Dr. Shobha Venkat

"Multiple pregnancy is highly fascinating. However it carries high risk both for the baby and the mother, It is a real challenge, both for the obstetrician and for the patient and of course to our sonologist also. There are some complications because of the multiple pregnancy. So let us consider in the first trimester that is in the first three months of the pregnancy there could be excess vomiting because of the extra production of the hormones, which can lead on to some nutritional deficiency and also dehydration and also there is risk of abortion in the multiple pregnancy Because of the increased chromosomal and also the congenital anomalies in the babies. In second trimester, there is increased risk of pregnancy induced hypertension and also excess water around the baby, call it as hydramnios and also there is increased risk of Iung and also there is abruption placenta, where there is a premature separation of the placenta and also because of the large size of the placenta, the placenta can also extend into the lower segment. The condition called as placenta previa is also more common in the multiple pregnancy and also multiple pregnancy is in the increased risk for diabetes and preterm delivery is one of the dreadful and one of the very common complication associated with the multiple pregnancy and following the delivery, there is increased risk for the bleeding, what we call it as a post-partum haemorrhage and they might have challenges with respect to the lactation and because of difficulties in handling two babies, there could be increased incidence of post-partum blues or the depression in Multiple pregnancy. In general there is increased incidence of caesarean in the case of multiple pregnancies. Under normal circumstances, each baby is surrounded by a membrane called as amnion and one more membrane called a chorion. So in twin pregnancies, what happens is there are two babies. If each baby is surrounded by its amnion and chorion, it is called as dichorioninc and diamnionotic. The beauty of that is that each baby has its own independent circulation and has its own placenta and because of which the complications are much lesser whereas if you consider the other types where the two embryos, each one has the amnion around it, but both together have a single chorion, what we call it as a monochorionic and diamniontic twin pregnancy. What happens here is that they may have two different placentas. But however there could be a vascular communication between the two placenta which can lead to special complications in these type of pregnancies or they may have a single placenta which might do a little bit of partiality for the blood supply for these two babies which in turn can lead to some special complications. That is why it is very important to identify, whether it is a monochorionic or a dichorionic, monoamniotic or a diamniotic in the initial stage of pregnancy so that we can lay down a specialised antenatal plan and also an antenatal scan modalities for the pregnancies and handle them accordingly"

"Some of the complications associated with the monochorionic twin pregnancy includes, other than TTTS, something like TOPS, and as a TRAP, wherein reverse arterial perfusion and also some growth discordancy is also very common in or monochorionic pregnancies and or monochorionic pregnancy is associated with increased risk of congenital anomalies. Monochorionic pregnancy is also associated with still birth and increased neurological disorders in the newborn. In general, it is associated with increased perinatal morbidity and the mortality"

"It is very important to understand the term called chorionicity in twin pregnancy because the outcome depends on the chorionicity. Chorion is the membrane, which covers or surrounds the baby and depending on the number of the chorion membrane, we call it as dichorionic or monochorionic pregnancy. So in dizygotic twins, invariably it will be dizygotic and dichorionic pregnancies, whereas in case of monozygotic, it could be the monochorionic or it may be dichorionic, depending on the stage of division. So if it is a monochorionic twin pregnancy, the risks are more associate with monochorionic pregnancies, compared to the dichorionic pregnancies. That is where it is important to identify the chorionciity of the pregnancy, which can be done as early as 7 to 13 weeks scan so that we can diagnose the prognosis associated with that type of twin pregnancy. Gold standard for the diagnosis of multiple pregnancy would be our ultrasound scan. However some of the symptoms are little bit exaggerated in multiple pregnancies because of the two babies and because of the excess level of the hormones in the body. In the first trimester it could be the excess vomiting, which we call it as a hyperemesis gravidarum and probably in the second trimester, the patient may complain of excess baby movements and towards the end they may have many symptoms because of the overdistension of the uterus, like the breathing difficulties, sleeping difficulties, eating difficulties. These are some of the symptoms which is extraordinary for the multiple pregnancy. Upto 20 weeks of pregnancy, more or less is singleton and the multiple pregnancy remains the same. But after 20 weeks of pregnancy, because of the rapid growth of the baby, there is an over distension of the uterus and there could be a shortening of the uterus. So the multiple pregnancy patients are at risk for the early delivery, what we call as preterm delivery. Because of these risks, somehow we recommend not to avoid strenuous exercises and activity in multiple pregnancy. However there is no need for the complete bed rest. They can carry on with their normal activity. But just to avoid the strenuous activity, they don’t risk themselves for the preterm delivery"

"By and large, twin pregnancy is more common compared to triplets and quadruplets and also even if it is triplets and quadruplets, because of the associated increased risk for the babies it will be reduced to twin pregnancy by the fetal medicine specialist in the initial part of the pregnancy. So henceforth, I will be referring the multiple pregnancy to the twin pregnancies. Multiple pregnancy to those pregnancies with more than one fetuses or the babies will be growing inside the uterus. So depending on the number of the babies, it is two, it is twin pregnancies, if it is three, it is triplets, if it is four, it is quadruplets and so on and so forth"

"Ideal position to sleep would be the left lateral position in order to maintain good blood supply to the babies. However there could not be possible all the time so that they can stick on to a little bit of left tilt or a semi sitting position or lean back and a little bit of pillow support so that there is a about of 15 degrees of tilt should be more than enough"

"Nowadays people enjoy taking 3D and 4D scans for their babies because looking at their babies in that dimension is really a joy. But however in multiple pregnancy because of two babies because of the overcrowding of the parts. The 3D and the 4D pictures may not be very clear. However around 24 weeks may be the ideal time. If at all if somebody wants to consider the 3D or the 4D picture"