Multiple pregnancies: Symptoms ,Causes, and Treatment

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More than one fetus is developing in the mother’s womb; it is called numerous pregnancies. It may be twins(two fetuses), triples(three fetuses), quadruplets(four fetuses), quintuplets(four fetuses), sextuplets(six fetuses).

Dizygotic twins (non-identical):

  • Dizygotic twins from two separate ova that are fertilized by two separate spermatozoa.
  • It may not be from the same ovary. 
  • Twins may be the same sex or maybe different sex.
  • They are having two placentae, two amnions, two chorions, and two umbilical cords.
  • The Dizygotic twins’ ratio is more common than monozygotic twins.

Monozygotic (identical) twins:

  • Monozygotic twins developed from a single ovum by fertilization of single sperm.
  • They are from the same sex.
  • They have similar physical, mental characteristics or blood group but not the fingerprints. 

Superfecundation:

  • It is the fertilization of two ova produced in the same menstrual cycle and by two spermatozoa and deposited in two separate acts of coitus.

Superfoetation 

  • It is the fertilization of two ova produced in two different menstrual cycles by two separate spermatozoa.

Examination of placenta and membranes

Dizygotic Twins

  • Dizygotic twins have two placentae; maybe they are entirely separated or fused. 
  • Amnion and chorion are there to surrounding the fetuses. 
  • Intervening membranes consist of 4 layers-amnion and chorion.

Monozygotic twins

  • The placenta is single.
  • The intervening membrane consists of two layers of amnion only.

Factors affecting the twinning 

  • Unknown causes Family history of the mother
  • Increased maternal age
  • Nutritional factors: heavy body women.
  • Infertility treatment 
  • High gonadotropin hormone.
multiple chemical pregnancies
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Clinical presentation of multiple pregnancies

Symptoms:

  • Increased nausea, vomiting
  • Increased pressure symptoms: constipation, pedal edema, varicosity of veins, palpitations, precordial pain
  • Fatigue, indigestion, backache, sleeplessness
  • History off over distension
  • History off premature labor
  • Excessive fetal movements
  • Ovulation-inducing drugs

Signs:

  • Size of the uterus: large than normal
  • Pressure symptoms: due to pressure on the diaphragm by enlarging uterus ex: breathlessness, palpitation
  • Anemia
  • Edema
  • Weight gain: more than normal
  • Malpresentation
  • Hydramnois
  • Pre eclamptic toxemia
  • Edema
  • High BP
  • Protein in the urine

Also read: Headache And Vomiting: How To Deal With It?

Diagnosis of multiple pregnancies

History

  • History of ovulation including therapy
  • Family history of twins – maternal side

Obstetrics Examination

Inspection

  • Enlargement of the abdomen in the second trimester. of pregnancy Palpation 
  • Fundal height is significant for the date by 4cm/more after 22 weeks
  • Two relatively small heads or three fetal pole or two fetal parts are usual signs.

Auscultation 

  • Two fetal heart sounds at a difference of 10 beats/min are heard by two auscultation at two sites.

Tape measurement

  • Abdominal girth at umbilicus shows measures in inches more than the corresponding action at gestation weeks at 30 weeks 30 inches.

Vaginal examination

  • One head will feel in pelvis & another one at brim or fundus.

USG

  • Congenital malformation
  • Conjoined twins diagnosed

Radiology

  • 28-30 weeks to diagnose twins, presentation, fetal death, gross congenital anomalies.

Complications of multiple pregnancies

Maternal complications

  • Pre-eclampsia
  • Hydramnios 
  • Antepartum hemorrhage Malpresentation Preterm labor
  • Mechanical distress nausea 
  • Vomiting 
  • Anemia
  • Early rupture of membranes and
  • Cord prolapse
  • Prolonged labor
  • Increased operative interference Bleeding
  • Postpartum hemorrhage
  • Infection

Fetal complications 

  • Congenital problems
  • Fetal anomalies 
  • IUGR

Management

  • Hospitalization
  • Frequent antenatal visit
  • Ante partum surveillance: USG examinations
  • Corticosteroids for the lung maturity of the fetus.
  • Proper diet
  • Tests of fetal well being
  • Adequate rest
  • Prophylactic tocolytics

For further reading

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