Multiple pregnancy in 12 questions for expectant mothers of twin babies

Expectant mothers expecting twin babies may be more excited than single pregnant women. They wonder if there are different practices in the case of twin pregnancy and what should be done. Because their excitement has naturally doubled. There are many questions that twin pregnancy symptoms, mothers who have twin pregnancies should pay attention to, how much weight pregnant women expecting twin babies should gain and many questions that those who have experienced multiple pregnancies wonder about the mode of delivery. The questions of mothers expecting twin babies were answered by Obstetrics and Gynecology Specialist Prof. Dr. Gazi Yıldırım.

What does multiple pregnancy mean? How is it formed?

Normal pregnancy is a condition that occurs with a zygote that settles in the uterus. Sometimes the condition that occurs when the embryo consisting of two zygotes coming into the uterus at the same time or consisting of a single zygote is divided into two is called twin pregnancy. If two separate eggs are fertilized, they are called fraternal twins. If the single egg is fertilized and settled in the uterus and this embryo is divided into two, it is called an identical twin. Twin pregnancies are the most common among multiple pregnancies and twin pregnancies occur in 1 out of every 85 natural pregnancies. In recent years, increasing reproductive treatment methods have increased the frequency of twin pregnancies a little more. Compared to 1980, there was a 52% increase in twin pregnancies and a 404% increase in triplet or above pregnancies.

How often should the routine physician control of pregnant women expecting twin babies be?

The problems of expectant mothers expecting twin babies are more than normal pregnancies. In twin pregnancy, the expectant mother experiences this process more metabolically and physically distressing. This expectant mother should pay close attention to her nutrition and avoid excessive physical activities. Single pregnancies normally require follow-up every 4 weeks up to 32 weeks, every 2 weeks from 32 to 36, and once a week from 36 weeks until birth. In twin pregnancies, doctor controls will be more frequent than in normal pregnancy. Because there is a risk of miscarriage in the first months of twin pregnancies and the risk of premature birth in the last months. It is appropriate to arrange these pregnancies so that the doctor's control is every two weeks. If they have identical twins, weekly follow-ups are required from 20 weeks onwards. In fraternal twins, the frequency of follow-up once a week will be more appropriate from 28 weeks onwards.

What tests are performed on expectant mothers who have a multiple pregnancy?

Pregnancy screenings are similar to those in single pregnancies. In the first weeks, ultrasonography is useful in recognizing identical and fraternal twins clearly. Fraternal twins always have a double placenta and a double amniotic sac, while 1% of identical twins have a single planenta and a single sac and 20% have a single placenta but a double sac. Early ultrasound diagnosis is useful because the risk in these is slightly higher. Between 11-14 weeks, only the nuchal translucency test can be performed. The contribution of the dual test to twins is not very clear. Instead, genetic tests that screen the baby's chromosomes in the mother's blood are useful from the newly released tests. Triple or quadruple test has no place in multiple pregnancies. Detailed ultrasonography should be performed between 20-23 weeks and 50 or 75 g sugar loading test should be performed between 24-28 weeks. NST, which is added to ultrasonography from 34 weeks in normal pregnancies, should be applied here from 30 weeks.

Are there any situations in which multiple pregnancy should be considered more attention than single pregnancy?

The dangers that may be encountered in twin pregnancies are much higher than in normal pregnancies. There is a risk of miscarriage in the first months and the risk of premature birth in the last months. Twin pregnancies fall into the risky pregnancy group. Because there are a number of risks for both the mother and the babies in such pregnancies: Since the amount of placental hormone secreted here is high, nausea and vomiting in the early stages of pregnancy may be intense and more long-lasting. Blood plasma volume increases by 10-20% more than in single pregnancies. Accordingly, iron deficiency anemia and heart load due to blood irrigation are higher than in single pregnancies. For this reason, pregnant women who carry twin babies should pay more attention to their eating and activities. It is useful for them to go to the doctor's controls more carefully.

Expectant mothers who have multiple pregnancies tend to eat more. How should they be fed? What should be the right application?

In multiple pregnancies, the mother's nutritional needs are 300 calories per day higher than in single pregnancies. For this reason, the twin pregnant woman does not need to increase the amount of food too much. But especially after 20 weeks of gestation, the need for more increases. Omega 3 is the nutrient that provides brain and eye development in babies. This nutrient can be obtained naturally from fish, walnuts and purslane, spinach. These must be consumed regularly. In the diet of the expectant mother should be 1 -2 walnuts per day, fish 2 times a week and spinach 2 times. Milk and dairy products should be used to meet the need for calcium. Drinking at least 2-3 glasses of milk a day significantly satisfies the need for calcium. If milk is not drinkable, yogurt, kefir or feta cheese should be eaten. The expectant mother of twin babies should not neglect to take protein from meat and some vegetables. That's because protein is necessary for the development of two growing babies. In addition, fluid consumption should be much higher than normal. It is recommended to take at least 1.5 liters of water and 1.5 liters of other liquids (fruit juice, tea, milk, etc.) and a total of 3 liters of liquid per day.

What is the weight range that the expectant mother who has a multiple pregnancy is expected to gain during her pregnancy?

People who are weak before pregnancy have a low birth weight infant birth rate and a high risk of developing pre-eclampsia. Those who are overweight before pregnancy have an increased risk of many complications such as hypertension, diabetes and difficulty in childbirth. Therefore, reaching the ideal weight before becoming pregnant is important for both pregnant and infant health. Weight monitoring in pregnancy is important in this respect. In single pregnancy, it should gain 0.5-1 kg every month in the first trimester and an average of 1.5-2.0 kg per month in the following months. The total weight gain during pregnancy should be 12±2 pounds (10-14 kg). In twin pregnancy, these rates should not be exactly 2 times, but 1.5 times higher. By the way, the total weight gained should not exceed 16 kilograms.

Are there any situations that the expectant mother who has a multiple pregnancy should pay special attention to?

Pregnancy toxemia (preeclampsia and arthropsis) with high blood pressure is more common in twin pregnancies. Again, in these pregnancies, the risk of detachment placenta with premature detachment of the placenta is higher. It is beneficial for such pregnant women to restrict their activities and say goodbye to working life after 30 weeks. An important problem especially seen in identical twins is twin-to-twin transfusion syndrome. In this syndrome, one of the identical twin babies fed through the same placenta constantly gives blood to the other. As a result, one of the babies is overdeveloped, while the other cannot develop due to anemia, which can result in infant death. This problem can be seen with bad results, especially if it is seen before the twentieth week of pregnancy. If it occurs after the twentieth week, it may be possible to treat it. Babies are kept under control and can be removed by premature birth when they have completed enough development to live.

How is the use of vitamins and blood medications? Do physicians necessarily recommend it?

The consumption of both fluids and nutrients of the expectant mother who is expecting a twin baby has to be very regular. Our most important rule is to get vitamins and minerals from food. For this, meat, fish and organic chicken should be consumed regularly 2-3 times a week. Milk and dairy products must be taken, as well as fresh or dried legumes. According to the season, fruits and vegetables should be taken with food. If possible, foods made of sugar and flour should be eaten minimally. In the first three months, folic acid supplementation should be done as 800 micrograms. If the doctor deems it necessary, iron intake can be doubled compared to single expectant mothers. Multivitamin supplementation is necessary. Omega 3 should be taken from the 3rd month onwards, as it both dilutes the blood and benefits the development of the baby's nervous system.

Can a mother with a twin pregnancy do pilates or similar sports?

Due to the risk of premature birth and miscarriage, physical activity restriction is appropriate in these pregnants. It is beneficial for such pregnant women to say goodbye to working life after 28-30 weeks. (The statutory prenatal leave for those with twin pregnancies is 10 weeks). Tempoless walking, light exercises that we recommend to normal pregnant women can also be done here. The doctor who follows pilates and yoga for up to 30 weeks is appropriate if he does not see a problem. Swimming is free if a clean pool is found. However, after 30 weeks, more caution should be exercised due to the risk of premature birth.

Do twin pregnancies always result in premature birth? What is the expectation of birth week for twins?

The risk of preterm labor (premature birth) is higher in multiple pregnancies. Accordingly, due to prematurity, it requires an experienced medical team during and after birth. In normal single pregnancies, the concept of completed pregnancy defines the period between 37 and 42 weeks. Pregnancy, which classically lasts 9 months and 10 days, is equal to 40 weeks. In twin pregnancies, the duration of myadh is thirty-seven weeks. While 6% of single pregnancies are born before 37 weeks, 43% of twins and 95% of triplets are born before 37 weeks.

Do birth methods differ in multiple pregnancies? Or are all the conditions in single pregnant women valid?

The frequency of difficult delivery is high due to the problems of coming to the birth canal (presentation) of babies.

Both babies can descend into the birth canal as head-head, head-rectum, breech-breech. In cases where both babies move from head to head to birth canal (head-to-head), cesarean section is generally preferred as the mode of delivery.

Do you have any suggestions for mothers who have multiple pregnancies?

As a result of twin pregnancy, the family experiences 2 times more happiness. The more you think about it, the more excitement and happiness you have. In order for this happiness not to turn into sadness and sorrow, our precious mothers who are experiencing twin pregnancies should be more careful. They should pay attention to symptoms such as bleeding, pain and fluid and should be in constant communication with their physicians who follow them. I wish convenience to our mothers who have twin pregnancies. Fathers-to-be also need to be at least twice as compassionate and loving. I think it is worth mentioning this with great importance.