Due date with twins

Twin Pregnancy: Answers from an Expert

Twin Pregnancy: Answers from an Expert | Johns Hopkins Medicine

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When you’re expecting twins, you know you’ll need two of everything for your registry. But what about staying healthy during your pregnancy? Do you need to double your food intake, weight gain and visits to the doctor? With regard to the babies, are there two placentas and two amniotic sacs, or can they share these?

Johns Hopkins maternal-fetal medicine specialist Jeanne Sheffield answers eight commonly asked questions.

Do twins share a placenta and an amniotic sac?

While some twins may share a placenta and an amniotic sac, that is not the case for the vast majority of pregnancies. Here are three major possibilities that exist:
- Two placentas and two amniotic sacs. A twin pregnancy with two placentas and two amniotic sacs is the optimal twin pregnancy, as each baby has its own nutritional source and protective membrane.
- One placenta and two amniotic sacs. In pregnancies with one placenta and two amniotic sacs, you will definitely have identical twins. Additionally, when your babies share a placenta, there is a greater risk for complications, such as twin-to-twin transfusion syndrome. Your physician will closely monitor your pregnancy to check for potential problems.
- One placenta and one amniotic sac. This is the riskiest and rarest type of twin pregnancy. Fetal complications can arise due to tangling of the umbilical cords or an imbalance in nutrients, blood or other vital life supporting systems.
Do I need to double my caloric intake during a twin pregnancy?

A common misconception surrounding twin pregnancy is that you need to double your caloric intake to provide your babies with enough nutrients. However, pregnancy nutrition guidelines aren’t simply based on the number of babies you’re carrying. Instead, they’re based on your body mass index at the time you became pregnant.

Your doctor will make individualized recommendations based on your starting weight. On average, it’s estimated that a woman’s caloric requirements will increase about 40 percent for a twin pregnancy. What’s most important, though, is that a woman eats as healthy as possible.
Do I need to take different prenatal vitamins for twins?

If you’re pregnant with twins, you should take the same prenatal vitamins you would take for any pregnancy, but your physician will recommend extra folic acid and iron. The additional folic acid and extra iron will help ward off iron-deficiency anemia, which is more common when you’re pregnant with multiples.
Will I need to visit my doctor more frequently?

While every pregnancy is different, most women carrying twins will have more frequent prenatal visits than women carrying only one baby. If your twins are sharing one placenta, you will automatically have a more frequent monitoring schedule.

If your pregnancy doesn’t have complications, your prenatal visits may not differ much from a singleton pregnancy until you get to the end of your second trimester. At that point, you’ll be seen more frequently because there is a higher risk of pre-eclampsia and preterm labor.
Do I have to see a maternal-fetal medicine specialist for a twin pregnancy?

Maternal-fetal medicine specialists see high-risk pregnancies, but not every twin pregnancy will fall into this category.

To find the best care provider for your twins, make sure that the physician is comfortable managing twins, including vaginal delivery of twins rather than only offering a cesarean section (C-section) for delivery.
Are all twin pregnancies delivered preterm?

A little more than half of twin pregnancies end in preterm delivery (before 37 weeks). While 40 weeks is the full gestation period of the average pregnancy, most twin pregnancies are delivered at approximately 36 weeks (range 32-38 weeks depending on the type of twin pregnancy).

Unfortunately, preventing preterm labor with multiples is more challenging than with a singleton pregnancy because the interventions used with singleton pregnancies are not as effective with multiples.
Can bed rest reduce the risk of preterm delivery?

Scientific data show that bed rest does not prevent preterm delivery. In fact, bed rest can increase your risk of developing blood clots and have negative financial and social consequences.

Although bed rest is not prescribed as frequently as it once was, your doctor may suggest reducing your activity level if you’re showing signs of early labor at the end of your second trimester or early in your third trimester.
Is labor and delivery significantly different with twins?

Labor is generally the same whether you’re having one baby or two. During delivery is when things differ significantly.

When it’s time to deliver your twins, you will go to an operating room even if you are delivering vaginally. This is a safety precaution known as a double setup. Following the vaginal delivery of the first baby, there is a small risk of an emergency cesarean section for the second baby. There is also the possibility of the second twin being delivered breech, which is a safe form of vaginal delivery if the obstetrician is experienced in this type of delivery.

Of women giving birth to twins over 32 weeks, only about 4 percent who try for a vaginal delivery will have a combined vaginal and cesarean section delivery. While it doesn’t happen very often, by delivering both babies in the operating room, physicians are better prepared to protect the health of the mother and the babies.

Although being pregnant with twins can seem very different, your doctor will treat your pregnancy like any other unless a complication occurs.

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Pregnancy Due Date Calculator | The Bump

Prep for baby's arrival with The Bump due date calculator. Learn how to calculate your pregnancy due date by hand—whether you’re having one baby, twins or underwent IVF—or simply plug in some info and let our pregnancy calculator do the work.

So you’ve found out you’re pregnant—congrats! For many moms-to-be, the next thing on their minds is “when is my due date?” But accurately calculating your pregnancy due date isn’t quite as simple as plotting a nine month forecast (in fact, pregnancy is typically 40 weeks long, which is more than nine months!). Your doctor will give you your official due date after your first prenatal visit, but when you just gotta know the baby’s birthday now, count down to the big day with The Bump due date calculator.

If you conceived through in vitro fertilization (IVF), the pregnancy due date calculator may not be the right method for you. If you fall into that bucket, see below for how to calculate your due date for an IVF pregnancy.

How to calculate due date by conception
How to calculate due date based on last period
How to calculate due date by ultrasound
How to calculate IVF due date
How to calculate due date for twins

How to Calculate Due Date By Conception

If you happen to know the exact day you conceived, you could calculate your baby due date by counting 38 weeks from the date of conception (38 weeks is said to be the length of human gestation). But figuring out an accurate due date based on conception date is easier said than done: Unless you were really deliberate about tracking your ovulation or were able to make a baby in one shot (and had no extracurricular fun with your man otherwise), knowing which day was the big one isn’t clear cut. Even if you had sex only once during your six-day fertile period, you may not have actually conceived that day unless you happened to be ovulating. Conception happens when your egg is fertilized, but since sperm can live inside your fallopian tubes for up to five days waiting for an egg to be released, you could conceive up to five days after having sex. It’s enough to make a mom-to-be’s head spin. That’s where a due date calculator, also known as a pregnancy calculator, helps.

How to Calculate Due Date Based on Last Period

The most common way of determining when baby will be born is to calculate your due date based on your last menstrual period (LMP), which is how a pregnancy calculator works. If you have an average-length cycle (about 28 days), your period came about two weeks before you ovulated and conceived. To arrive at your baby due date, count forward 40 weeks (that’s the 38-week gestation plus two weeks) from the first day of your last period and mark a big X on your calendar for Baby Day! Or, if you’d rather not rely on your math right now (the pregnancy brain struggle is real), simply plug the date of your last menstrual cycle into The Bump pregnancy due date calculator above and get instant results. Of course, not every woman has a 28-day cycle or ovulates exactly mid-cycle (and not everyone remembers with perfect precision the first day of their last period). Another (more accurate) way to calculate your pregnancy due date is by ultrasound (see below).

How to Calculate Due Date By Ultrasound

Other than using a due date calculator based on your LMP, your doctor can also calculate your pregnancy due date by ultrasound, especially if you have an irregular cycle. When you go in to see your OB or midwife for your first prenatal appointment, they’ll likely schedule you for an ultrasound to confirm the pregnancy. During the ultrasound, the technician or physician will measure baby’s length, from crown to rump, to gauge how far along you are and calculate your due date. According to the American Academy of Obstetricians and Gynecologists (ACOG), a first-trimester ultrasound is the most accurate method to establish or confirm gestational age. If baby is much bigger or smaller than expected for the gestational age based on your LMP, your doctor will likely change your due date based on what they see on the first-trimester ultrasound.

How to Calculate IVF Due Date

If you underwent in vitro fertilization, you have the benefit of knowing exactly when the egg was fertilized, so an IVF due date calculator can be very precise. Plus, you don’t have to worry about any changes to baby’s anticipated date of arrival as you might with a pregnancy calculator based on LMP. (Whether baby is actually born on that day is of course another story.) Your baby due date is determined by either when you ovulate—meaning your egg retrieval or intrauterine insemination (IUI) day—or whether you’re having a three- or five-day embryo transfer. For a day three embryo, count forward 263 days from the transfer for your due date; for a day five embryo, add 261 days. If you’re undergoing IUI, your due date is 266 days (or 38 weeks) later.

How to Calculate Due Date for Twins

If you naturally conceived twins or multiples and haven’t already been told your pregnancy due date by your doctor, you can use The Bump due date calculator above based on your LMP, just as you would if you weren’t doubling (or tripling) down on babies. How to calculate due date for multiples is the same method you’d use for a singleton baby, but keep in mind that delivery day recommendations may change: For example, di/di twins are usually delivered between 38 weeks and 38 weeks and six days instead of 40 weeks. So just know that twins may arrive earlier than the due date noted by the pregnancy calculator. A first-trimester ultrasound is the most accurate way to calculate due date, and changes to the date after that measurement is done are extremely rare.

Now that you know what month baby will be born in, you can also get the scoop (just for fun) on if your wee one will supposedly be a boy or a girl. Use the Chinese Gender Chart to predict baby's sex while you wait for the official (and more reliably accurate) ultrasound or prenatal testing results.

Medical content was reviewed August 2020 by Temeka Zore, MD, a board-certified ob-gyn and reproductive endocrinologist and infertility specialist at Spring Fertility in San Francisco.

Twin births: natural and caesarean section

Natural births

In order to calculate the date of birth of twins, it is necessary, as in the case of a singleton pregnancy, to take the first day of the last menstruation as a starting point. From this date, subtract 3 months and add 7 days. The resulting day in the calendar is the estimated date of birth (ED). To find out which week the twins will be born, you can safely subtract 2-3 weeks from the DA. After all, usually with multiple pregnancy, babies are born two or three weeks before the planned date, or even earlier. Especially if the birth of twins occurs in the second or subsequent births.

Important!

If there are no deviations in the development of both babies, and the mother's health throughout the entire period of pregnancy is assessed as excellent, there are all indications for a natural method of delivery. At the same time, both babies should be in a normal presentation, i.e. heads down.

The long-awaited event has a number of harbingers. One of them is abdominal prolapse. It becomes easier for the expectant mother to breathe, because the diaphragm also dropped. In the second birth, the stomach does not drop in advance, but two or three days in advance, and with the third birth of twins, this may not happen at all. And the head of the first baby will descend into the small pelvis already in the process of childbirth.

A sign of imminent labor is the presence of loose stools. Biologically active substances that promote uterine contraction also affect the intestinal wall. Also, in late pregnancy, the uterus puts more pressure on the bladder, causing more frequent urination.

In the same way as in a singleton pregnancy, a woman develops a "nesting syndrome". The expectant mother feels a surge of strength. She enthusiastically equips a children's corner, washing and ironing tiny things.

When the birth of twins is approaching, a woman may feel pain in the lower back, in the area of the sacrum. They indicate that twins may be born in the coming days or even hours.

Harbingers are most pronounced in primiparas. In multiparous women, the birth canal is more prepared for the process, which means that precursors may appear immediately before childbirth. The expectant mother of twins should remember this.

Contractions are a signal of the onset of labor - this is a sign of the opening of the uterus. They are manifested by severe pain in the lower abdomen with a certain frequency. With each new contraction, the pain intensifies. Reduce pain manifestations with the help of special massage techniques.

The birth of twins has the same stages as the birth process with one fetus, but some stages proceed with peculiarities. The sequence of the process of the birth of babies is as follows:

The cervix opens.
The fetal bladder of the first baby is opened.
The eldest of twins is born.
A pause comes, it lasts differently for everyone.
The second amniotic sac opens.
The next baby is born.
The afterbirth of both children comes out simultaneously, if it is common, or sequentially, if each has its own.

Every birth of twins is a crucial moment for specialists. However, in the practice of the birth of two babies, there are cases that require special attention.

Childbirth after IVF. Until recently, during pregnancy as a result of in vitro fertilization, a planned operation was necessarily performed, but now it is possible to successfully give birth naturally. What will be the birth, experts determine, taking into account all the risks.

The third birth of twins has its own nuances. They consist in a weak manifestation of precursors, and sometimes a woman may not even notice them. The question of how long the birth of twins lasts for the third time can be answered: less than an hour from the start of contractions in the most extreme case.

Caesarean section for twins

Sometimes twins are best delivered by elective surgery. This guarantees the safety of the health of babies, as well as their mothers.

Indications for a planned cesarean section are from both the future mother and the fetus. A planned operation is recommended if there are deviations in the health of the pregnant woman: previous operations on the uterus, the presence of HIV infection, clinical manifestations of genital herpes, diseases of the cardiovascular system, urogenital area (tumors, fistulas), pathology of the organs of vision.

Important!

Natural birth of twins can end in a caesarean section. A woman should have an inner readiness for such an outcome.

On the part of babies, indications for caesarean section are: incorrect placenta previa, pelvic or transverse position, fusion or adhesion of fetuses. If the babies have one placenta for two and single fetal membranes, then the woman will also be offered an operation so that the second child does not suffer during the birth of the first child.

Preparation for a planned delivery

Preparation for a future operative delivery begins from the moment a planned operation is scheduled and continues for the rest of the time until delivery. When preparing for a planned delivery, you should find out from the observing specialist how long the operation will be performed, how many days you need to go to the hospital. It is advisable to attend preparatory courses for women in labor who are to have a caesarean section.

Important!

If you are pregnant with twins, it is important to immediately inform specialists about any signs of a change in the state of health, deviations that have appeared.

Every woman wonders what week the birth of twins by planned caesarean section takes place. There is no universal formula for how to calculate this date during surgery, everything is determined on an individual basis. Usually, a planned operation for pregnant twins is carried out as close as possible to the term of natural childbirth - 38 weeks.

One or two weeks before the appointed date, the expectant mother is hospitalized in the maternity pathology department of the maternity hospital where the birth will take place. She is undergoing the necessary examinations and medical preparation. On the eve of the operation, the method of anesthesia is determined, an enema is given.

During conduction anesthesia, the mother is conscious and hears the first cry of the babies. Each of the children is alternately applied to the chest. With general anesthesia, the meeting will occur later. After giving birth, the woman is transferred to the intensive care unit, and the babies are transferred to the nursery. During the first day, newborns are repeatedly brought to breastfeeding. In the normal course of the postpartum process and the satisfactory condition of the children, the mother and her babies are reunited in the postpartum department on the second day after the birth of twins.

The appearance of two children is always an amazing, doubly joyful process. This happens both when expecting the firstborn, and when twins appear in subsequent births. The reward for painful toxicosis, excess weight, temporary deterioration in health will be the loud cries of babies, daily reporting that they have come into this world.

Twin birth - Juno

Twin birth: the content of the article

Twin birth: understanding the terminology

Carrying 2 or more children is a multiple pregnancy. It rarely happens - a maximum of 1.6% of expectant mothers. Now there is an upward trend.

Twins are dizygotic twins. They appear when two eggs fertilize two sperm. Such brothers and sisters are not alike. By appearance, you can determine that they are relatives, but the children are not the same.

Twins are different and same-sex. They may have a radically different character, temperament.

Causes of twins

Researchers have identified a number of factors that increase the likelihood of conceiving two babies:

Maturity - in a woman at 35-40 years old, the level of gonadotropin increases, it increases the chances of becoming a mother twice in one pregnancy;
Heredity - women on the line of the future mother had twins. She is also at risk;
Genetics - the IGF-1 gene is responsible for tissue development, cell division. There is a direct connection between his rise and the conception of twins;
High levels of IGF-1 protein - observed in women who are overweight and consume a lot of dairy products. Therefore, vegan women are much less likely to have two babies;
Hormonal therapy - for example, treatment of infertility with gonadotropins;
IVF - the procedure involves the stimulation of the ovaries, which leads to the fertilization of two eggs.
Nationality - African women most often on the planet give birth to two or more children in one pregnancy.

Scientists from Amsterdam have identified another factor - 2 genes (one or a combination of them). The first is associated with an increase in the FSH hormone, a natural ovarian stimulator for the release of an egg. With a high level of the hormone, 2 eggs can be released.

The second is SMAD3. It is responsible for the reaction of a woman's body to the FSH hormone. If the ovaries are sensitive to it, two eggs can be fertilized. In this case, the level of FSH is not important.

The first version of the gene increases the chance of carrying and giving birth to two children by 18%, the second - by 9%, their combination - by 29%.

Features of pregnancy

Bearing several fruits is harder than one. After all, the body of the expectant mother works in an increased load mode: the uterus grows, the diaphragm and internal organs are displaced and compressed.

The heart works harder, the urge to urinate becomes more frequent, the woman suffers from shortness of breath and a feeling of lack of air. More weight gain negatively affects the spine, legs, and veins.

Higher risk of preeclampsia, hemorrhoids, varicose veins, intestinal disorders, heartburn - few pregnant women are lucky to avoid these troubles.

Probability of complications during pregnancy and childbirth of twins

We will determine the risks for the future mother.

Preeclampsia. Diagnosed five times more often. It proceeds more severely, against its background, acute pyelonephritis develops.

Anemia. It develops as a result of iron deficiency - it is consumed in large quantities.

Gestational diabetes. It occurs more often than when carrying a single child.

pathology of pregnancy. Bleeding, placenta previa, premature birth, miscarriage, abnormalities in labor activity.

Wrong position of children. Low position, breech, foot or mixed presentation complicate the birth of twins.

Postpartum complications. After the first birth (older twin), the uterus may begin to contract - this leads to placental abruption and a threat to the life of a younger brother or sister.

Massive blood loss. An overstretched uterus can contract poorly after the birth of children. For the mother, this is fraught with blood loss, uterine atony.

Complications for children

Among the risks for babies, doctors point to the following:

Body weight less than normal by at least 10%. In most cases, the weight does not reach 2.5 kg;
Developmental delay. The mother's body is not able to saturate two children at the same time with nutrients and oxygen. Therefore, twins are born small and immature;
Unpreparedness for birth. Babies are born prematurely, often severely premature. Even if one baby is ready to meet his mother, then the chances are high that the second one will be less ready for this.

Due dates for multiple pregnancies

In most cases, pregnancy ends at 35-36 weeks.

The birth at 32-33 weeks is assessed as premature. Both or one of the babies may not be ready. The consequences are a lag in physical development, low body weight and height. This is an indication for a caesarean section.

At 35 weeks, it is advisable for the expectant mother to be hospitalized in the maternity hospital. From now on, a meeting with children can happen at any moment. At 36 weeks, independent childbirth is possible.

The appearance of children at 37 weeks is considered optimal. Usually around this time this happens. They are as ready for the event as possible: healthy, strong. Weigh less than single peers. In the absence of previously identified pathologies, everything proceeds without complications.

At 38 weeks, twins appear extremely rarely. This is the best outcome.

How to calculate the due date of twins

The reference point is the first day of your last period. Subtract 3 months from this day and add 7 days. Here is the expected day of delivery. This method is more suitable for women expecting one child.

It would be more correct for you to subtract 2-3 weeks from this date. If this is your second birth, twins may be born even earlier.

Duration of twin labor

The birth process includes 3 stages:

Cervical dilation - from irregular contractions to full dilation;
Expulsion of the fetus - from attempts to birth;
Postpartum - from the birth of a child to the release of the placenta.

The duration of these stages does not depend on the number of fruits. The state of health of their mother plays a role.

The duration of childbirth - the period of exile - is longer than with uniform gestation. This is due to the successive exit of the children. For most women, this step takes 15 minutes.

The kids go out one after another on average with an interval of 13. 5 minutes.

Method of delivery in multiple pregnancy

Expecting twins is not a reason for operative delivery. With good health of them and their mother, easy bearing and no contraindications, the woman in labor can handle it herself. An important condition is the cephalic presentation of both children, the normal location of the placenta.

In case of complications, pathology of pregnancy, contraindications on the part of the mother or babies, surgical intervention is indicated.

Natural childbirth

First, the harbingers of an imminent meeting with babies come.

The stomach drops - mom breathes easier. With repeated births, the stomach drops shortly before an important event - in a couple of days, with a third it may not fall.

Liquid stool is the second harbinger. Substances are more actively released to start the contractile activity of the uterus. They also irritate the intestines.

Increased urge to the toilet "in a small way. " The uterus presses on the bladder - urination becomes more frequent.

Decreased activity in children. The symptom is not typical for everyone.

Pain. The sacrum, lower back aches - twins can appear from day to day or even in the next few hours.

In first-born mothers, these signs are more pronounced.

Start of the birth process

It starts with contractions - this is how the uterus opens. They are accompanied by severe pain, regular and growing.

The birth process proceeds according to the standard scheme. Some stages are specific.

The sequence is:

Neck fully open;
The eldest child is born: the waters break from the bladder, and the child is born;
Pause;
The youngest child is born. By the same principle;
Sequence out.

If the water does not leave, the fetal bladders are pierced - an amniotomy is performed.