Double placenta. Multiple pregnancy - probability, causes, signs, diagnosis, complications, reviews

A modern married couple, expecting a happy addition, is significantly different from their parents. At the service of the young - a dozen special magazines for pregnant women, the same number of sites on the Internet, courses of various kinds, consultations of doctors ... Yes, our contemporary is an advanced user in this area, and you will not intimidate him with Latin. But, as the ancients said: "In much wisdom - a lot of sorrow!" It's no secret what an important role the placenta plays during pregnancy. And of course, we get scared when doctors tell us about the various abnormalities associated with it. We fear for happy outcome pregnancy, worry about the baby. And we don't always know exactly what to do.

Today we will talk about everything that competent parents need to know on this topic. The very word "placenta" of Greek origin and in translation means "flat cake". Such a prosaic and, in general, irreverent name is given to the placenta for its appearance. Indeed, in appearance it is very reminiscent of a thick and round cake. But we all know how deceiving looks can be!

What is placenta

The structure of the placenta, or, as it is also called, the child's place, is very complex. It begins to form almost from the moment the embryo attaches to the wall of the uterus, or, as doctors say, from the moment of implantation. The main part of the placenta is represented by villi that branch in it, creating a resemblance to the crown of a mighty ancient oak. Inside the villi, the baby's blood flows; on the outside they are bathed in the mother's blood. Thus, it becomes clear that there are two systems of blood vessels in the placenta - fetal and maternal, and it is here that the constant exchange of substances between mother and child takes place. Oxygen and nutrients come from the mother's blood, the baby "returns" carbon dioxide and metabolic products to be removed from the body. And, what is especially interesting, at the same time, the blood of the mother and the child does not mix anywhere! The point is that two vascular systems separated by an amazing membrane that can pass some substances and prevent the penetration of others. It's called the "placental barrier".

The placental barrier begins to work fully to protect the fetus by 12 weeks. It retains the bacteria contained in the mother's blood, some viruses, the mother's antibodies produced during the Rhesus conflict, but freely passes oxygen and nutrients. The barrier function of the placenta during pregnancy is known to be very selective. The same substances overcome this boundary in different ways in the direction of the fetus and the mother. For example, fluoride perfectly passes through the barrier from mother to baby, but does not pass at all in the opposite direction. Or bromine: this trace element penetrates to the baby much faster than back.

In addition to the protective, excretory, respiratory (because it replaces the baby's lungs!) And other described functions, the placenta has another, no less important - hormonal. Imagine, the placenta produces about 15 hormones for various purposes! And among them, the first place is occupied by sex hormones, designed to maintain pregnancy.

The role of the placenta during pregnancy is so great that at first it even grows faster than the baby. Indeed, at 12 weeks, the fetus weighs 4 g, and the placenta - up to 30 g. At the end of pregnancy, closer to the time of birth, the diameter of the placenta will be about 15-18 cm, thickness - 2-3 cm, weight - 500-600 g.

The placenta is connected to the baby by the umbilical cord, in which the vessels (two arteries and a vein) pass. The umbilical cord, or umbilical cord, can be attached to the placenta in three ways. different ways. The first and most common is the central attachment; lateral and marginal attachment is less common. And very rarely, the umbilical cord is attached not to the placenta itself, but to the fetal membranes. This type of attachment is called - shell.

Unfortunately, things don't always work out the way we would like. Any system, even the most well-coordinated, sometimes fails. For a variety of reasons, different terms pregnancy, deviations in the development and functioning of the placenta occur. These changes never go unnoticed for mom and baby, and often have dire consequences. Therefore, all parents need to know the causes and manifestations of placental abnormalities. We will tell you about the most common problems that obstetricians and gynecologists have to face today, and about methods for preventing and treating placental pathology.

placenta during pregnancy

Hypoplasia of the placenta, or initially a small child's place, is uncommon. By saying "small placenta", we mean a significant decrease in its size relative to the lower limit of the norm assumed for this period pregnancy. The exact origin of this pathology is unknown, but the combination of primary placental hypoplasia with a genetic pathology of the fetus has been statistically proven.

Immediately it is worth making a reservation: such a diagnosis can be made only after a long observation. That is, one ultrasound examination is not enough for such serious conclusions. And of course, we must not forget that there are individual deviations from generally accepted norms that will not be a pathology for a given woman and a particular pregnancy. A small graceful mother will have a much “slenderer” placenta. Finally, we are not talking about a 100% combination of placental hypoplasia during pregnancy and genetic disorders. With a confirmed diagnosis, parents should undergo a medical genetic examination.

During pregnancy, a secondary decrease in the size of the placenta is possible, associated with various adverse factors. These are stress, malnutrition, smoking, alcoholism, drug addiction of the mother. Often the cause of secondary placental hypoplasia is hypertension in a pregnant woman, exacerbation of chronic diseases, an acute infection during pregnancy. However, preeclampsia of pregnant women remains in the first place, manifested by edema, increased blood pressure and the appearance of protein in the urine.

A giant or very large placenta during pregnancy most often develops in severe diabetes mellitus. There is also a sharp increase in the size of the child's place when a pregnant woman becomes ill with infectious diseases such as syphilis or toxoplasmosis. Finally, a giant placenta can be a manifestation of the pathology of the baby's kidneys, Rh-conflict - a situation in which the red blood cells of a Rh-positive fetus are destroyed by antibodies produced in the body of a Rh-negative mother. A significant increase in the size of the placenta is observed with thrombosis of its vessels, when the lumen of the vessel is closed by a thrombus, or pathological growth of small vessels in the villi.

Sometimes there is a membranous - extensive and thin - placenta. Such a child's place has a diameter of 30-40 cm (normally its size is 18-20 cm), and its thickness is sharply reduced. The reasons for the development of this anomaly is a chronic inflammatory process in the uterus, leading to thinning (dystrophy) of its mucous membrane - the endometrium.

What is the danger of a significant change in the size of the placenta during pregnancy? In this case, functional insufficiency of the placenta often develops, the same fetoplacental insufficiency - FPI, which many readers have already heard about. This means that the placenta does not cope with its tasks properly and the baby is chronically lacking oxygen and nutrients. The problem grows like a snowball: the body of a child suffering from a deficiency of essential substances begins to lag behind in development - a delay in intrauterine development of the fetus is formed (abbreviated as IUGR or FGR - fetal growth retardation syndrome).

It is clear that prevention in this case is the treatment of chronic diseases, and it is better - in advance, before pregnancy. In this case, special attention should be paid to diseases of the uterus and appendages. It is also necessary to correct blood pressure indicators, blood sugar indicators, the maximum protection of the pregnant woman from the likelihood of infection (polyclinics, hospitals, public transport, children's institutions, etc.), a full rational and balanced diet, the mandatory intake of multivitamin complexes for pregnant women.

For the treatment of placental insufficiency, drugs such as ACTOVEGIN, CURANTIL, TRENTAL are used. These drugs are able to improve blood circulation in the mother-placenta-fetus system. In addition to the main drugs, with a delay in the development of the fetus, intravenous administration of rheopolyglucin, glucose, ascorbic acid, saline solutions is prescribed. As with any pathology, both FPI and IUGR come in varying degrees of severity; it depends on the treatment strategy. In any case, it is absolutely impossible to self-medicate. Both the pathology and the drugs used are quite serious, so strictly follow the instructions of your doctor!

The structure of the placenta

Normally, the placenta has a lobular structure. All of it is divided into 15-20 lobules, each of which is formed from villi and tissue located between the villi; the lobules are separated from each other by incomplete septa.

With changes in the formation of the placenta during pregnancy, new variants of the lobed structure arise. So, there is a bilobed placenta, which consists of two lobes connected by placental tissue. Sometimes a double or triple placenta is formed. It is represented by two or three equal parts, respectively, one of which is the umbilical cord. In a normally formed placenta, a separately located accessory lobule may form. Less commonly, the definitive placenta is found, which has sheathed areas resembling windows.

The causes of changes in the structure of the placenta during pregnancy are very diverse. Most often, the violation of the structure is genetically determined or is the result of inflammation of the uterine mucosa; accordingly, prevention will also be serious treatment inflammatory diseases of the genital area before a planned pregnancy. I must say that structural deviations affect the baby to a lesser extent during pregnancy, but they can cause a lot of problems and troubles in childbirth and the postpartum period - such a placenta can be difficult to separate from the uterine wall after the baby is born, which will require a manual examination of the uterus. Therefore, a change in the structure of the placenta does not need treatment during pregnancy, but requires increased attention from the doctor during the birth of the placenta and especially in the early postpartum period. If, according to the results of ultrasound, you know about the pathology of the structure of the placenta, be sure to warn the doctor who takes delivery!

maturation of the placenta

During its existence, the placenta during pregnancy consistently goes through 4 stages of development: formation, growth, maturity and aging. Nature has its own time limit for each stage. If the normal course of pregnancy is disturbed, too fast or delayed maturation of the placenta is possible.

Premature or accelerated ripening is of two types: uniform and uneven. Moms with a weight deficit "sin" with a uniform acceleration of the maturation of the placenta, so remember, "thin and sonorous", pregnancy is not the time for diets! The result may be premature birth.

Uneven maturation of the placenta occurs when blood circulation is disturbed in certain areas of the placenta. This complication occurs in pregnant women with obesity, with prolonged late toxicosis, more often with repeated pregnancy. This increases the risk of miscarriages, stillbirths and premature births. Treatment is similar to that for FPP, prevention is the prevention and correction of late toxicosis. Delayed maturation of the placenta is observed much less frequently. The most common causes are maternal diabetes, smoking and alcoholism. The last two reasons probably do not need comments!

Diseases of the placenta

Alas, the placenta during pregnancy is sick, just like we are with us! It is prone to infection, heart attacks, when there are areas deprived of blood supply; blood clots can occur in the vessels of the placenta, the placenta can even undergo tumor degeneration. Fortunately, this doesn't happen often. Let's touch on this problem, though.

Placentitis, or infection of the placenta, is caused by various microorganisms that try to get into the placenta in all conceivable ways. They can be brought in by blood flow, penetrate the fallopian tubes from the appendages, “rise” from the vagina. And of course, if the microbe already lives permanently in the uterine cavity, it will not be difficult for it to penetrate the placenta!

Inflammation can spread to the entire placenta or to its individual components. Of course, here too, the severity of the course of the disease is distinguished. Treatment will be specific, depending on the type of pathogen; of course, your doctor will choose from the possible drugs those that are approved for pregnant women. As for prevention, you probably already understood: it is necessary to treat a chronic infection, first of all - the genital tract!

Placental infarction, like myocardial infarction, develops as a result of prolonged vasospasm; the area of placental tissue that was supplied with blood by this vessel experiences ischemia - an acute lack of oxygen - and dies. Placental tissue infarction is usually the result of a severe course of late toxicosis or hypertension in a pregnant woman, so prevention will be appropriate. Both of these complications can cause placental insufficiency and delayed development of the baby.

Intra-placental thrombi occur in the vessels of the placenta as a result of inflammation, damage to the vessel wall, impaired blood viscosity during toxicosis or, elementarily, when the baby moves. Nothing is known about the direct effect of blood clots on the course of pregnancy and the development of the child.

As for tumors of the placenta during pregnancy, I would not like to dwell on them in detail. Note that they are benign and malignant, often accompanied by polyhydramnios, fetal malformations, interfere with it with their size and “steal” nutrients from it.

Location of the placenta

Ideally, the children's place is located in upper divisions uterus. However, there are conditions and diseases that prevent the usual location of the placenta during pregnancy. Such ailments include uterine fibroids (benign tumors of muscle tissue), congenital malformations of the uterus, a large number of mother's pregnancies in the past, and most importantly - abortions and inflammation in the uterus.

Being located on the "lower floor", the placenta can close, partly or completely close the exit from the uterine cavity - the internal pharynx. With the last arrangement, independent physiological childbirth is unambiguously impossible, with the previous two, they are called into question; in most cases, a caesarean section is performed. The incorrect position of the placenta is called previa and is often manifested by repetitive bloody discharge from the genital tract. The consequences of bleeding can be significant anemia (decrease in hemoglobin in the blood), oxygen starvation of the baby, partial and complete abruption of the placenta and the death of the child. Accordingly, the treatment in this case will be serious, in a hospital setting. Even in the absence of bleeding, a pregnant woman with such a diagnosis needs rest, including sexual!

Physical education, swimming pool, long walks, trips, work are contraindicated.

Let's talk about premature detachment of a normally located placenta. As the name implies, the placenta in this case is in the right place, but leaves it earlier than expected. Normally, the placenta is separated only after the birth of the baby - in the third stage of labor. If this happens earlier, an emergency operation is needed to save the life of mother and child! In cases where detachment occurs in a small area, they try to stop it and keep the pregnancy; but even with a slight episode of bleeding, the danger of resuming detachment remains until the very birth.

The causes of premature detachment of the placenta can be injuries, blows to the abdomen, various chronic diseases of the pregnant woman, leading to defects in the formation and blood supply of the placenta (diseases of the heart, lungs, kidneys, etc.). Various complications of pregnancy can also lead to premature detachment of the placenta, most often it is preeclampsia - a complication in which all organs of the pregnant woman and the fetus suffer (it is manifested by an increase in blood pressure, the appearance of protein in the urine, edema). In any case, premature detachment of the placenta is a very formidable complication, and it is treated only in a hospital!

Attachment of the placenta

The placenta during pregnancy may be in its place, but it is wrong to attach to the wall of the uterus. Usually it is associated with the lining of the uterus and is easily separated after the birth of the baby. But as a result of inflammatory changes in the wall of the uterus or the placenta itself, it can tightly attach to the mucosa, adhere to it, and even grow into the muscle layer. In the latter case, everything is very serious: a woman may lose the ability to give birth to children. With a tight attachment, the doctor, under anesthesia, inserts a hand into the uterine cavity and separates the "adhered" placenta.

Finishing the conversation about the placenta, I would like to emphasize that no misfortunes happen to us just like that. Pathology of the placenta, as the old doctors said, does not occur "among full health". Dear future mothers! Take your health seriously before and during pregnancy!

The placenta is a unique female organ. Its eccentricity lies in the fact that it can exist only during the bearing of a child, while becoming the most important link between the mother and the fetus until the moment it is born. With the birth of a child, the placenta also leaves the woman's body, she no longer needs this organ.

During pregnancy, the state of the placenta is constantly monitored by a doctor. Its proper development and normal functioning play a huge role in this crucial period, since the placenta solves important tasks throughout the entire period of bearing a child.

Like any organ, the placenta goes through certain stages of evolution - formation, development, maturity and aging. If any deviations occur at any of these stages, the woman is prescribed appropriate treatment.

Translated from Latin, the placenta sounds like a "cake", however, this is exactly what this organ looks like.

But, despite the unsightly appearance, it plays an important role. It depends on the state of the placenta normal development future child.

Normally, the development of the placenta begins from the first minutes after the fertilization of the egg. After meeting with the spermatozoon, it begins the process of active division, and some of the cells that form against this background will take on the role of the placenta in the near future.

On the 10th day after conception, a gap is formed on the mucous membrane of the uterus - a cavity completely filled with the vessels of a woman. It is in it that the embryo will begin its development.

All the nutrients the fetus will receive from the mother's body. A specific choroid will begin to form around the embryo - the rudiment of the future placenta, into which the vessels of the mother and child will subsequently grow.

Thus, a full-fledged mutual exchange of blood will be established between the mother and the fetus, in which there will be oxygen and nutrients.

The functions that the placenta performs:

Respiratory: is responsible for delivering oxygen to the fetus and removing carbon dioxide.
Trophic: transfers nutrients to the fetus - water, proteins and fats, vitamins and trace elements.
Endocrine: transfers the mother's hormones to the fetus - sex, thyroid and adrenal hormones. In addition, the placenta independently begins the synthesis of its own hormones - progesterone, lactogen, cortisol and prolactin, which are necessary for the full development of the fetus and the course of pregnancy.
Protective: the placenta successfully protects the fetus from the negative influence of many pathogenic factors. But, unfortunately, some hazardous substances still penetrate its barrier. Their list includes alcohol, nicotine and a number of components of drugs.
immune: a specific immune barrier is formed in the body, due to which the organisms of the mother and child do not conflict with each other.

This list allows you to evaluate how important the normal functioning of the placenta during pregnancy is. Throughout the entire gestation period, this body solves the most important tasks, and much depends on the stage of its development.

Since the placenta goes through certain stages of evolution, doctors closely monitor any changes in it during pregnancy in order to prevent and eliminate possible pathologies in time.

The development of the placenta and its location

This unique organ is born together with the unborn child. Active growth of the placenta begins from the 2nd week of pregnancy and does not stop until the onset of childbirth.

By week 13, its structure is formed. The placenta reaches its full development by the 18th week of gestation - by this time the body is working at full strength.

With a normal pregnancy, the formation of the placenta takes place in the body of the uterus, usually on its back wall with a smooth transition to the sides.

This arrangement of the organ is due to the fact that the back wall of the uterus changes the least during pregnancy and is protected from all kinds of injuries.

In some women, the placenta can be located on the anterior wall and even on the bottom of the uterus.

A properly located placenta should not reach the cervix by at least 7 cm. If the organ reaches or overlaps the cervix at least partially or completely, this condition is called presentation.

Such a pregnancy requires special supervision by medical personnel, it usually ends with operative delivery.

Gradually, the structure of the emerging placenta will begin to change depending on the needs of the developing fetus. Around week 35, the placenta will reach its peak of maturity.

maturation of the placenta

As mentioned above, the placenta continues to grow and develop during pregnancy. This process is called the maturation of the placenta.

With the help of ultrasound diagnostics, the maturity of the organ and its compliance with the gestational age are assessed.

There are 5 degrees of maturity of the placenta:

zero - up to 30 weeks;
the first - from 30 to 34 weeks;
the second - from 34 to 37 weeks;
the third - from 37 to 39 weeks;
the fourth - immediately before childbirth.

If the degree of maturity of the placenta does not correspond to the gestational age, most likely there are some pathologies in the state future mother. Fortunately, this is not always the case. For example, a lower degree of maturity is not considered a deviation.

The full maturation of the organ can be judged by the 35th week of pregnancy, when the process of its development ends smoothly. By this time, in all women with a normal pregnancy, the placenta acquires certain parameters: weight 500 g, thickness up to 4 cm, diameter at least 18 cm.

Before the birth of a child, the body begins to gradually decrease in volume, it will be possible to detect salt deposits on it.

Possible deviations in the development of the body

Pathologies of the placenta are not uncommon. But there is no need to worry in advance. Of course, some violations in the structure and location of the organ can harm the child, but this does not apply to all pathologies of this organ.

In addition, even serious problems can be solved thanks to timely medical care. Therefore, if any symptoms of trouble appear (bleeding from the vagina, abdominal pain,) you need to inform the doctor about them in order to exclude the development of pathology.

The main pathologies of the placenta are:

lag or, on the contrary, rapid maturation of the organ;
detachment before the start labor activity;
pathological growth or, on the contrary, an extremely slow growth of the organ;
the formation of intraplacental thrombi;
violation of the lobular structure of the body;
inflammatory process;
increment or too tight attachment to the wall of the uterus;
thickening of the placenta;
low localization of the organ (near the pharynx of the cervix);
placental tumors;
placental infarction.

All of the above pathologies can develop due to the following reasons:

diabetes;
atherosclerosis;
infections, including influenza and toxoplasmosis;
Rh incompatibility of mother and fetus;
severe anemia;
pregnancy after 35 years;
stress;
bad habits;
acute and chronic somatic diseases of a woman;
excess or, on the contrary, insufficient body weight of the expectant mother;
congenital malformations of the fetus.

In order to successfully cure placental pathologies or prevent their development, it is necessary to eliminate the factors contributing to these disorders.

Characterized by more early development placenta (aging), which entails possible conditions that threaten the health of the fetus. Most often they talk about fetal hypoxia, that is, its insufficient supply of oxygen, which leads to oxygen starvation. At the same time, due to insufficient supply of nutrients to the unborn baby, violations of the functions of the brain are possible, and for the process of childbirth - their premature onset and severe course.

Causes of premature aging of the placenta:

diabetes mellitus and other hormonal disorders in the mother's body;
abortions that a woman had before a real pregnancy;
endocrine diseases of the expectant mother (thyroid disease);
late toxicosis - preeclampsia;
smoking or drinking by the mother;
chronic disorders of the cardiovascular system;
hepatitis and other liver diseases;
diseases of the urinary system;
infections of the genital tract and uterus.

However, despite such ominous data, a woman who is diagnosed with placental maturity stage 2 for a period of less than 33 weeks should not panic. The doctor will definitely prescribe additional tests and studies on the blood flow of the fetus. If this pathology is not detected, then the woman has nothing to worry about. In case of confirmation of a real threat to the normal life of the fetus, effective treatment in the hospital. As a rule, the drug course is aimed at restoring the functions of the placenta to fully supply the child with all the nutrients. substances.

2 degree of maturity of the placenta at a period that does not correspond to the norm does not always mean the presence of pathology. If the doctor does not notice a real threat of premature birth, then, most likely, a course of treatment with Curantil or other appropriate medicines at home will be prescribed. In any case, a woman should strictly adhere to the recommendations of the doctor and regularly come to the appointment.

What is chorionicity?

It has now been established that the outcome of a multiple pregnancy is affected, first of all, by chorionality - the correspondence of the number of placentas to the number of fetuses. Unfavorable is the so-called monochorionic (MC) type of placentation, in which there is one placenta for two (identical twins).

The formation of MX placentation is noted if, on the 4th-8th day after fertilization, one blastocyst (embryo) divides into two. Identical twins in this case will have a common placenta but two separate amniotic sacs.

If the division of the embryo occurred immediately after conception (on days 0-4) or after IVF, then bichorial (BC) twins may occur. At the same time, twins are also considered identical, because they are descended from the same egg. The babies will live in different "houses" (amniotic sacs) and, most importantly, have separate placentas. The presence of two placentas in twins compared to one is more favorable for the course and outcome of pregnancy, since it leads to the death of the fetus / fetuses 3-4 times less often.

Bichorionic diamniotic twins can also occur if two eggs are fertilized at the same time, for example, during IVF. In this case, the embryos will have two placentas and two amniotic sacs (twins). Such babies can have a different gender and even unequal appearance.

One placenta for two: what are the features?

Due to the lack of nutrients and oxygen during multiple pregnancy, the embryos suffer, one of them or even all of them may die. This is possible at any time. AT 1st trimester the death of one of the fetuses most often does not have any negative consequences for the development of the second. However, in a quarter of cases, a miscarriage can occur.

As we have already said, with MX twins, there is one placenta for two. In this case, the vessels supplying blood to the embryos are connected to each other (anastomose). The redistribution of blood can occur unevenly. As a result, one fetus gives blood (donor), the other accepts (recipient). This is how the syndrome of feto-fetal blood transfusion (SFTG) develops.

With SFFG, the recipient fetus develops polyhydramnios, dropsy, and heart failure; the donor has oligohydramnios and hypoxia (lack of oxygen). In addition to the development of SFFR, in the presence of one placenta for two, the syndrome of growth retardation (SZR) of the fetus / fetuses is often noted.

SFFG and SZR are the main causes of late intrauterine death of the fetus / fetuses in the II and III trimesters. With monochorionic placentation, this risk is 2 times higher than with bichorionic placentation. After the death of one of the fetuses in the II-III trimesters, the placenta of the deceased fetus begins to secrete pro-inflammatory substances (cytokines and prostaglandins), which stimulate uterine contractions and provoke abortion.

Ultrasound for multiple pregnancy

Pregnant women with multiple pregnancies require careful monitoring from early gestation. The first ultrasound is performed at 11-14 weeks. To clarify the type of placentation, the thickness of the septum between the fetuses is measured. The possibilities of ultrasound diagnostics of chorionicity after 15 weeks, unfortunately, are reduced.

Ultrasound performed in the first trimester allows to identify markers of fetal chromosomal pathology (for example, Down syndrome), first of all, collar edema, which in every fourth with monochorionic twins is also a prognostic sign of a severe degree of FFS.

In the second trimester, ultrasound data allow us to estimate the number amniotic fluid in the amniotic cavity of every baby. The pronounced difference between the two fruits in terms of the amount of water is an important feature of the SFFG. In this case, the diagnosis of polyhydramnios is established in the recipient if at 16-18 weeks the volume of water exceeds 6 cm; at 18-20 - 8 cm; for periods of more than 20 weeks - more than 10 cm. Oligohydramnios is diagnosed in a donor if the volume of water is less than 2 cm. Other ultrasound criteria are also used to detect SFFG: Bladder or the impossibility of its visualization, the absence motor activity in the donor fetus.

Measurement of the size of the fetus (fetometry) is carried out at 16-19, 20-23, 24-26, 27-29, 30-32, 33-35, 36-38 weeks of gestation. The lag of one of the fetuses in development is estimated by the ratio of the difference between the weight of the larger and smaller fetuses to the mass of the larger one. If it exceeds 25%, this indicates uneven fruit growth and requires special monitoring.

An important part of ultrasound monitoring of the condition of a pregnant woman with multiple pregnancies is the assessment of the viability of the cervix, which is carried out starting from 22-23 weeks. A distinctive feature is the faster shortening of the cervix after 24 weeks (about 0.6 mm per week) with multiple pregnancies compared with singleton pregnancies (1.4 mm per week).

Assessment of blood flow velocity in the fetal middle cerebral artery

Today, ultrasound data allow not only to estimate the size of body parts, organs and the fetus itself. With the help of a modern modification of ultrasound - dopplerometry, which studies the blood flow in various vessels, it is possible to assess the composition of the fetal blood non-invasively, that is, without using surgical methods for taking the baby's umbilical cord blood.

So, by the speed of blood flow in the middle cerebral artery of the fetus, one can judge the level of its hemoglobin (oxygen carrier), as well as the presence and severity of anemia (decrease in red blood cells and hemoglobin) and hypoxia (lack of oxygen).

Evaluation of blood flow parameters in the middle cerebral artery makes it possible to determine the tactics of management in case of multiple pregnancies and various complications (SZR, SFFG). If, according to Doppler data, there is no anemia in the fetuses, then the pregnancy is prolonged. If signs of anemia are detected, an intervention is performed - intrauterine blood transfusion (IPT) to the fetus to replenish the volume of circulating blood (up to 32-33 weeks of gestation) or delivery (after 32-33 weeks).

Proper nutrition for multiple pregnancy

Every pregnant woman with multiple pregnancies needs to eat fully and rationally, consuming at least 3500 kcal per day. The total weight gain for the entire pregnancy should be about 18-20 kg. In this case, an increase in body weight in the first half of pregnancy (at least 10 kg) is especially important to ensure the physiological growth of the fetus. Otherwise, complications are inevitable - malnutrition and fetal growth retardation.

Also, when compiling your diet, it must be remembered that during pregnancy, especially multiple pregnancy, a woman's need for iron increases dramatically. Therefore, in the diet of a pregnant woman, foods that include iron and animal proteins must be present: meat, liver, fish, dairy and sour-milk products, buckwheat porridge, raw vegetables (carrots, apples, cabbage) and fruits.

However, it is not always possible to compensate for iron deficiency in a pregnant woman only with the help of a special diet. After all, no more than 6% of iron is absorbed from food. Therefore, in addition to good nutrition, expectant mothers bearing twins or triplets should use iron-containing preparations in order to prevent anemia. They are highly effective, safe, easy to use, well tolerated and, most importantly, provide the body with up to 30-40% of the iron contained in the preparation.

Laser coagulation of blood vessels between two fetuses

Currently, the main method of treatment for MX placentation is fetoscopic laser coagulation of vessels (anastomoses) between fetuses, because of which both babies suffer. The intervention is carried out after ultrasonic detection the location of the placenta, the anastomoses in it, the partitions between the fetuses and the places of attachment of the umbilical cords.

A special instrument (fetoscope) is inserted into the recipient's amnion cavity under ultrasound guidance. Coagulation of the vessels between the fetuses is performed by a laser. Surgery ends with drainage of amniotic fluid until their quantity is normalized. After laser treatment of SFPG, half of the patients are born with both or one healthy child.

Premature birth: who is at risk?

The risk of preterm birth in multiple pregnancy increases due to overdistension of the uterus, as well as increased pressure on the cervix and the occurrence of isthmic-cervical insufficiency (ICI).

In order to predict preterm birth, the determination of fetal fibronectin in the cervical mucus is now widely used. It is a glycoprotein that is normally found in amniotic fluid and placental tissues. Fibronectin is normally found in the first half of pregnancy.

Its presence in the cervical mucus after 20 weeks is considered pathological. positive test with fibronectin in pregnant women with symptoms of preterm labor indicates the possibility of delivery within 7 days. The most sensitive in predicting preterm birth is a positive test for fibronectin for a period of 24-28 weeks. The fetal fibronectin test predicts ¾ of preterm birth.

The risk group for preterm birth with multiple pregnancies should include women who:

Premature births were in the past;
- there is a habitual miscarriage in this pregnancy;
- high levels of fibronectin;
- there is a shortening of the neck of the label according to ultrasound;
- there are socio-demographic factors (low level of education and income, adolescence).

In order to maintain pregnancy with multiple pregnancies, it is recommended to prescribe a natural micronized progesterone(utrogestan) in vaginal form (100-600 mg) up to 36 weeks of gestation.

If signs of CI are detected according to ultrasound data during pregnancy, surgical correction of the cervix is performed in the period from 13 to 24 weeks of pregnancy. In this case, a circular seam is applied - a cerclage. Abroad, this is done prophylactically - immediately after IVF or before it is carried out. If the gestational age exceeds 24 weeks, an obstetric unloading pessary can be used, which is removed before delivery.

It should be borne in mind that pregnancy with twins is considered postponed from 39 weeks of gestation. Therefore, the optimal terms of delivery for multiple pregnancy are 37 and 38 weeks of pregnancy.

With bichorionic twins, natural childbirth is possible, with intrauterine death of one of the twins, prolonging the pregnancy to 37-38 weeks is considered the best tactic. The second is more often born alive and healthy, in rare cases, neurological abnormalities are possible.

The timing of childbirth with monochorionic type of placentation depends on the condition of the fetus. In the absence of complications (SZR, SFFG), pregnancy is prolonged up to 37-38 weeks. If necessary and at risk of death of the fetus / fetuses, perform cesarean section earlier, starting at 32-33 weeks.

Delivery of women with multiple pregnancies is desirable to be carried out in a high-level maternity hospital (perinatal center), capable of providing qualified assistance with resuscitation of newborns.

Always with you,