In recent years, the number of multiple births has increased markedly. A multiple birth has its risks, but thanks to medical control, most of the possible complications can be anticipated in advance, to adopt concrete solutions.
In general, both the timing and the form of delivery cannot be predicted. When it comes to a pregnancy with a single baby, it is possible to be correct when making some predictions regarding the time of delivery, but in the case of a delivery of twins or twins, it is much more difficult.
The type of delivery it will depend on the position of the babies inside the uterus. Most babies, as the day of their birth approaches, they position themselves in a cephalic position, that is, head down. But in the case of twins or twins it is normal for present different combinations in the position they adopt and, according to this position, the medical team will choose the most suitable type of delivery.
The odds of the delivery of a multiple pregnancy either by cesarean section, it is larger than in a single baby delivery. As in any birth, they can also occur problems with the umbilical cord or the position of the placenta.
Normally, although not always, in a twin pregnancy babies are usually smaller and weigh less. Being smaller than other babies, their expulsion by vaginal route is easier than in a single fetus delivery. However, size is not the only thing that matters in determining whether the two babies will be delivered vaginally or by cesarean section.
The choice betweencaesarean section or vaginal route depends on several factors:
1. The moment in which labor begins, since if it is very premature, it is not possible to do it vaginally.
2. The position of fetuses.
3. If there is fetal suffering.
4. If there are other types of complications.
Thecomplications In multiple births, the most frequent that can occur in a twin or twin delivery are usually:
1. Slow dilation. In multiple pregnancies, it is normal for contractions are less intense and, therefore, the slowest dilation. The reason is that the womb is very distended by the weight of the fetuses and the uterine muscles lose flexibility and do not cause the desired contractions. To solve this problem, oxytocin is given to the mother.
2. Misplaced fetuses. With ultrasound, doctors preview the position of the fetuses to make the appropriate decisions.
3. Tangled umbilical cords. It occurs in the case of univiteline twins, that is, they share an amniotic bag.
4. Compression of the umbilical cord. The danger of the cord becoming compressed occurs when the cord of the first baby is ahead of the presentation of the second baby. In this case, the baby may not get enough oxygen, that is, suffer from fetal distress. To avoid this it is necessary to perform a cesarean section.
5. Placental abruption. Sometimes it can happen after the first baby is born. To avoid possible symptoms of fetal suffering in the second baby, the latter should be removed immediately.
6. Retention of placenta. It can be solved by performing a manual delivery.
7. Postpartum hemorrhage. This complication occurs when the uterus is very dilated and cannot contract on its own. Drug administration is necessary.
In multiple births, they are usually present, in addition to a gynecologist and / or midwife, an anesthetist and a neonatologist so that you value babies at birth. It is advisable for the clinic or hospital to have a special unit for premature babies.
During delivery, the mother will be connected to a fetal monitor so the doctor can monitor each baby's progress. If the delivery is vaginal, as babies are usually smaller, their size will make it easier to push them out.
After delivery, the placentas and membranes should be carefully examined for establish zygosity. In case you need a cesarean section, you will receive anesthesia and a vertical and horizontal incision will be made in your abdomen and uterus. Babies will come out at intervals of a few minutes. In the event of preterm delivery, the babies will be immediately transferred to the neonatal ICU for special care.
The position of the babies inside the womb will determine the type of delivery that the mother will have. Statistics say that in 75-80 percent of cases, the first twin is usually in the cephalic position, spontaneous vaginal delivery is possible. However, the second twin must be born within the next twenty minutes. If after that wait, the second baby has not been born, the team has to intervene to avoid fetal distress or lack of progress.
Between the possibilities of action is it so:
- Breech extraction
Suction cup if presentation is cephalic, but the baby is high in the uterus
Forceps, when the baby's head is embedded
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