For many women, the birth of twins naturally takes place without any complications. However, the risk of termination of pregnancy by cesarean section increases with the number of fetuses. At the same time increases the probability of complications during pregnancy and childbirth.

This, of course, does not mean that the birth twins or triplets have to end unfavorable, but during pregnancy and childbirth need to be more careful monitoring of both mother and fetuses.

When multiple pregnancies in the first stage of labor more likely to develop weak labor contractions than in singleton. After the birth of their first child fights for some time stop, as the volume of the uterus is reduced by half, and it takes some time to acquire the necessary to reduce the tone. During this time the doctor constantly monitors the heart rate of the second fetus. Then opened his bag of waters, after which the child rather quickly is born, even breech. This is understandable - the birth canal already prepared (rasshreny) the birth of the first child and, in addition, the children in multiple pregnancies usually have no more weight and body size. When multiple pregnancies are often found in children the consequences of fetal hypertrophy and hypoxia. Very often hypoxic second born fruit.

Usually, it is recommended that at birth twins attended the anesthesiologist, in case there is a need to resort to caesarean section, although the majority of the twins can be born by natural forces (sometimes with the help of pliers to prevent them from excessive injury). Nearby should be a pediatrician or neonatologist also ready to assist, if needed.

In the case of twins should always be prepared for the eventuality that may arise during childbirth. It may be that the birth of the first child by natural means, second, lying crosswise, and which will not be able to turn, will have to help by caesarean section. It is also possible, although amniotic fluid moves independently during birth of the first child, the fetus would have to break the membrane artificially.

In most cases, the second child is born after the first. If this second born slowly, your doctor may recommend to introduce oxytocin or impose forceps, or make partial cesarean section. After giving birth afterbirth usually goes quickly. However, sometimes it happens so slowly that you may need medical attention.

It argued for emergency operations traumatic forceps and vacuum extraction of the fetus head. Indeed, the relative number of injuries received during childbirth in which these operations are performed is higher than during childbirth, which may end spontaneously. The fact that there is a cause and effect reversed. The cause of injury to the fetus is not in operation, and in the condition in which it is produced.

Think about it, what to do if the fetal head has descended in the pelvic area, and labors weakened? On the monitor, which is fixed fetal heartbeat, an obstetrician sees it first quickens, then it becomes spasmodic and finally begins bradycardia - slowing heartbeat. It is clear that the child is in danger and, if urgent action is taken, he will die. Cesarean section in this situation impossible. Yes and remove the fetus through an incision in the uterus, when his head had fallen in the pelvic area, it is very difficult and necessarily lead to injury to the child and the mother. The only thing that is possible - an operation forceps or vacuum extraction of the fetus. But the child is already suffering from hypoxia, and it is clear that after the birth, he will feel far better.

Certainly, the operation to a professional with careful observance of technology of its performance and, most importantly, on time, that is when the fetus has not significantly deteriorated, or there is a threat to his health.

The operation forceps and vacuum extraction of the fetus is that by means of special devices creates an additional force to extract the fetus from the birth canal.

The difference between the operations is not so much in the process of extracting the fetus, but in the fact that the forceps can completely replace the generic activities (eliminating the need for any attempts), and vacuum extraction only complement the efforts of their own mothers. Therefore, when the voltage is contraindicated in labor (it happens at heart diseases in pregnant women, OPG-gestosis with high blood pressure, hypertension and so on. D.), At the end of the second stage of labor is applied forceps. With the weakening of labor forces and the threat of fetal hypoxia may be made both of these operations.

Removing the head of the fetus does not, as is sometimes thought, to stretch the neck of the fetus and the injury of the cervical spine, since the location of the fetal head in the pelvic cavity shoulder girdle fetus is at its widest part and experiencing barriers to their advancement.

Methods for evaluating the health of the fetus in the womb is constantly being improved and new tests is quite common. At the same time in each clinic and every doctor has some specific instruments and methods of determining the state of health of the fetus. Here are the most frequently used methods (tests).

Assessment of fetal movements can afford to judge the state of health of the fetus, as being the most simple way to detect the danger arose. If a pregnant woman does not feel fetal movement, other studies are needed.

The test for the absence of pathology

The test for the absence of disease - nonstress test. This test is quite safe and is the most affordable. It is based on the observation that a healthy baby heart rate increases about 15 beats per 15 seconds while running under normal oxygen supply. Record heart rate seen with ultrasound. The doctor asks his mother say when she feels the movement of the child. Since then made observation of a change in heart rate. If for 20 minutes twice, a change in heart rate, the result is normal. If within 40 minutes of heart rate increase were observed, the result is considered pathological.

A positive result corresponds to the normal fetus, but with a negative result in 75% of cases the alarm is false. A child, for example, can sleep during the test. If the test is repeated after some time, the result would be normal. If the re-analysis, and points to a stressful condition of the fetus, the doctor can prescribe a test to check the pathology of labor.

Acoustic and vibroacoustic stimulation   - Nonstress test, which assesses the response of the fetus to the sound or vibration.

The test for abnormal contractions

The test for abnormal contractions - studies used to assess the effect on the uterine spasm of the fetal heart. These studies are more complex and require more time (can last up to 3 hours). If the cramps do not occur often enough on their own, they can be induced by administration of intravenous oxytocin or by stimulating the nipples (with hot towels or a hand pregnant). The response of the fetus to determine the probable state of spasm of the child and child seats. Negative or calming result means that the baby's heartbeat is normal during labor. Positive or alarming result indicates that there is a pathology of heart during or after labor, that is, there is a risk of finding the child in the long battles.

It was found that stimulation of the nipples or the injection of oxytocin produce the same results. However, stimulation of the nipples are much simpler, cheaper and faster. The woman herself may periodically stimulate your nipples rubbing their fingertips through clothes for 2 minutes every 5 minutes. In this test, a very high percentage of false positives. Therefore, fetal assessment can be made only on the basis of several tests.

Biophysical profile

Biophysical profile. This forty-minute treatment combines ultrasound test for non-pathological condition of the fetus, as well as check the general condition of the child: the reactive heart rate, breathing, muscle tone of extremities, body movement and the amount of amniotic fluid. A child receives a score of 0-2 for each of the five items listed as in the calculation of Apgar score. High score (8-10) means that the baby is healthy. The low number of points (0-2) means that a child's life in danger. Then the doctor can offer immediate delivery. High and low points fairly accurately reflects the state of the child. But the intermediate value (3-6) is much more difficult to interpret. Although the results of this analysis are ambiguous, it is one of the safest ways to check the status of prenatal child.

"Modified" biophysical profile . This compound is the study of the biophysical profile and non-stress test. This allows you to accurately assess the condition of the child.

Analysis of fetal blood

Analysis of fetal blood. If you suspect that hypoxia (lack of oxygen) for the analysis of blood is taken of the child. After opening the membranes in the doctor inserts a thin tube cervix and attaches it to the skull of the child. On the scalp is a small puncture and a blood sample is taken. If the concentration of oxygen in the blood is normal, it means that a child is all right. A blood test child avoids misinterpretation of the monitor readings at EMI, and allows the doctor did not
make a hasty and unjustified interference. In some hospitals the equipment for analysis of the baby's blood is next to a generic, what would the results could be obtained without delay (otherwise blood test takes about 20 minutes). The longer the time between blood collection and the results obtained, the less the significance of the test for deciding to intervene.

The amount of amniotic fluid

The amount of amniotic fluid. Amniotic fluid are the kind of cushion for the child, allow him to move, helping to develop easy to stabilize the temperature of the baby's body and serve as a barrier to infection. This fluid comes from two sources: the body of the mother and child. Part of it comes from the mother's blood serum, part excreted by the kidneys and lungs of the child. Most of the amniotic fluid is fetal urine. In the last month of pregnancy the amniotic fluid fetal urine replenished in an amount of 30 ml per hour. In the last weeks of pregnancy the amniotic fluid volume is usually reduced.

The amount of amniotic fluid is maintained in equilibrium as a result of constant replenishment and removal. If the equilibrium is disturbed, then a too much (polyhydramnios) or too little (oligohydramnios) amount of water. In both cases there is a danger to the fetus. For example, water scarcity can mean that the child's kidneys do not work well and produce too little urine. Especially dangerous is the dramatic decrease in the volume of amniotic fluid before birth. If this is happening against the background of other signs of fetal distress, it becomes a pretext for intervention. But since ultrasound determination of the amount of amniotic fluid is not giving accurate results, and their number can be affected by many factors, this analysis does not in itself provide an unequivocal decision to intervene.

There are many other studies fetal assessment :   alternately holding ultrasound studies evaluating the continuous growth of the fetus, sampling the amniotic fluid (by amniopunktsii) volume of blood through the umbilical cord, quick test fetal assessment for admission to the maternity ward (compound acoustic test to estimate the amount of amniotic fluid), electrocardiography the fetus ( evaluation of fetal heart using electrodes placed on the head of the fetus), fetal head stimulation test (evaluation of the reaction of the fetal head and compressive injections). However, the necessity of application of a test defined by many objective reasons.