Support for multiple pregnancies

The importance of early diagnosis and management

The correct management of multiple pregnancies and delivery relies on an early diagnosis and an individualized approach for each patient. Before the introduction of ultrasound in obstetric practice, a woman could only learn of a multiple pregnancy at a late stage or during labor. Today, it is possible to accurately determine the number of fetuses from the earliest stages of gestation. This allows for the timely identification of potential risks and the adaptation of pregnancy management.

Multiple pregnancies have specificities in monitoring and management, whether natural or resulting from the use of assisted reproductive technologies (ART).

Particularities of managing multiple pregnancies

In the last 15 years, the number of cases of multiple pregnancies has increased significantly:

• The number of twins has increased by 50%.
• The number of triplets has quadrupled.

This growth is associated with:

• The hereditary factor.
• The age of women giving birth (especially after 35 years).
• The use of medically assisted reproduction (including ovulation induction and in vitro fertilization (IVF)).

Diagnostic methods

Modern diagnostic methods allow for early determination of multiple pregnancies:

• Transvaginal ultrasound - reveals the presence of multiple fetuses as early as 6 weeks of pregnancy.
• Transabdominal ultrasound is informative from 10 weeks of pregnancy.

Signs of multiple pregnancy

Signs of multiple pregnancy include:

• Rapid increase in the size of the uterus that does not correspond to gestational age.
• Significant weight gain, not associated with pre-eclampsia or increased appetite.
• Polyuria, increased uterine tone.
• Early fetal activity felt by the mother.
• Early development of late pre-eclampsia, anemia (iron deficiency).
• Simultaneous detection of heartbeats of multiple fetuses.
• Determination of twins or triplets upon palpation of the pregnant woman's abdomen.

Laboratory signs of multiple pregnancies

Confirmation of a multiple pregnancy through laboratory methods can be confirmed by:

• high levels of chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP).
• A decrease in hemoglobin levels and hematocrit count.
• Hypervolemia (increase in circulating blood volume).
• Frequent cases of glucose intolerance.

Protocol for managing multiple pregnancies

In managing a multiple pregnancy, it is important to determine the type of twins or triplets, as this affects the frequency of follow-up appointments and additional examinations.

Frequency of medical visits and ultrasounds

• Dichorionic diamniotic twins - check-ups with a gynecologist-obstetrician at 11-13, 20, 24, 28, 32 weeks; at 34 weeks without ultrasound, then at 36-37 weeks.
• Monochorionic diamniotic twins - examinations at 11-13, 16, 18, 20, 22, 24, 26, 28, 32, 34, 36 weeks.
• Monochorionic monoamniotic twins - examinations at 11-13, 16, 18, 20, 22, 24, 26, 28, 32 weeks.

Medical support for multiple pregnancies

As part of the protocol, the doctor prevents possible complications:

• Pre-eclampsia - monitoring blood pressure and biochemical indicators.
• Fetal respiratory distress syndrome - it is possible to take medications that promote lung maturation.
• Preterm labor - regular monitoring of the state of the cervix and adaptation of the pregnant woman's activity.

Additionally, it is recommended for women:

• To take folic acid to prevent neural tube defects.
• An increased intake of products or preparations containing iron to prevent anemia.

Optimal timing for delivery in case of multiple pregnancy

• For monochorionic (diamniotic) twins, the optimal timing for delivery is 36-37 weeks.
• For dichorionic twins, it is 37 to 38 weeks.
• For triplets, the most common delivery date is the 33rd week.

The management of labor depends on the position of the fetus, the condition of the mother, and the presence of any complications. The doctor decides on the method of delivery - natural labor or cesarean section - based on the obstetric situation.

Management of multiple pregnancies at Natuvitro clinic

The obstetricians and gynecologists at Natuvitro clinic have extensive experience in managing both single and multiple pregnancies. The specialists at the clinic offer an individualized approach, attentive monitoring of the future mother and her babies, as well as comprehensive medical support at all stages of pregnancy.

At Natuvitro, patients benefit from:

• Qualified management of pregnancy, taking into account its specificities.
• Modern methods of diagnosis and monitoring of the fetus.
• Information and psychological support at all stages of pregnancy.

Make an appointment for a consultation at Natuvitro clinic to receive a personalized management plan for multiple pregnancies and recommendations for its smooth progression!