HOME
• HEALTH
• LIBRARY
• AREAS
• CENTERS
• BOARDS
• CHATS
• JOIN
FREE
|
|
|
|
|
|
|
Week 32 How Big Is Your Baby? By this week, your baby weighs almost 4 pounds (1800g). Crown-to-rump length is over 11.6 inches (29cm), and total length is 18.9 inches (42cm). How Big Are You? Measurement to the top of the uterus from the pubic symphysis is about 12.8 inches (32cm). Measuring from your bellybutton, the top of the uterus now measures almost 5 inches (12cm). How Your Baby Is Growing and Developing Twins? Triplets? More? When talking about pregnancies of more than one baby, in most cases we refer to twins. The chance of a twin pregnancy is more likely than pregnancy with triplets, quadruplets or quintuplets. You and your partner may be in shock if you learn you have more than one baby on the way! It's a normal reaction. Eventually the joy of expecting two babies may help offset the fear and responsibility you may feel. If you are expecting two or more babies, you will visit your doctor more often. You will need to plan carefully for delivery and care of the babies after you go home. Identical Twins and Fraternal Twins Twin fetuses most commonly result from the fertilization of two separate eggs. These are called dizygotic twins or fraternal twins. With fraternal twins, you can have a boy and a girl. About 33% of the time, twins come from a single egg that divides into two similar structures. Each has the potential of developing into a separate individual. These are known as monozygotic twins or identical twins. The two babies are almost always the same sex. Identical twins are not always identical. It is possible for fraternal twins to appear more alike than identical twins! Either or both processes may be involved when more than two fetuses are formed. For example, quadruplets may result from fertilization of one, two, three or four eggs. Division of the fertilized egg occurs between the first few days and about day 8. In this book, I refer to it as the third week of pregnancy. If division of the egg occurs after 8 days, the result can be twins that are connected, called conjoined twins. (Conjoined twins used to be called Siamese twins.) These babies may share important internal organs, such as the heart, lungs or liver. Fortunately this is a rare occurrence. Frequency of Twin Births The frequency of twins depends on the type of twins. Identical twins occur about once in every 250 births around the world. This type of twin formation appears to be uninfluenced by age, race, heredity, number of pregnancies or medications taken for infertility (fertility drugs). The incidence of fraternal twins is influenced by race, heredity, maternal age, the number of previous pregnancies and the use of fertility drugs. The frequency of multiple fetuses varies significantly among different races. Twins occur in 1 out of every 100 pregnancies in white women compared to 1 out of every 79 pregnancies in black women. Certain areas of Africa have an incredibly high frequency of twins. In some places, twins occur once in every 20 births! The occurrence of twins among Asians is less common: about 1 in every 150 births. Heredity also plays a part in the occurrence of twins. In one study of fraternal twins, the chance of a female twin giving birth to a set of twins herself was about 1 in 58 births. The occurrence of twins is probably more common than we know. Early ultrasound exams often reveal two sacs or two pregnancies. Later ultrasounds of the same woman may show one sac or one pregnancy has disappeared, while the other pregnancy continues to grow and to develop normally. Some researchers believe ultrasound should not be done in the first 8 to 10 weeks of pregnancy. Parents who are informed of twins at this point may be distraught to learn later that one of the babies will not be born. Triplets occur once in every 8000 deliveries. Many doctors never deliver or participate in the delivery of triplets in their medical careers. I have been fortunate in my medical practice to deliver two sets of triplets. Some families are more blessed than others. In one case I know of, a woman had three single births. Her fourth pregnancy was twins, and her fifth pregnancy was triplets! She and her husband decided on another pregnancyùthey were surprised (and probably very relieved) when the sixth pregnancy resulted in only one baby. Fertility Medication, In-Vitro Fertilization and Multiple Pregnancies We have known for a long time that fertility drugs increase the chance of multiple pregnancies. Several different medications are used to treat infertility. Each one affects your chances of conceiving more than one fetus to a different degree. One of the more common medications is clomiphene (Clomid«). It increases the chance of multiple fetuses somewhat less than other medications. But an increased chance is still there. Twins are more common in pregnancies that result from the use of fertility drugs or with the implantation of more than one embryo with in-vitro fertilization. The percentage of male fetuses decreases as the number of fetuses per pregnancy increases. This means more females are born in these multiple pregnancies. Discovering You're Carrying More than One Baby Diagnosis of twins was more difficult before ultrasound was available. The illustration on page 265 shows an ultrasound of twins. You can see parts of both fetuses. It is uncommon to discover twin pregnancies just by hearing two heartbeats. Many people believe when only one heartbeat is heard, there could be no possibility of twins. This may not be the case. Two very rapid heartbeats may have a similar or almost-identical rate. That could make it difficult to tell there are two babies. Measuring and examining your abdomen during pregnancy is important. Usually a twin pregnancy is noted during the second trimester because you are too big and growth seems too fast for a single pregnancy. Ultrasound examination is the best way to tell if you are carrying more than one baby. Diagnosis can also be made by X-ray after 16 to 18 weeks of pregnancy, when fetal skeletons are visible. However, this method is used very infrequently today. Do Multiple Pregnancies Have More Problems? With a multiple pregnancy, the possibility of problems goes up. Possible problems include: ò increased miscarriage ò fetal death or mortality ò fetal malformations ò low birth weight or growth retardation ò pre-eclampsia ò maternal anemia ò problems with the placenta, including placental abruption and placenta previa ò maternal bleeding or hemorrhage ò problems with the umbilical cord, including entwinement or tangling of the umbilical cords with the babies ò hydramnios or polyhydramnios ò labor complicated by abnormal fetal presentation, such as breech or transverse lie ò premature labor One of the biggest problems with multiple pregnancies is premature delivery. As the number of fetuses increases, the length of gestation and the birth weight decreases, although this is not true in every case. When I was a resident, I delivered a set of triplets, and each baby weighed over 6 pounds at birth! The average pregnancy for twins is about 37 weeks. For triplets it is about 35 weeks. For every week the babies remain in the uterus, their birth weights increase, along with the maturity of organs and systems. Major malformations in multiple pregnancies are more common than they are in single pregnancies. The incidence of minor malformation is twice as high as it is in a single pregnancy. Malformations are more common among identical twins than fraternal twins. One of the main goals in dealing with multiple fetuses is to continue the pregnancy as long as possible to avoid premature delivery. This may best be accomplished by bed rest. You may not be able to carry on with regular activities during your entire pregnancy. If your doctor recommends bed rest, follow his or her advice. Weight gain is very important with a multiple pregnancy. You will gain more than the normal 25 to 35 pounds, depending on the number of fetuses you are carrying. Supplementation with iron is essential. Some researchers believe use of a tocolytic agent (medication to stop labor), such as ritodrine, is critical in preventing premature delivery. (See Week 29.) These agents are used to relax the uterus to keep you from going into premature labor. Follow your doctor's instruction very closely. Every day and every week you're able to keep the babies inside you are days or weeks you won't have to visit them in an intensive-care nursery while they grow, develop and finish maturing. Delivering More than One Baby How multiple fetuses are delivered often depends on how the babies are lying in your uterus. Possible complications of labor and delivery, in addition to prematurity, include: ò abnormal presentations (breech or transverse) ò prolapse of the umbilical cord (the umbilical cord comes out ahead of the babies) ò placental abruption ò fetal distress ò bleeding after delivery These problems occur more often with multiple fetuses. Because there is higher risk during labor and delivery, precautions are taken before delivery and during labor. These include the need for an I.V., the presence of an anesthesiologist and the availability and possible presence of pediatricians or other medical personnel to take care of the babies. With twins, all possible combinations of fetal positions can occur. Both babies may come head first (vertex). They may come breech, meaning bottom or feet first. They may come sideways or oblique, meaning at an angle that is neither breech nor vertex. Or they may come in any combination of the above. (See discussion of birth presentation in Week 38.) When both twins are head first, a vaginal delivery may be attempted and may be accomplished safely. It may be possible for one baby to deliver normally. The second one could require a C-section if it turns, the cord comes out ahead of the baby or the baby is distressed following delivery of the first fetus. Some doctors believe delivery of two or more babies requires a C-section. After delivery of two or more babies, doctors pay strict attention to maternal bleeding because of the rapid change in the size of the uterus. It is greatly overdistended with more than one baby. Medication, usually oxytocin (Pitocin«), is given by I.V. to contract the uterus to stop bleeding so the mother doesn't lose too much blood. A heavy blood loss could produce anemia and make a blood transfusion or long-term treatment with iron supplementation necessary.
Changes in You Until this week, your visits to the doctor have probably been on a monthly basis, unless you've had complications or problems. At week 32, most doctors begin seeing a pregnant woman every 2 weeks. This will continue until you reach your last month of pregnancy; at that time, you'll probably switch to weekly visits. By this time, you probably know your doctor fairly well and feel comfortable talking about your concerns. Now is a good time to ask questions and to discuss concerns about labor and delivery. If there are complications or problems later in pregnancy or at delivery, you'll be able to communicate better with your doctor and know what is going on. You'll feel comfortable with the care you're receiving. Your doctor may plan on talking to you about many things in the weeks to come, but you can't always assume this. You may be taking prenatal classes and hearing different things about labor and delivery, such as stories about enemas, I.V.s and complications. Don't be afraid to ask your doctor any questions you have. Most doctors and nurses are receptive to your queries. They want you to discuss things you're concerned about instead of having you worry about them unnecessarily. How Your Actions Affect Your Baby's Development Taking Prenatal Vitamins Jackie admitted to me that she wasn't taking her prenatal vitamins as regularly as she had early in pregnancy. She said she was tired of taking them and asked if it was OK to skip them now that she was in the third trimester. I told her it was a mistake not to take her prenatal vitamin every day. The vitamins and iron in prenatal vitamins are essential to your well-being and the well-being of your baby. If you're anemic at the time of delivery, a low blood count could have a negative effect on you and your baby. Your chance of needing a blood transfusion could be higher. After I explained these things, Jackie realized that taking her prenatal vitamin every day until delivery was good for her and her baby. You Should also Know Postpartum Bleeding and Hemorrhage It's not unusual to lose blood during labor and delivery. However, a heavy postpartum hemorrhage is different and significant. Postpartum hemorrhage is a loss of blood in excess of 17 ounces (500ml) in the first 24 hours after your baby's birth. There can be many reasons for postpartum hemorrhage. The most common causes include a uterus that will not contract and lacerations or tearing of the vagina or cervix during the birth process. Other causes include trauma to the genital tract, such as a large or bleeding episiotomy, or a rupture, hole or tear in the uterus. Blood loss may be related to the failure of blood vessels inside the uterus (where the placenta was attached) to compress to stop bleeding. This may occur if the uterus fails to contract because of very rapid labor, a long labor, several previous deliveries, a uterine infection, an overdistended uterus (with multiple fetuses) or certain agents used for general anesthesia. Heavy bleeding may also result from retained placental tissue. In this situation, most of the placenta delivers, but part of it remains inside the uterus. Retained placental tissue may cause bleeding immediately, or bleeding may occur weeks or even months later. Problems with blood clotting can cause hemorrhaging. This may be related to pregnancy, or it may be a congenital medical problem. Bleeding following delivery requires constant attention from your doctor and the nurses caring for you. Previous Week > Contents > Next
Week
|
|||||||
Home | Help | Feedback | Privacy Policy | Register | Contact Us | Visitor Survey | Subscribe to HealthMail | Advertising | About MDAdvice.com Copyright
© The Online Medical Network Inc. All rights reserved. All material provided by
MDAdvice.com is intended for informative purposes only and is not a
substitute for professional medical advice. Please consult your
physician with any questions or concerns you may have regarding your
health. Use of this site indicates your agreement with the Terms
of Use. |
|
|
|
|
