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Multiple Pregnancy

Multiple pregnancy is pregnancy of more than one fetuses such as two (twin), three (triplet), four (quintuplet) or more.

Type of Multiple Pregnancy

Monozygotic twins means the twins come from a single fertilized oocyte and sperm which later develop and separate into two different fetus. This type of twin also called identical twin because they are genetically identical. They will be the same sex and look exactly alike. There are cases where the twin not separated completely and remain attach at some parts of their body at birth. This is called conjoined twin or Siamese twin.

Dizygotic twins means the twins are formed from two or more separate oocytes and sperms which later develop individually in two different gestational sacs and placentas. This type of twins also called fraternal twin. They are not genetically identical. The twin can be the same sex or different and not physically identical.

 Causes of Multiple Pregnancy

1.
Heredity-If you have twins in your family, there are higher chances for you to get multiple pregnancy.
2.
Advance age-women over 30 years of age have higher chance of getting twin. This is caused by changes of hormones in the body that cause the ovulation of more than one oocyte as in younger women.
3.
Infertility treatment-Infertility regime that is use in infertility treatment which stimulates the maturation of more than one oocyte can lead to multiple pregnancy. Those who undergo assisted reproductive technique also have higher chances of getting multiple pregnancy because most of the time multiple embryos is transferred into the uterus.

 Signs and Symptoms of Multiple Pregnancy

1.
Excessive weight gain-Early weight gain in the first trimester can be a sign of multiple pregnancy. This is due to increase in uterine size and blood volume.
2.
Large gestational sac-Unusual increase in uterus size also can be a sign of multiple pregnancy
3.
Severe morning sickness and fatigue. Women with multiple pregnancy tends to experience severe morning sickness and fatigue than women with single pregnancy. However this is not always true.

 Diagnosis of Multiple Pregnancy

1.
hCG level-hCG is human Chorionic Gonadotrophin, a hormone that is secretes during pregnancy and it is usually used to detect pregnancy. In women with multiple pregnancy, the level of hCG is higher than women with single pregnancy.
2.
Alpha fetoprotein level-alpha fetoprotein is a protein in mother’s blood. It is released by the fetal liver. In multiple pregnancy, this protein level is expected to be higher than normal because more than one fetus release it.
3.
Ultrasound-Via ultrasound doctors can confirm a multiple pregnancy by seing multiple sacs and heartbeat. This method is more reliable than the others.

Complication of multiple pregnancy

1.
Preterm labor-Preterm labor is common in multiple pregnancy. It occurs when uterus starts to contract and the cervix is dilating before pregnancy reach 37 weeks. This will lead to preterm labor.
2.
Preterm birth-Preterm birth is an implication of preterm labor. Baby will be born earlier than expected before the internal organs mature completely to function. This will lead to very serious complication to the baby and the baby will need external help such as ventilator to survive. Preterm baby usually very small and low birth weights (less than 2.5 kg).
3.
Pregnancy Induced Hypertension (PIH)-Women with multiple pregnancy are more likely to develop PIH. Preeclampsia is an extension of PIH which needs treatment to prevent serious complication to the mother and baby.
4.
Gestational diabetes-Gestational diabetes is also common in multiple pregnancy and it can also effect both the mother and baby.
5.
Twin to Twin Transfusion Syndrome (TTTS)-This syndrome only occur in twins who share a placenta for example identical twin. The problem occur when the distribution of blood to the twin is uneven, one get too much and the other too little. This will cause one of them swollen while the other shrunk. It is a serious condition and the baby need to be delivered as soon as possible.
6.
Congenital abnormalities-Twins have higher risk of congenital abnormalities such as spina bifida and heart abnormalities. They are at risk of long term health problem.
7.

Miscarriage-There is a condition called vanishing twin syndrome when one of the fetus vanishes as the pregnancy in progress.
8.
Postpartum Hemorrhage-Giving birth to multiple babies put a mother at risk of profuse bleeding after the delivery. This is due to extra large placenta and distended uterus.
9.
Caesarean section delivery-Altough multiple fetuses can be delivered vaginally, some hospital has the policy of delivery by caesarean section for multiple pregnancy. This decision however will rely on condition or position of the baby and also condition of the mother. Caesarean section can avoid many complications especially for higher order multiple.

 What you should do?

1.
Frequent check-ups-Multiple pregnant women need more frequent check-ups rather than a single pregnant. This is important to monitor the growth and development of the fetuses as well as the mother.
2.
Diet-To make sure the fetuses are healthy the mother need to take care of her diet. She will need more calories, protein and other supplement such as iron and folic acid.
3.
Rest-More rest is required depends on the condition of the women. Bed rest always advised as a safeguard of preterm labor even the effectiveness has not been proven.

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