What is Multiple Pregnancy?
Multiple pregnancy refers to the development of more than one embryo or fetus in a woman’s uterus at the same time. In a normal pregnancy, usually a single embryo settles in the uterus and develops into a single fetus, while in multiple pregnancies, more than one embryo settles in the uterus and develops into multiple fetuses. Multiple pregnancies can usually include twins, triplets, quadruplets or more.
Today, with the increasing use of assisted reproductive techniques (IVF, in vitro fertilization), the frequency of multiple pregnancies has also increased. Twin pregnancies are the most common of multiple pregnancies. Twin pregnancies usually occur in two ways: identical twins (monozygotic twins) and dizygotic twins (dizygotic twins). Identical twins are the result of the fertilization of one egg by one sperm and are babies who are usually very similar to each other because they have the same genetic material. Fraternal twins, on the other hand, occur when two eggs fertilized separately from different eggs develop and are not as genetically similar as monozygotic siblings.
Pregnancies involving triplets, quadruplets, and more are rare and usually occur as a result of multiple eggs being fertilized at the same time. The likelihood of such pregnancies varies depending on various factors, but generally, increasing maternal age, a family history of multiple pregnancies, and the use of assisted reproductive technologies increase the risk.
Multiple pregnancies can pose special conditions that may require medical monitoring and management, and therefore it is important to monitor them carefully. Such pregnancies are generally at a higher risk than normal and may require extra attention during the prenatal and postnatal period. Therefore, early diagnosis and appropriate management of multiple pregnancies are important.
Multiple Pregnancy Symptoms and Diagnostic Methods
Multiple Pregnancy Symptoms:
Abdominal Growth: Multiple pregnancies can often cause the abdomen to grow more rapidly than a single pregnancy. The mother may gain weight more quickly than normal and notice a significant increase in the abdominal area.
Bloating and Discomfort: Women carrying more than one fetus may experience more bloating and discomfort than those carrying a single fetus. This may be associated with greater pressure on the stomach and intestines.
Intensity of Movement: More than one fetus can move more in the womb, causing the mother to feel the movements of the fetuses more intensely.
Nausea and Vomiting: Multiple pregnancies can produce more pregnancy hormones than a single pregnancy, causing the mother to experience pregnancy symptoms such as nausea and vomiting more severely.
Diagnostic Methods for Multiple Pregnancy:
Ultrasound Examination: Multiple pregnancies are usually detected during routine ultrasound examinations. Ultrasound is a safe and common imaging method used to assess the presence of more than one fetus and the health of the fetuses.
Blood Tests: Some blood tests can help identify multiple pregnancies. In particular, beta hCG levels during pregnancy can be used to determine the likelihood of multiple pregnancies.
Doppler Monitoring: Doctors may use Doppler ultrasound to monitor the heartbeats of the fetuses in multiple pregnancies. This is done to confirm that each fetus is growing and developing healthily.
Amniocentesis or Chorionic Villus Biopsy: Genetic anomaly screening tests performed with double testing, triple testing, and most free DNA examination techniques are not used in multiple pregnancies because of their low reliability. Ultrasound measurement of nuchal translucency and detailed ultrasound evaluation at 20-24 weeks are strongly recommended. In rare cases, invasive tests such as amniocentesis or chorionic villus biopsy may be performed to detect genetic abnormalities in multiple pregnancies. These tests are used to analyze the genetic material of the fetuses and can be performed separately for each fetus in multiple pregnancies.
The symptoms of multiple pregnancies can vary from woman to woman and not every woman will experience the same symptoms. Therefore, it is important to consult a doctor in case of doubt. The doctor will direct the appropriate diagnostic tests and ensure that the multiple pregnancy is managed correctly if necessary.
Risks and Complications of Multiple Pregnancies:
Risk of Premature Birth: The risk of premature birth is higher in multiple pregnancies than in single-fetus pregnancies. Premature birth can cause babies to be born prematurely and develop health problems related to prematurity.
Low Birth Weight: The risk of low birth weight increases in multiple pregnancies because the uterus can provide insufficient nutrition for each baby and there may be limited space. Low birth weight can have long-term effects on the health and development of the babies.
Pregnancy Toxicosis: In multiple pregnancies, the mother-to-be may be at increased risk of pregnancy-related hypertension disorders such as preeclampsia or pregnancy toxemia. This can cause serious health risks for the mother and the baby.
Gestational Diabetes: Multiple pregnancies can increase the risk of gestational diabetes in expectant mothers. Gestational diabetes is a condition that occurs during pregnancy and causes higher than normal blood sugar levels, and can have serious effects on the health of the mother and the baby.
Placental Problems: Placental problems are more common in multiple pregnancies. Placenta separation early, placenta previa, or conditions such as the placenta covering the cervix can pose serious risks for both the mother and the baby.
Anemia and Bleeding: In multiple pregnancies, the risk of anemia and bleeding may increase in the expectant mother. The body may have to produce more blood to feed more than one fetus, which can increase the risk of anemia. In addition, due to the expansion of the uterus in multiple pregnancies, the blood vessels connected to the placenta may stretch more, which can increase the risk of bleeding.
Amniotic Fluid Problems: In multiple pregnancies, the amount of amniotic fluid may decrease or increase more quickly than normal. These changes in the level of amniotic fluid can affect fetal development and cause complications.
Since multiple pregnancies carry higher risks than singleton pregnancies, they require careful medical follow-up and management. Expectant mothers and healthcare professionals should be aware of the possible risks throughout pregnancy and take appropriate precautions when necessary.
Treatment and Monitoring of Multiple Pregnancies:
Regular Doctor Check-ups: Regular doctor check-ups are important in multiple pregnancies. During these check-ups, the health status of the mother and the babies are evaluated, any potential complications are detected early and appropriate treatment plans are created.
Nutrition and Vitamin Supplements: Healthy nutrition is important in multiple pregnancies. The mother-to-be should consume sufficient quality food to get the extra nutrients the babies need. In addition, iron, folic acid and other vitamin supplements recommended by the doctor should be taken.
Rest and Stress Management: It is important for the mother-to-be to rest and manage stress in multiple pregnancies. High stress levels and excessive physical activity can negatively affect the pregnancy process and increase the risk of complications.
Premature Birth Risk Management: The risk of premature birth is a significant concern in multiple pregnancies. Doctors can take appropriate measures to reduce the risk of premature birth. These measures may include bed rest, medication and medications to control uterine contractions.
Birth Planning: Birth planning should be done carefully in multiple pregnancies. Doctors determine the most appropriate delivery method to protect the health of the mother and babies at the highest level. In multiple pregnancies, since the babies are mostly positioned in the uterus and the way they come is breech or lateral, cesarean delivery is preferred, but in some cases where both babies come in cephalic presentation and conditions are suitable, vaginal delivery may also be possible.
NICU (Neonatal Intensive Care Unit) Preparation: In multiple pregnancies, since the babies are likely to be born prematurely, NICU preparation before birth is important. The NICU is a unit that provides expert care for premature babies and it is important that the necessary medical equipment and personnel are ready to protect the health of the babies.
In multiple pregnancies, proper treatment and monitoring are vital to protecting the health of the mother and the babies. Expectant mothers should fully comply with the treatment and monitoring plans recommended by their doctors and share any concerns or questions with their doctors.
Nutrition and Care Recommendations for Multiple Pregnancy:
Balanced and Varied Nutrition: A balanced and varied nutrition plan is very important in multiple pregnancies. The expectant mother should follow a healthy and balanced diet to provide all the nutrients required for each baby. This includes a nutrition plan that includes fruits, vegetables, whole grains, protein sources, and healthy fats.
Protein Intake: Protein intake is important in multiple pregnancies because protein is a basic building block for the growth and development of babies. Focus on high-quality protein sources such as eggs, fish, chicken, red meat, dairy products, legumes, and tofu.
Folic Acid and Iron Supplements: It is important to take folic acid and iron supplements in multiple pregnancies. Folic acid is critical for the development of the baby’s spine and brain, while iron is necessary for the increase in blood volume of the mother and the baby. It is important to take the supplements recommended by the doctor regularly.
Fluid Intake: Adequate fluid intake is very important during pregnancy, but it is even more important in multiple pregnancies. Drinking plenty of water supports the mother’s body functions, provides fluid balance and relieves common pregnancy symptoms such as constipation.
Snacks: Regular snacks are important in multiple pregnancies because the mother’s energy needs increase. Healthy snacks help balance blood sugar levels and maintain energy levels. Nutritious snacks such as dried fruit, yogurt, nut butter, and whole grain crackers should be preferred.
Caffeine and Alcohol Consumption: Caffeine and alcohol consumption should be limited in multiple pregnancies. Caffeine and alcohol can negatively affect the health of babies and increase the risk of premature birth. Therefore, the consumption of caffeinated beverages and alcoholic beverages should be reduced as much as possible or preferably stopped completely.
Follow the Doctor’s Recommendations: Most importantly, the expectant mother should follow her doctor’s recommendations exactly. The doctor can create an appropriate nutrition plan by taking into account the expectant mother’s special condition and make recommendations according to her needs during pregnancy.
Paying attention to nutrition and care measures in multiple pregnancies is important to protect the health of the expectant mother and the babies. Maintaining a healthy lifestyle can make pregnancy more comfortable and reduce the risk of complications.
Birth Process and Postpartum Care in Multiple Pregnancy:
Planning the Birth: Birth in multiple pregnancies should be planned carefully. Doctors usually prefer a planned cesarean section in multiple pregnancies, but in some cases, vaginal birth may also be appropriate. The birth plan is determined by considering the health of the mother and the babies.
Close Monitoring of Birth: The birth process is carefully monitored in multiple pregnancies. Doctors constantly monitor the babies’ heartbeats and can intervene quickly in case of any complications. The risk of complications during birth is higher in multiple pregnancies, so the birth is closely monitored.
Postpartum Care: Postpartum care is very important in multiple pregnancies. The expectant mother should be supported during the postpartum recovery process and receive medical help when necessary. The risk of postpartum depression may also increase in multiple pregnancies, so attention should be paid to the emotional and psychological well-being of the expectant mother.
Newborn Care: The newborn care of babies born in multiple pregnancies may require special attention. Since multiple babies are more likely to be born prematurely, they should be carefully monitored after birth and receive specialist care in the neonatal intensive care unit if necessary.
Breastfeeding Support: Breastfeeding is important for the healthy growth and development of babies in multiple pregnancies. The expectant mother should be supported appropriately in breastfeeding and should seek help from experts in breastfeeding when necessary. In multiple pregnancies, breastfeeding more than one baby can be difficult, so extra care may be required in breastfeeding.
Family Support: In multiple pregnancies, the expectant mother and family can receive extra support in the postpartum period. Family members can help with housework, provide support in baby care, and support the expectant mother emotionally. In addition, receiving professional support can also be beneficial, especially when help is needed in the postpartum period.
In multiple pregnancies, the birth process and postpartum care should be carefully planned to protect the health of the expectant mother and babies. During the birth and postpartum care process, Assoc. Prof. Dr. Esra ÖZBAŞLI’s recommendations should be followed carefully and medical help should be sought when necessary.
