since 2004. and the lowest birth rate of dizygotic twinning occurs in Asia. Ortibus et al found that twin-to-twin transfusion syndrome and assisted conception increased the risk of both death and neurodevelopmental impairment. hyperemesis gravidarum. Mortality/Morbidity Multifetal pregnancies are high-risk pregnancies. whereas early onset discordant . postpartum endometriosis). 29-30 weeks' gestation in triplets. preterm labor. The Yorubas of western Nigeria have a birth rate of 45 twins per 1000 live births. A combination of factors including the widespread use of assisted reproductive techniques and advancing maternal age at conception are associated with this phenomenon. malpresentation. polyhydramnios. Multifetal pregnancies are complicated by a higher incidence of hypertensive diseases. Specific morbidities in multiple fetal pregnancies are controversial. placental insufficiency). Neonates born to multiple fetal pregnancies may have a higher risk of acute respiratory morbidities. placental abruption. fetal growth restriction. In 2006 in the United States. such as respiratory distress syndrome but do not have a higher incidence of chronic lung disease.[4. the prevalence of twin deliveries in the United States has remained stable at approximately 32 per 1000 live births. anemia. 6% of singletons had low birth weight (birth weight < 2500 g) and 59% of multiples had low birth weight. nosocomial infection . The neonatal mortality rate in multiple fetal pregnancies is similar to singleton rates and parallels decreasing gestational age. The percentage of very low birthweight neonates (birth weight < 1500 g) was 1% in singletons and 11% in multiples. Birth rates of dizygotic twins vary by race. combining for a frequency of 1%.
Physical Women with multifetal pregnancies may have a uterine size that is inconsistently large for dates and may experience accelerated weight gain. and race. hypoxia. Fetal echocardiography: This is used to screen for congenital heart disease in neonates. Echocardiography: This is used to screen for congenital heart disease. 90% resulted in both twins surviving. more than one fetal heart rate may be heard. or family history of dizygotic twins should alert caregivers to the possibility of a multifetal pregnancy. periventricular leukomalacia. Neonatal: Chest radiography is used to evaluate respiratory distress. mortality was 8% and neurodevelopmental impairment occurred in 10% of infants. including screening for hypoglycemia and hypocalcemia.growth increased only the risk of death. and 6% resulted in no survivor. acidosis. family history of dizygotic twins. Overall. Laboratory Studies The evaluation of a multifetal pregnancy involves routine prenatal and postnatal care. Obstetrical: Routine prenatal laboratory studies are indicated. . Guidelines for complicated multifetus pregnancies have been established by American College of Obstetricians and Gynecologists. Upon auscultation. ABG and cord blood gas (CBG): These are measured to evaluate for respiratory distress. Bilirubin level: This is obtained to screen for increased risk of hyperbilirubinemia associated with prematurity and polycythemia. use of ovulation-inducing drugs. as well as specific evaluation directed by the type of multiple pregnancy and neonatal complications. Maternal complaints of excessive weight gain. hyperemesis gravidarum. Fetal MRI: This is used to screen for fetal anomalies. History Most multifetal pregnancies are prenatally diagnosed. Imaging Studies Obstetrical: Prenatal ultrasonography is used to confirm multifetal pregnancy and to monitor intrauterine fetal growth. Metabolic panel: Fluid and electrolyte levels should be obtained and metabolic status should be determined. and perinatal depression. 4% resulted in 1 survivor. Causes Risk factors for multifetal pregnancy can be divided into natural and induced. Ultrasonography: This is used to screen for intraventricular hemorrhage. Neonatal: A CBC count is obtained to evaluate for anemia and polycythemia. the sensation of more than one moving fetus. Risk factors for natural multifetal pregnancy include advanced maternal age. Of the 136 pregnancies studied. and abdominal abnormalities. Induced multifetal pregnancies occur following infertility treatment via the use of ovulationinducing agents or gamete/zygote transfer.
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