multiple pregnancy
Introduction
Introduction to multiple pregnancy Multiplegestation refers to the simultaneous presence of two or more fetuses in a uterus, but does not include multiple pregnancy or uterine fallopian tube pregnancy. In human multiple pregnancy, twins are most common, three are rare, and four and four are rare. Although multiple pregnancy is a physiological phenomenon, the complications and mortality of multiple pregnancy are higher than single pregnancy, the risk of severe disability in twins is 2 times higher, and the third is 3 times higher. Therefore, multiple pregnancy is a high-risk pregnancy. Category, clinical should pay more attention. basic knowledge The proportion of illness: 0.02% Susceptible people: women Mode of infection: non-infectious Complications: threatened abortion, premature rupture of membranes, anemia
Cause
Causes of multiple pregnancy
Genetic factors, multiple pregnancies have a family-oriented tendency. In the case of a couple who have multiple births in a family, the incidence of multiple births increases. Single-oval twins are not related to heredity. The double-oval twins have a clear genetic history. If the woman is one of the twins, the probability of giving birth to twins is higher than that of the husband who is one of the twins, suggesting that the mother's genotype is more affected than the father.
Age and parity, age has no significant effect on the incidence of single-oval twins. Hauser et al found that the incidence of single-oval twins was 3 in women under 20 years old and 4.5 in women under 40 years old. The incidence of double-oval twins increased significantly with age, only 2.5 in the 15-19 age group, and increased to 11.5 in the 30-34 age group. The number of births increased and the incidence of twins increased. Chai et al. (1988) reported that the primipara was 21.3 and the multipartum was 26 .
Endogenous gonadotropin, the occurrence of spontaneous double-oval twins is associated with higher levels of follicle stimulating hormone (FSH) in the body. Mastin et al (1984) found that women who gave birth to twins had significantly higher levels of blood FSH in the early follicular phase than those who gave birth. One month after women stop taking the pill, the rate of twins and twins increases, which may be due to the increase in the secretion of gonadotropins from the pituitary gland, leading to the maturity of multiple primordial follicles.
The application of ovulation-promoting drugs, multiple pregnancy is the main complication of drug-induced ovulation. It is related to the difference in individual response and the dose is too large. The use of human menopausal gonadotropin (HMG) treatment is prone to ovarian hyperstimulation, resulting in multiple ovulation, the chance of twins will increase by 20% to 40%.
Prevention
Multiple pregnancy prevention
Prevention of pregnancy-induced hypertension syndrome
Twin or multiple pregnancy, due to excessive uterine uterus, the uterus placenta under pressure ischemic, easy to develop pregnancy-induced hypertension syndrome, and to a greater extent. The main methods of prevention are:
1 pay attention to the changes in basal blood pressure in the early pregnancy, and then regular prenatal checkups to measure blood pressure.
2 In terms of diet, in addition to eating fresh and nutritious foods, the intake of salt, sugar and animal fat should also be limited.
3 Life should be regular, to ensure that you sleep more than 8 hours a day.
4 The living environment is comfortable, the clothes are wide, and the texture is soft.
5 If the mean arterial pressure in the second trimester is more than 11.3 to 12.0 kPa (85 to 90 mm Hg), take aspirin and calcium tablets as appropriate.
After the above-mentioned health care measures, the pregnancy can be extended to 37 weeks. At this time, all aspects of the fetus have matured and basically have the ability to survive.
In the prevention and treatment of anemia, the blood volume of women with multiple pregnancies is significantly higher than that of single-pregnancy, and the demand for iron is also increased. Anemia often occurs at an early stage, and pregnancy-induced hypertension syndrome may occur later.
Prevention of premature delivery, due to more fetuses, resulting in excessive uterine enlargement, it is often difficult to maintain until full term and early delivery. The predisposing factors of preterm birth are mainly improper rest and intemperate sexual intercourse.
Methods to prevent preterm birth are:
1 bed rest: after 28 to 30 weeks of gestation, should rest in bed, must take the left lateral position, should not take the sitting position, semi-sitting position and supine position, the left lateral position can increase uterine blood flow, reduce fetal pressure on the cervix And expansion.
2 Pregnancy to 28 to 30 weeks, you need to take salbutamol sulfate tablets, one tablet each time, 4 times a day, to 37 weeks of pregnancy to stop the drug.
3 have cervical dysplasia, internal mouth loose, can be performed in the mid-pregnancy cervical ligature ligation.
4 Those with signs of threatened premature labor should be hospitalized for treatment. Prevention of pregnancy-induced hypertension syndrome, twin or multiple pregnancy, due to excessive uterine uterus, the uterus placenta under pressure ischemic, easy to develop pregnancy-induced hypertension syndrome, and to a greater extent.
Complication
Multiple pregnancy complications Complications, threatened abortion, premature rupture of membranes
Obstetric complications of triple and triple pregnancy are more common than singleton, threatened abortion, premature rupture of membranes, premature delivery, anemia, pregnancy-induced hypertension, pre-eclampsia, HELL syndrome, pulmonary edema, pulmonary embolism, acute fatty liver Fetal development is limited, low birth weight infants, fetal and neonatal mortality are increasing. In multiple pregnancies, preterm birth is the most important cause of neonatal death.
1. Premature delivery: the incidence of preterm birth in triple pregnancies is 87.8%, and the preterm birth rate in four pregnancies is 100%. Premature birth is still the leading cause of death in neonates with multiple pregnancies. It should be noted during bedtime to rest in bed, prevent miscarriage and increase fetal lung. Maturity, cervical cerclage can also be performed at 12 weeks of gestation to increase the lifting force of the internal mouth, which helps to prolong the gestational age and reduce premature birth.
2. Pregnancy-induced hypertension: the incidence of three-child is 40%, the fourth child is 60%, and the incidence increases with the number of fetuses. It should be checked regularly during pregnancy, pay attention to rest, oral aspirin 40 ~ 80mg / d, dipyridamole Mo 150 ~ 200mg / d or Chinese medicine rhubarb preparations to prevent pregnancy-induced hypertension and thrombosis, such as pregnancy-induced hypertension, can be treated according to the treatment program of pregnancy-induced hypertension.
Symptom
Symptoms of multiple pregnancy symptoms Common symptoms Fetal intrauterine asphyxia uterus enlargement is obvious (... Epilepsy dyspnea pattern-like fetal pregnancy-induced hypertension Physiological changes during pregnancy Abnormal uterus during pregnancy Prenatal signs Uterine-shaped gourd
1. Clinical manifestations and medical history: there is a history of ovulation induction drugs, family history of multiple births, early pregnancy reaction in early pregnancy occurs early, heavy, prone to lower extremity edema and pregnancy-induced hypertension in the mid-term, due to enlarged abdomen, compression of the diaphragm, cardiac position shift Position, etc., causing difficulty breathing.
2. Abdominal examination: The uterus increases beyond the gestational age, touches multiple carcasses and fetal poles, and has multiple fetal heart sounds.
Women with multiple pregnancies have anemia, pregnancy-induced hypertension syndrome (PIH), eclampsia, low placenta prevalence is higher than women with single-pregnancy, and clinical manifestations related to it can occur.
Examine
Multi-pregnancy check
The serum alpha-fetoprotein (FP) assay also contributes to the diagnosis of multiple births. Macfarlane's multiple-child data show that serum FP is only 29.3% higher in twins, 44.8% in three, and four or more. 80%, so screening for maternal serum FP can help to find multiple births.
Ultrasound examination is the most effective tool for early diagnosis of multiple pregnancy. It can be diagnosed around 6 weeks of pregnancy. It is of great significance for reducing complications and improving prognosis. Color Doppler can detect abnormal arteriovenous anastomosis in time. TTTS), in addition to fetal malformations, B-ultrasound can also determine the fetal position to determine the mode of delivery.
B-ultrasound is a powerful tool for diagnosing three or more pregnancies. Daw (1987) believes that 18 to 20 weeks of gestation is a suitable time for diagnosis of multiple births. The accuracy of B-ultrasound diagnosis for three and four births is 70% and About 65%, with the increase of gestational age, the diagnostic accuracy rate also increased.
Diagnosis
Diagnosis and diagnosis of multiple pregnancy
Diagnostic criteria
In recent years, the development of B-ultrasound has greatly improved the diagnosis rate of twins and early diagnosis.
1. There are multiple births in the family history, and ovulation-promoting drugs have been used. It is necessary to pay attention to the possibility of having twins.
2. Signs
(1) The mother's excessive weight gain cannot be explained by obesity and edema.
(2) The height of the fundus is greater than the actual pregnancy month (>4cm).
(3) Abdominal palpation can reach multiple small carcasses.
(4) Two different fetal hearts were recorded at the same time, and the difference between the two fetal heart rates was 10 min (10 bpm).
(5) One or more fetuses can still be reached at the end of the fetus.
Differential diagnosis
(A), a huge fetus of a single pregnancy: the fetus can be larger than the amenorrhea date, but only one fetus can be touched, and one fetal heartbeat is heard.
(B), polyhydramnios: any single or multiple pregnancy can be accompanied by excessive amniotic fluid, simple amniotic fluid often occurs after 28 weeks of gestation, the uterus increased sharply in the short term. Pregnant women have belching, abdominal pain, and can not sit flat. During the examination, the abdominal wall was tense, the fetal position was unclear, and the fetal heart was far away. It can be identified by ultrasonic image inspection.
(C), pregnancy with uterine fibroids: uterine fibroids with pregnancy, the general uterus is larger than a single pregnancy, but the shape is regular and the hardness is not uniform. B-mode ultrasound can confirm the diagnosis.
(D), pregnancy with ovarian tumors: ovarian tumors are usually single, isolated, soft and soft, different degrees of activity, generally difficult to diagnose, through the B-type ultrasound can be differentiated from multiple pregnancy.
(V), hydatidiform mole: early multi-pregnancy, the uterus increased significantly, the mother serum human chorionic gonadotropin (HCG) level increased, easy to be confused with the mole. After the 12th gestational week, the maternal serum HCG was significantly reduced, while the hydatidiform mole was increased. After the 18th week of pregnancy, pregnant women can consciously move fetally, Doppler can hear the fetal heart, but the hydatidiform mole has no fetal movement, can not hear the fetal heart with Doppler (except for a few moles combined with normal fetus). Ultrasound images can quickly separate the two.
(6), bladder retention: rectal filling can increase the uterus of a single pregnancy, can allow pregnant women to check after large, urinary, it is easy to distinguish from multiple pregnancy.
