Twins: the birth and the first days of life
Fortunately, now twin childbirth are not a surprise neither for doctors, nor for newly made mummy. Already much behind. Behind first surprise, first alarms and pleasures. There are last, longest weeks of pregnancy. It is a little more - and expectations will be met, childbirth, same unusual - “double“ will begin. In what their feature? What to expect and, the main thing how to help itself and children with this hard business?the Most part of twins is born
before term - somewhere after 37 - y weeks, and only 10% of twins “maintain“ about the put 40 weeks. The average duration of pregnancy for triplets of 34 - 35 weeks. And the organism of mother and child in this term is not absolutely ready to childbirth yet what the bigger number of complications is connected with. Therefore it is worth choosing in advance the medical center which will conduct such childbirth. The center has to have strong obstetric surgical service and a wide experience on nursing of newborns. Conducting such childbirth is charged to the most skilled doctors in crew on duty. And still you should not wait for childbirth of the house. Polycarpous childbirth is that case when it is better to meet the beginning together with doctors.
In the majority (80%) of cases by the end of pregnancy both twins are in longitudinal situation and occupy one right, another the left half of a uterus. In 50% of cases prelying (that is being at an exit from patrimonial ways) part at both fruits is the head; one fruit in head, another is in pelvic prelying in 44% of cases; both fruits in pelvic prelying - in 6% of cases. Besides, happens that one fruit settles down in longitudinal, another - or both fruits are in cross situation cross. Precisely it is possible to recognize these provisions at ultrasonography. In case of head prelying both or at least first fruit perhaps natural rodorazresheniye. There is an opinion that the first that from twins who are stronger is born. It is the myth. The major role is played here by an arrangement of twins.As everything begins
the disclosure Period - the first period of childbirth during which due to fights there is a disclosure of a neck of a uterus.begin
of 40% of twin childbirth with a premature otkhozhdeniye of waters at an unripe neck of a uterus. Normal waters stream when the uterus neck completely opened. The unprepared neck of a uterus is not softened, not shortened, its channel is closed; such condition of a neck of a uterus speaks about insufficient readiness of an organism for childbirth. Situation is aggravated also with the functional insufficiency restretched, the thinned muscles of a uterus owing to what weakness of patrimonial forces develops, the period of disclosure drags on. At weak contractions it is necessary to resort to stimulation of patrimonial activity by medicamentous means.
In general, at polycarpous childbirth are applied by very many various medicines, and future mother of twins should not be afraid of it. Widely use the anesthetics, means eliminating spasms, watch dynamics of arterial pressure, carry out prevention of a pre-natal hypoxia (oxygen insufficiency) of fruits.
If at the beginning of the disclosure period the prelying part of the first fruit is over an entrance to a small pelvis (it is defined at vaginal inspection), for the purpose of prevention untimely the izlitiya of waters and loss of small parts of a fruit and an umbilical cord to the woman in labor strongly recommend to observe a bed rest. At a mnogovodiya make an artificial rupture of a fetal bubble (amniotomiya). After removal of excess of amniotic waters excessive stretching of a uterus disappears, and its sokratitelny activity improves. Waters let out gradually as fast izlity waters can cause a number of adverse effects: loss of an umbilical cord, handle, premature otsloyka of a placenta.
“Culmination“ of childbirth
Second, the most “responsible“ period of childbirth - the period of exile (attempt) - also quite often drags on. The prolonged period of exile constitutes serious danger to mother (from - for possible infections) and fruits (to them oxygen starvation - a hypoxia - and infection threatens). The exile period in “double“ labor drags on because in the lower department of a cavity of a uterus there are at the same time two large parts belonging to various fruits which advance requires long work of a uterus: one of these large parts has to be inserted into a small pelvis, and the second - to depart up.
Rare and extremely heavy complication - the simultaneous introduction in a basin of heads of both twins which is followed by coupling of twins heads. This complication can arise and when the first fruit is born in pelvic prelying, and the second - in head. Both twins and in those extremely exceptional cases when they lie in the general cavity can get into dangerous situation, at the same time umbilical cords of both fruits can intertwine and at the birth of the first twin to drag on that causes asthma both or one fruit - depending on the features created in the bound umbilical cords.
to accelerate the period of exile and to minimize risk of a patrimonial trauma, make a crotch section. After the birth of the first fruit carefully tie up not only the fruit, but also maternal end of an umbilical cord. It is necessary because in case of uniovular the twins second fruit can die from blood loss (through an umbilical cord of the first fruit if it is not tied up).open with
In 20 - 30 minutes at renewal of fights a fetal bubble of the second fruit, amniotic waters let out slowly. If not to make it, then the overdue rupture of a fetal bubble of the second fruit is possible owing to what the period of exile will drag on. With the same purpose, and also for the purpose of prevention of the postnatal bleeding caused by uterus restretching at twins surely adjust intravenous administration of the reducing means (more often than OXYTOCIN). At this stage complications are also possible. For example, after the birth of the first twin of the second can reach cross position even in case by the beginning of childbirth he was in longitudinal. Besides, after the birth of the first fruit there can come a premature otsloyka of a placenta of yet not been born twin (or the general placenta). At the same time there is severe bleeding menacing to health of the woman in labor and a hypoxia of the second fruit. Life of the last can be saved only by its immediate extraction from patrimonial ways. It is carried out by means of obstetric operations (for example, imposing of obstetric nippers). The premature otsloyka of a placenta after the birth of the first fruit occurs in 3 - 4% of childbirth by twins.
the Last stage
After the birth of both twins comes the posledovy period of childbirth. In this period the most important is to avoid bleeding. If bleeding arises at the separated, but not been born placenta, it is deleted from a uterus with external receptions, and at not separated placenta - the hand entered into a uterus.
the been born afterbirth is carefully examined to be convinced of its integrity and to establish character of twins (one - or dvuyaytsovy) - at two-egg twins two or one accrete placenta and four leaves of fetal covers in a partition between fruits are defined. The introduction of oxytocin begun even during disclosure or exile is continued and in the early postnatal period within 15 - 20 min., at the same time carefully watch a tone of a uterus and allocations from a genital tract.to
When needs operation?
Despite all difficulties of twin childbirth, every second twins are born without surgery today. In a case when the risk of complications at childbirth is very big, doctors suggest to make Cesarean section in a planned order. Planned Cesarean section at twins is done on 38 - y to week of pregnancy, and at triplets - on 35 - 36 - y week of pregnancy.should do to
in half of cases after the beginning of natural childbirth the emergency Cesarean section. The indication to the emergency Cesarean section are various complications of childbirth menacing to health of mother or children.
the First days after the delivery
After the delivery mother and children continue to remain under persistent supervision of doctors. Decrease in a tone of a uterus and its restretching can become the bleeding reason. Reduction of a uterus after the delivery is slowed down (obstetricians call this state subinvolution of a uterus). Subinvolution of a uterus (insufficient reduction of muscles of a uterus) is followed by bleeding and can become the reason of inflammatory postnatal diseases. Such diseases at polycarpous childbirth arise a little more often than after the delivery one fruit; it depends not only on involution delay, but also on the considerable frequency of complications and surgical interventions at the time of delivery. The special gymnastic exercises strengthening muscles of a belly wall and a pelvic bottom, earlier feeding of kids a breast and also preventive purpose of the reducing preparations if necessary will help to avoid complications after the delivery.by
to the Children who were born before term also requires additional attention and is frequent - treatment. Possibly, the first days they should be in an intensive care unit. Depending on their health, mother or will be invited to nurse children, or will ask to decant for them breast milk. As soon as children get stronger, will transfer them to chamber to mother or to the nursery. Mother till this time should make every effort to restore forces after the delivery, then on it there will be not enough time because the most part of days should be devoted to feeding of kids.
Krom of usual difficulties, also additional arise. As children are born premature, weak, at first they it is often bad, inactively suck. Therefore in the first weeks of twins it is better to feed in turn especially as they should teach to be taken correctly a breast, and here not to do without two hands.When the lactation will be adjusted by
, and children will get stronger, it is possible to pass to joint feeding, it will preserve time. Especially conveniently joint feeding if kids have an identical day regimen. The consultant for breastfeeding or the patronage nurse of children`s policlinic will help to pick up the correct pose. However it is better to keep one or two feedings a day separate to pay to each child enough attention. If children were born with a big difference in weight, then small it is necessary to feed more often. It is impossible to forget that breastfeeding helps twins to catch up quicker with peers on development, and to mother - successfully to be restored after difficult childbirth.