Multiple pregnancy - specialists and information on complications and prevention

Types of identical multiple pregnancies

• An increased level of the pregnancy hormone HCG (human chorionic gonadotropin)
• Morning sickness with vomiting in the first weeks of pregnancy
• Significant weight gain in the first trimester (1st to 12th week of pregnancy),
• A significantly enlarged abdominal circumference and
• A significantly enlarged uterus. The gynaecologist can feel this or detect it on ultrasound.

The general check-ups during pregnancy include

• Checking the blood group, haemoglobin and urine
• Regular measurement of body weight, abdominal girth and blood pressure (RR)
• Inspection of the size of the uterus
• Examination of the pelvis and cervix

With multiple pregnancies, the usual pregnancy symptoms occur in an intensified form:

• Severe nausea with frequent vomiting
• Water retention (congestive edema) and tingling in the legs from the 14th week of pregnancy onwards
• Back pain due to weight gain
• Breathlessness (due to pressure of the multiples on the lungs)
• Strong kicks and bumps against the abdominal wall
• General restlessness and restlessness

The most common pregnancy complications

• Hyperemesis gravidarum: frequent vomiting
• Pre-eclampsia: High blood pressure with protein excretion in the urine
• Increased risk of premature birth: A birth that takes place before the 37th week of pregnancy is referred to by doctors as a premature birth. Signs of a premature birth include premature contractions, premature rupture of the membranes or a severely shortened cervix (uterine cervix) of less than 3 centimetres
• Acute or chronic placental insufficiency: The exchange of substances and blood flow are insufficient. This can result in damage to the fetus or fetuses.
• Reduced growth or shrinkage of the fetus (hypotrophy)
• Neurological damage to the fetus or fetuses: In the event of a reduced oxygen or nutrient supply
• Miscarriage (abortion): If the pregnancy ends before the 23rd or 24th week of pregnancy. At this point, the children are not yet viable. The first examinations by the pediatrician are important to determine the developmental status of the fetuses after a multiple pregnancy.
• Feto-fetal transfusion syndrome: Occurs in twin pregnancies when the two fetuses share a placenta in the womb. The problem with the condition is that the blood flow between the two fetuses is unevenly distributed. While one receives too much blood, the other receives too little. Both are damaged. Laser ablation can help in this case. Laser ablation uses a laser to obliterate the vascular connections within the placenta. This procedure is risky. Therefore, only specialized centers should perform laser ablation.

Emergency signs during a multiple pregnancy

If the following symptoms occur during a multiple pregnancy, please take them seriously and contact a doctor immediately:

• Contractions: these indicate that labor is about to begin.
• Bleeding: If you experience bleeding, please call the emergency services immediately.
• Abdominal pain: Should be checked by a doctor as soon as possible.
• Fever: Indicates an infection or other complication.
• Severe pain in one leg or in the legs: May indicate a leg vein thrombosis.
• A decrease in the baby's movements: Should be urgently checked by a doctor.
• Leakage of amniotic fluid
• Burning pain when urinating: Indicates a urinary tract infection requiring treatment.
• Deteriorating general condition due to pre-eclampsia (increased blood pressure and abnormal protein excretion in the urine).
• Signs of eclampsia (seizure)

Possible birth complications

There is also an increased risk of multiple pregnancies during birth.

The following complications can occur:

• A prolonged opening phase of more than twelve hours.
• Premature placental abruption after the birth of the first twin.
• An umbilical cord prolapse: in which vital blood vessels in the umbilical cord are pinched off. This results in hypoxia of the child.
• Heavy post-partum bleeding: Due to reduced contractions of the uterine muscles (uterine atony).

Treatment and care for multiple pregnancies

If you are pregnant with multiples, avoid stress and physical exertion. The primary aim of a multiple pregnancy is to maintain the pregnancy for a long time.

Women who go into labor before the 34th week of pregnancy or who suffer from cervical insufficiency (opening of the cervix) are given medication such as tocolytics or corticosteroids. Corticosteroids are drugs that accelerate the maturation of the unborn child's lungs. They are usually used for premature births.

The birth plan

The birth plan contains all the important information about the pregnancy and delivery. It also documents the state of health of the unborn children and the mother.

For example:

• Is a natural vaginal birth possible?
• Has pain relief been administered?
• Is a caesarean section planned?

As a natural birth is complicated and risky in the case of multiple pregnancies, doctors usually perform a caesarean section ( caesarean section).