Multiple Pregnancy

Multiple pregnancy mans more than one child. Multiple pregnancy when more than one fetus simultaneously develop in the uterus. Twin Pregnancy is most common variety of multiple pregnancy.
When simultaneously development of two fetus in the uterus is the common example of multiple pregnancy.

When two sperms during during the single ovarian cycle occur this result in fertilization.
Their subsequent implantation and development differ little from those of single fertilized ovum. The babies bear only fraternal resemblance to each other.

In sonography two gestational sacs can be detected as early in pregnancy. Detection of two fetal heads and their accurate measurement of biparietal diameter can be made by the 14th week.

In some case twining may occur at differ period after fertilization and this procedure influences the process of implantation and formation of the fetal membranes. In twining ,the separation occur is probably after the formation of inner cell mass. In such manner two embryo will develop enclosed by a single chorion and having single placenta. Twin having same sex is most common, but twin having opposite sex is rare.

Some symptoms are related to the undue enlargement of the uterus. Symptoms of multiple pregnancy

1. Increased nausea and vomiting in early months.
2. Cardio-respiratory embarrassment in later month such as palpitation or shortness of breath.
3. Tendency of swelling legs, varicose veins and haemorrhoids is greater.
4. Unusual rate of abdominal enlargement and excessive fetal movement may be noticed.

Generally prevalence of anaemia is more than in single pregnancy. Unusual weight gain, preclampsia, obesity. In twin pregnancy, when palpation occur the height of the uterus is more than the period of amenorrhoea. Palpation finds two fetal heads.

Multiple pregnancy imposes physical changes on the mother in excess. There is increase in weight and cardiac output. Plasma volume is increased by an addition of 500ml. In multiple pregnancy there is no corresponding increase in red cell volume resulting in exaggerated haemodilution and anaemia.

In multiple pregnancy serial ultrasound imaging early gestation has revealed occasional death of one fetus and continuation of pregnancy with the surviving one .The dead fetus simply vanishes by resorption.
 

Complication during multiple pregnancy:

----- In multiple pregnancy nausea and vomiting with increased frequency and severity.

-----   In twin pregnancy anaemia is more common. This is because of increased iron and folate requirements by the two fetus. Deficiency of folic acid leads to increased incidence of megaloblastic anaemia.

----- Pre-eclampsia is increased more than three times over singleton pregnancy. Overtension of the uterus may be the possible explanation.

-----  In case of  twin pregnancy Malpresentation is quite common as compared to singleton pregnancies.So malpresentation is thus more common in second baby.

-----  In case of twin pregnancy Preterm labor frequently occur and the mean gestational period for twins is 37 weeks. The main factors responsible for preterm labor are Overtension of the uterus, hydramnios and premature rupture of the membranes

----- Mechanical distress such as palpitation ,dyspnoea, varicosities and haemorrhoids may be increased compared to a single pregnancy.

----- Some Times bleeding following the birth of the first baby ,may at times ,be alarming and is due to the separation of placenta following reduction of placental site.

----- Generally there is Postpartum Longer time taken by the big placenta to separate. haemorrhage is real danger in twins.

------ In case of multiple pregnancy there is increased incidence of subinvolution because of bigger size of the uterus. Infection because of increased operative interference, pre-existing anaemia and blood loss during delivery .Failing lactation.

----- In pregnancy abortion rate is increased.

----- Premature rate is very much increased and babies suffer from its hazards.

----- Some time structural anomalies occur in one fetus. Growth problem occur in twin pregnancy.

----- Intrauterine death of one fetus occur most of time . If a loss occur early in gestation, the affected fetus simply 'vanishes' by resorption. If death occur late in pregnancy, there may be death of the other fetus may complicate the mother.

----- Fetal anomalies are increased two folds over the singleton pregnancy.

----- In such case Stillbirth are more common due to increased prevalence of preeclampsia ,malpresentation ,placental abruption and increased operative interferences. The second baby is more at risk.

----- In multiple pregnancy maternal mortality is increased as compared to singleton pregnancy. Death is mostly due to haemorrhage before, during and after delivery, preeclampsia and anaemia.

----- Some times death occur due to stillbirth and some of due to neonatal death. The second baby is more at risk than the first one due to retraction of uterus leading to placental insufficiency, increased operative interference, increased incidence of cord prolapse.

----- There is increased risk to both mother and baby ,compared to that of a single pregnancy, the twin pregnancy is considered  'high risk'.

----- Increased dietary supplement is needed for increased energy supply to the extent of 300kcal per day, over and above that needed in a singleton pregnancy.

----- Increased rest at home and early cessation of work is advised to prevent preterm labor and other complication.

----- Supplementary therapy is needed such as iron, additional vitamins, calcium and folic acid are to given.

----- Fetal growth assessment should be done by ultrasound at every 2-3 weeks interval.

----- Most of the time Complications occur such as the commonest one being the aftercoming head of the first baby getting locked with the forecoming head of the second baby.

----- Two heads lying at the same in the uterus. Spontaneously delivery may occur if the babies are extremely premature.

----- In multiple pregnancy most of the time twins are joined , here is more advantageous as the conjoined twins can often be surgically separated.