Dangerous periods during pregnancy with twins. Diagnosis of an interesting situation

Congratulate me - I recently became a mother for the second time. Or the third? In general, this is the second birth, and now there are three children. The fact is that my second pregnancy brought me two daughters at once. This happens in about 1 case out of 50 and is due to various factors. My case is due to several reasons.

Why will I have twins - I understand the reasons for multiple pregnancies

If the list of reasons does not include one that might be right for you, this does not mean that something is wrong. The female body has its own plans, and twins can be born even to someone who does not expect it at all.

Causes:

Heredity – the tendency to have twins is most often transmitted through the female line through a generation; My grandmother's sisters were twins.
Taking hormonal contraceptives , or rather, stopping taking it. Sometimes women who cannot get pregnant on their own are prescribed such drugs, since after they stop taking them, the likelihood of conception increases several times. But sometimes it happens by accident, as in my case.
Age . It is known that women over 30 are more likely to carry twins. This happens due to the fact that ovulation no longer occurs “clockwise”, as at 20 or even 25 years old. And the ovaries produce several eggs at a time.
ECO . During in vitro fertilization, a woman is implanted with several fertilized eggs at once. Doctors want to play it safe - it’s not a fact that at least one of them will develop. But it also happens that 2, or even 3, develop at once - as a result of twins and triplets.

However, as my example shows, in order to give birth to twins, you don’t have to resort to IVF.

First signs of twin pregnancy

How do the signs of a multiple pregnancy differ from a normal pregnancy:

Test . The line on the home test appears as a result of a reaction to the level of hCG in the urine. During pregnancy (any), this level increases significantly, but if a woman becomes a mother of twins, then hCG is several times higher than during normal pregnancy. That’s why the strip on the test will be much clearer and brighter.
Belly size . Usually in the early stages the belly is not visible at all, but in the case of a multiple pregnancy it will be noticeable already in the first or second month.
Weight . Weight gain is faster than when carrying one child.
Early and heavy . When the body begins to rebuild, feeling unwell is normal for the expectant mother. But if two babies are growing in her belly at once, this restructuring will be harder and more noticeable, that is, nausea and other symptoms will appear earlier and will be more intense.
Pigmentation . This sign is optional, but is present in at least half of women expecting the birth of two or more babies.

It cannot be said, of course, that these signs will definitely indicate a multiple pregnancy (perhaps only with the exception of the hCG level), but they should raise serious suspicions.

The doctor’s listening to the baby’s heartbeat and the results of an ultrasound will finally dispel doubts.

How did I find out I was pregnant with twins?

I realized quite early that I was pregnant. Perhaps because this is not the first time this has happened to me. Already at the 7th week, the doctor dispelled all suspicions, but just in case, she sent me for an ultrasound, because she realized that the uterus was not enlarged in proportion to the term. Then it was a matter of technology, or rather, an ultrasound machine. The study showed that I have two fertilized eggs in the uterine cavity.

However, both of my pregnancies began not with a trip to the doctor, but with a test at 6 weeks. And if the first time the stripe was barely visible, and some doubts still remained, then the second time the stripe was bold and gave a clear answer to the question.
During a normal pregnancy, I started to feel nauseous around the middle of the third month, but I still felt quite normal. The second time, dizziness and severe nausea with bouts of vomiting haunted me almost from the moment of conception.
Something completely unimaginable was happening with the pigmentation: already in the first month, not only the face, but also the shoulders became covered in spots.

However, all this could not spoil the pleasant anticipation of my girls. All that remained was to carefully monitor your weight and follow all the doctor’s instructions.

Weight gain by week during twin pregnancy (table)

The doctor immediately said that I would have to appear at the consultation more often than women who are expecting only one child. Multiple pregnancies are associated with various risks and complications . First of all, you need to control your weight.

On the one hand, the weight gain will still be greater than usual, but on the other hand, excess weight should not be allowed. On average, everyone gains about 17-21 kg, but we must take into account that these are very individual indicators. What does a table of average weight gain look like for a woman whose pre-pregnancy weight was 70 kg?

These figures are very average.

In reality, things may turn out completely differently:

At the very beginning, due to severe toxicosis, you can not only not gain weight, but also lose up to several kilograms.
Towards the end of pregnancy, you are likely to suffer from swelling, so the indicators may differ greatly from those in the table, to a greater extent.
Ideally, as gynecologists have determined, the indicators should be radically opposite: in the first half of the three trimesters you should gain more, and in the second - less.
Rarely does anyone carry twins to term until 40 weeks, so you may not have time to gain all the required kilograms.

To control your body weight and that of your future children, you must not only weigh yourself, but also go for ultrasounds regularly to know the weight of the fruit. After all, it may turn out that the entire increase is , and the kids receive nothing, or vice versa.

It is known that Twins are born with less weight than those who had more room in their mother's belly . Mine were born 3100 and 3270 - this figure is above average. But you always need to subtract the weight of the baby, placenta, amniotic fluid, enlarged uterus and blood volume, then you can understand how much you have gained yourself.

Overweight

All these calculations are possible only after the babies are born.

While they're waiting overweight(especially on later) can threaten with the following:

Varicose veins.
Increased pressure.
Hemorrhoids.
Shortness of breath.
Cramps.
Hypoxia in children.
Development of diabetes.
Tissue rupture, etc.

To prevent this, it is necessary eat right and move as much as possible , if the doctor allows it. Sometimes the second half of a multiple pregnancy can be quite static due to the threat premature birth.

Lack of weight

Weight deficiency is also dangerous, especially when carrying twins:

Premature birth, which in the case of multiple pregnancies can lead to disastrous results.
Lack of nutrients in children and their diseases.
Improper formation of organs and systems in infants.

A good doctor will monitor your weight closely, measuring it every 7-10 days. And about once every two weeks you will need to do an ultrasound to monitor the weight of the children.

Twin pregnancy calendar

Of course, I couldn’t know what was going on in my stomach during all 9 months, how the children were growing and developing.

But you can control your feelings:

Threat of miscarriage of twins - how to avoid it?

To be calm, it was enough for me to know that almost 90% of all multiple pregnancies develop normally, and as a result, healthy children are born.

But the biggest danger in this situation, as the doctor warned me, is premature birth. These are considered birth before 35 weeks and, as a rule, at least 60% of children are born at this stage . But it is necessary to distinguish between premature birth and the threat of termination.

To begin with, you should know that before the 12th week everything can still change - even if you were told on an ultrasound that they see 2 fertilized eggs, this does not mean that in the end two children will be born. It may also happen that one embryo stops developing, and as a result, only one baby will be born. From a medical point of view, this is normal, since nothing threatens the developing fetus.
In the second trimester, the doctor may threaten abortion . This often happens due to overstretching of the uterine muscles. To avoid this, you must follow your doctor's advice. Sometimes medications are prescribed that relax the muscles of the uterus. If the drugs do not help, you will most likely be put on conservation treatment and prescribed complete bed rest.
With the onset of the third trimester, we can talk about premature birth . Of the 60% of babies born before 35 weeks, only 7% were born at 24-28 weeks. But even in this case, in a good hospital, where there is the necessary equipment and qualified personnel, the children are nursed and then are no different from their peers.

To protect yourself as much as possible from such surprises, you need to:

Get ready for pregnancy in advance, having cured all infectious diseases.
Avoid infections during pregnancy (especially in the early stages).
Track monitoring hormone levels by getting tested in a timely manner.
Avoid injuries and falls (generally limit activity).

How is labor during pregnancy with twins?

I, like everyone carrying twins, was very interested in the question of the method - whether I would give birth naturally or having a caesarean section.

They say that if a woman is pregnant with twins, it is a double blessing from God. Why does it happen that two babies are born at once? Scientists have long explained the essence of this phenomenon. We know from our school curriculum that conception occurs through the process of fusion of the father's sperm and the mother's egg. As a result, one child is born. Twins are born due to the maturation of two eggs that must be fertilized. Science also knows cases when, at an early stage of its fragmentation, a fertilized egg is divided into two separate organisms with the same genetic material. In this case, identical twins are born. It is difficult to distinguish them, as they are similar to each other, like two peas in a pod.

Twin pregnancy: heredity

Those families who already have twins in their family do not exclude the possibility of having them. This is the most significant factor that increases the chances of multiple pregnancy. This predisposition is mainly traced through the female line, although it is also possible through the male line. The birth of two children at once is more common in those families where mom or dad (or both parents) have twin brothers or sisters. Recurrence of twins occurs mainly after a generation.

Modern medicine has several versions of the birth of twins. But one of the most common is heredity. More precisely, the transmission of the hyperovulation gene through the female line. This phenomenon is explained by the fact that during ovulation several eggs mature. In those families where women have this gene, there is a high probability of giving birth to twins. We often see photos of happy parents with two pairs of twins, like two peas in a pod. This phenomenon is explained by the fact that their mother is 3-4 times more likely to give birth to another such pair. If she is one of a set of twins, then she is 2.5 times more likely to have twins than any other woman. It's all mysterious genetics...

How to determine pregnancy with twins: signs

There is one most reliable way to find out if you are pregnant with twins - this is ultrasonography. Even in the early stages, the doctor will determine the presence of one or two fetuses. If you have not yet gone for an examination, then your body may tell you that you are carrying twins.

There are several signs of multiple pregnancy. The first of them is increased weakness, fatigue and drowsiness. During the first trimester of pregnancy, expectant mothers constantly want to sleep. It doesn't matter that they had a good night's sleep. They take advantage of any moment to put their ear to the pillow and take a nap. As a rule, they sleep longer in the morning and go to bed earlier in the evening. This is explained by the fact that the body works overtime, bearing two fetuses at once. But we must not forget what it is constant desire sleep is experienced by many pregnant women (with one fetus).

In the early stages of pregnancy, when testing for the presence of a fertilized egg, mothers carrying twins, as a rule, have more pronounced fatty stripes than mothers carrying one baby. This indicates that twins increase the amount of the hormone HcG (human chorionic gonadotropin), which is found in the urine or blood early after fertilization.

Another sign of multiple pregnancy is severe toxicosis. It can be called double toxicosis. It especially manifests itself in the morning, accompanied by nausea and vomiting. But some women note a normal pregnancy without severe toxicosis. As you can see, it all depends on individual characteristics body.

A sign that you are carrying two babies at once is big size abdomen - more than when carrying one fetus at the same time. The uterus increases in size, this fact will be confirmed by the results of measuring the height of the uterine fundus.

When listening to the fetal heart rate using the Doppler system (counting heart beats), the doctor will detect double heartbeats in multiple pregnancies. But often the second pulse is not a pulse at all, but extraneous noise or the mother’s pulse. So this test sometimes misleads doctors.

As a rule, women undergo a blood test in the second trimester. If a larger amount of protein is found in it, which is produced by the fetus during its growth, then the pregnancy is multiple. This protein is called alpha fetoprotein. Naturally, two fruits produce more protein for the widow.

Twins pregnancy week by week: fetal development and woman's feeling

During the first trimester of pregnancy, twins live and develop each in their own zygote. Towards the end of the first month, the zygote turns into the endometrium. Already in the second trimester, babies begin to squint and seem to be identified because they have their own fingerprints. The third trimester is the final stage of fetal formation.

In the first trimester of bearing twins (weeks 1-10), the expectant mother's breasts swell and the hCG level rises. By the end of the eighth week, the embryos increase in size to 3 centimeters. During this period, they are clearly visible using ultrasound. Symptoms of pregnancy are no different from those of a singleton pregnancy. Only possible early toxicosis or more pronounced. Closer to the ninth week, the embryonic development of the children ends, and by 10-11 weeks, hearts are formed. During this period, children weigh only five grams.

During the 10-20th week of bearing children, the expectant mother’s uterus and, naturally, abdomen are actively growing. The twins also do not lag behind in growth and development. Starting from the 16th week, their gender is easily visible using ultrasound. The movements of future babies inside the womb become more active every day.

The maternal placenta is the main metabolic organ. Gradually, the digestive and excretory systems begin to form. Twins swallow amniotic fluid, but breakdown products are eliminated through urination. During these months, the twins are actively growing, and by the end of the sixteenth week their length is about 17 cm, weight - up to 200 g. By the end of the twentieth week, they gain another 100 grams of weight and grow up to 10 cm. During this period, they can already distinguish well sounds, so mothers are encouraged to talk to them. Mothers usually feel much better, toxicosis recedes.

The period from the 20th to the 30th week is characterized by competition between future children in the mother's womb for the best position. At the same time, mom feels their shocks well. The uterus grows at an accelerated pace, which leads to stretch marks on the abdomen and thighs. During this period, a woman's metabolism accelerates.

The fruits reach 30 cm by the end of the 25th week and weigh approximately 700 g. The formation of their facial features is also completed. During this period, a woman increasingly feels the urge to urinate, and swelling appears in her legs. She gets tired quickly. The 28th week of the formation of twins signals that the children are already quite viable. And even in the event of premature birth, they will survive. By the 30th week, the baby’s weight is close to a kilogram, height is 35 cm. Doctors say that during this period the fetus is 95% formed.

From the 30th to the 40th week, the most important stage begins for expectant mothers. The fruits are almost fully formed and ready to see the world with their own eyes. It's like they're trying to get out. One gets the impression that the twins are fighting over who will be born first. But mom is already accustomed to their pushes and reacts calmly to them. It is becoming increasingly difficult for her to lie down and sleep, as her huge belly is in the way. Heartburn may also occur. During this period, women need to stock up on special patience. Starting from the 32nd week, false contractions are possible. By the 37th week, the twins are fully formed, their weight ranges from 2.3 to 3.1 kg. During this period, the mother can be hospitalized and prepared for childbirth.

Pregnancy with twins: Ultrasound

Ultrasound examination is the most reliable and effective method definitions of multiple pregnancy. Only starting from 10-12 weeks, with the help this study twins can be distinguished.

In the early stages, the doctor can see only one embryo, sometimes two, but the heart rhythm can be heard in only one. There are cases when the second embryo disappears somewhere on its own, as if dissolving, while the first continues to develop. If the development of two embryos up to 12 weeks is detected, then do not rush to share your joy. After the second screening everything will be visible and clear.

Pregnancy with twins in a dream: dream book

Different interpretations have different interpretations of the meaning of dreams. In order to find out why you had a dream about being pregnant with twins, you should remember well the small details of the dream, how you felt in it.

Knowledgeable people say that such a dream portends big profits. Perhaps you will be given real estate or a large sum of money. The money may come to you in a different way, but the profit is guaranteed.

If a woman who had such a dream is actually in an interesting position, then most likely this dream is prophetic.

If an unmarried girl had a dream, then it foreshadows disappointment in her personal life. For a lonely girl, such a dream promises deception and disrepute. You should be more attentive and responsible when choosing your future husband.

If a poor person had a dream about being pregnant with twins, then it foreshadows a wonderful relief from debts, some gift of fate and a further rich life. If such a dream occurs to a rich person, then there is a great risk of losing his fortune.

If you dreamed that someone was pregnant with twins, it means that great success awaits that person.

Especially for - Ksenia Manevich

Pregnancy with twins is a real miracle that does not happen to every mother, while there are plenty of people who want to have two children similar to each other.

Twins birth process
in ultrasound fluid
what do the photo weight look like?
features in the situation of what should happen

According to statistics that vary from country to country, the proportion of new mothers who give birth to two or more babies at one time is about 1 percent of total number. Depending on the country, it can either be slightly lower or reach up to one and a half percent.

An interesting fact is that twin pregnancies reach 70% of the total, and the higher the number of fetuses, the lower the already tiny chances of raising two identical babies in the future.
Getting acquainted with this topic is worth starting with the basics, since often people simply do not understand who are twins and who are twins.

Difference between twins and twins

Twins are any children whose conception occurred at a close time. At the same time, the conception of both babies does not always occur at the same time; there are often cases when the second egg is fertilized within a week after the first, which does not interfere with exceptional cases two or even three babies can develop at once. Twins, triplets - this is just a clarification of the number of brothers and sisters.

Pregnancy with twins

However, twins are divided into identical and fraternal - here the difference is quite serious:

Identical twins are the result of one fertilized cell dividing into two, which must subsequently separate before attaching to the mother's uterus. If this happens in the first three weeks after conception, both fetuses will receive their own placenta for nutrition, but if this happens later, then there will be one placenta. In this case, both babies will receive the necessary nutrients through one placenta, to which two umbilical cords will be attached at once.
Fraternal twins always develop separately, have their own placenta, and are less similar to each other, while the bond between identical relatives is extremely strong. The reason, according to scientists, lies in an absolutely identical set of genes, since both babies, in fact, come from the same cell. Fraternal twins are no more similar to each other than ordinary brother and sister.

Signs of this feature

Pregnancy with twins has a slightly different course compared to normal pregnancy. Thus, during pregnancy with twins, the belly grows more intensively, and, often, quite quickly begins to advance beyond its due date, compared to a normal pregnancy. This may be one of the signs of twin pregnancy.

However, this largely includes rapid enlargement of the uterus, which, when observed by a doctor, becomes noticeable in the early weeks, at about 6-8. Agree, if at 6 weeks your beloved’s belly is 3 centimeters larger than what happens during a singleton pregnancy, you are unlikely to notice it, and neither will she, especially if this is the first pregnancy with twins.

Expectant mother of twins

In terms of size, it is better to judge at a later date, when at 10 weeks your chosen one becomes the owner of a beautiful tummy, more typical for the 14th week of pregnancy. However, at this stage it is always known for certain that there are at least two babies, and, in principle, it is not uncommon for a competent doctor to notice signs of a twin pregnancy a little later than the fifth week.

He sends the mother for examination to monitor the pregnancy of twins with an ultrasound, since this is the most reliable way to determine this interesting, rare fact. It is also possible to diagnose this trait using a blood test, but this is not as accurate and is not used often.

Positive aspects of the feature

If we talk about the benefits of twin pregnancy, just look at the photos happy moms and fathers hugging their identical children. Yes, you shouldn’t expect any global list of advantages: there is only one plus, but what is it:

babies, be they twins or twins, will always get along well with each other, nipping all possible quarrels in the bud. Such kids also do not have jealousy towards each other, which is often found in other children of different ages when the older child is jealous of the younger one because he receives a little more attention from his parents;
later, when the kids grow up, there will be no rivalry between them either, this is understandable - why compete with someone who was always there, with whom you shared everything, including maternal love during the first 9 months of life in your mother’s tummy?
All these related feelings are especially strongly expressed, of course, in identical twins who often feel the state of their significant other even from a distance;
and, of course, the most pleasant moment for parents will be watching how two identical children with their eyes frolic and play together.

According to statistics, a pregnancy after twins has a much greater chance of becoming multiple births again, and this time it may not be limited to twins. Of course, this does not mean that the second pregnancy will certainly end in twins, but the chances of this will be much higher than the first time, since the body begins to adapt to bearing two fetuses at the same time.

Diagnosis of an interesting situation

You can usually find out for sure that you are having twins fairly quickly. An ultrasound can accurately answer your question already at 5-6 weeks - usually at this point the babies already reach several centimeters in size, and they can be examined.

Birth of boys

It is noteworthy that, in principle, few people do an ultrasound before 4 weeks, since girls often find out about their pregnancy after a delay, which occurs four weeks after intimacy with a man. Only after this should you take pregnancy tests and go to an ultrasound to see for the first time in ultrasound photographs a twin pregnancy.

As already mentioned, pregnancy with twins is a more complex process that is more difficult for both the baby and the mother. Let's consider the weekly changes in the body that will be most noticeable to the expectant mother during pregnancy according to the weeks of twins, accompanied by a photo of the belly:

from 1 to 5 weeks;

Usually everything goes smoothly and unnoticed. Often during this period the pregnancy itself is not yet known.

week 6;

Possible onset of toxicosis. This unpleasant phenomenon is especially common in pregnant women with twins, and very often lasts longer than usual. In terms of its intensity, toxicosis is mother of many children usually stronger.

from 7 to 10 weeks;

The expectant mother's uterus enlarges, and by the 10th week its size becomes identical to the 14-week uterus of a singleton pregnancy.

from 11 to 13 weeks;

It goes on as usual, until the 13th week, when pain makes itself felt, but it is in no way related to the proximity of labor, since there is no pressure in the lower part. Most often, discomfort appears in the so-called iliac region.

from 14 to 25 weeks;

A smooth increase in the abdomen, to a size that is usually not found in mothers of one baby. During this period, you need to be attentive to your health, and if you have the slightest pain in the abdomen or even the head, consult a doctor. And in general, it is simply necessary to go to an antenatal clinic when you are pregnant with twins or triplets earlier than ordinary pregnant girls visit.

26 – 30 weeks;

Shortness of breath appears, since the size of the uterus does not allow the lungs to expand sufficiently. After the thirtieth week, babies are usually no longer in danger, and they can completely calm down.

31-36 weeks.

Possible discomfort in the region of the ribs, associated with an impressive tummy. It’s time to switch to constant monitoring with a doctor, and everything will end with the birth of the long-awaited twins.

Healthy babies

How does childbirth go?

Childbirth, like pregnancy with twins, is more difficult than for others, and there are a number of reasons for this.

First, the position of two or more fetuses is often unpredictable, so natural childbirth They are not always successful, although such cases do occur. But even with the apparent absence of alarming facts during pregnancy, in the end you still have to do a cesarean section. However, today it is not so scary, and there is no need to be afraid of it.
TO possible complications During childbirth, tangling of the umbilical cords is also attributed, which often causes additional troubles for doctors. All this serves as a reason for mothers carrying twins to be hospitalized in advance, most often 3-4 weeks before childbirth, in order to carefully study the mother’s body and prepare for all possible developments situations.

However, the overall positive impression of giving birth to twins cannot be overshadowed by any of the problems that young mothers have to go through. We have not yet examined in detail the general discomfort, fatigue, etc. from carrying several babies at once. But reviews about twin pregnancy are extremely positive.

The onset of pregnancy is a very important event in the life of any woman, regardless of whether she planned to become a mother or whether fate decreed it so. Exciting preparations begin for the birth of the baby. Sometimes you need to prepare for the arrival of two babies at once. This is double happiness, but also double burden and responsibility.

Carrying twins is on the border between normal and pathological due to the increased load on the female body. Multiple pregnancies increase the risks of health problems, miscarriage, and complications during childbirth. That is why it requires increased attention and observation.

From the first days of discovering the fact that she is pregnant with twins, a woman comes under careful control both from medical personnel and from relatives and friends.

Multiple pregnancy, early signs

Early diagnosis of twin pregnancy is extremely important for the normal course of pregnancy, because it requires special attention and constant monitoring.

In general, a woman at first does not feel at all that she is pregnant with twins. Most often they find out about this during the first ultrasound examination when registering at the antenatal clinic.

Please note some early signs, in which the presence of a multiple pregnancy can be suspected:

Increased sense of smell, odor intolerance, toxicosis
Pronounced swelling of the mammary glands
Appearance age spots on the face and chest
At the first examination, the presence of two fetuses may be suspected by the gynecologist due to the size of the uterus and its rapid enlargement at the next appointment. Sometimes pregnant women are given an incorrect due date at the first appointment due to the fact that the size of the uterus does not correspond to the due date.
At 10 weeks, multiple pregnancies can be detected by electrocardiography
Elevated hCG levels, which can be detected with a blood test

Important: The first ultrasound examination does not guarantee the detection of a multiple pregnancy, because one fetus may be hidden behind another.

After 20 weeks, multiple pregnancies can be detected without the help of an ultrasound machine:

When palpating the abdomen, four large parts are felt in different places (heads and buttocks)
The height of the uterine fundus and its dimensions significantly exceed those of a normal pregnancy
The expectant mother clearly feels the movements of two fetuses
Listening to the abdomen reveals two heartbeats

Pregnancy test, twins

A pregnancy test is the first tool that can be used to suspect the presence of a multiple pregnancy.
In this case, the level of HcG (hCG - human chorionic gonadotropin human) is significantly higher, as a result of which the second line on the test, which indicates the presence of pregnancy, is distinct and bright in color
Besides, increased level HCG helps detect the presence of multiple pregnancies earlier than detecting a normal one

Pregnancy with twins - sensations

During a multiple pregnancy, a woman’s well-being and sensations are somewhat different from being pregnant with one child. What might they encounter? future mom:

Severe long-term toxicosis
Varicose veins due to weight gain
Shortness of breath due to excessive enlargement of the uterus, resulting in displacement of the fundus diaphragm
Heartburn
Increased fatigue, drowsiness
Edema
Back pain
Dark spots
Anemia, dizziness, fainting

A pregnant woman begins to feel fetal movements a couple of weeks earlier than during normal pregnancy; they are more intense and numerous. This is explained by the fact that babies are cramped and lie closer to the wall of the uterus.

Pregnancy: twins or twins

There are two types of twins: monozygotic or dizygotic:

Monozygotic (identical) twins involve the birth of very similar babies (twins). They come from one egg and have one set of chromosomes. The egg divides early in its development. With such a pregnancy, children of the same sex are born
Dizygotic (fraternal) twins develop when two eggs are fertilized by two sperm and have a different set of chromosomes. As a result of such a pregnancy, babies of different sexes may be born. Twins do not imply strong similarities between children

Interesting: Since ancient times, the birth of twins has been given a mystical connotation. For example, in Ancient Greece such a phenomenon was considered a gift from the gods.

Weight during pregnancy with twins

There is a misconception that weight gain during pregnancy with twins is much higher and can reach 30-40 kg. However, this is not true.

The rate of gain depends on the woman’s weight before pregnancy and her height. It is from these data that BMI is calculated - body mass index. To calculate BMI, you divide your weight (in kilograms) by your height squared (in meters). For example, for a girl of 56 kg with a height of 1.6 m, the BMI will be 21.9.

Based on the initial BMI, we can predict how much the expectant mother of twins will gain when normal course pregnancy:

BMI< 20 — набор веса 16-20кг
BMI 20-27 - gain 13-17kg
BMI > 27 – gain 11-13kg

For determining ideal weight on different dates multiple pregnancy, you can use the online calculator.

Belly during pregnancy with twins

During a multiple pregnancy, the belly begins to grow earlier than during a normal pregnancy. By the 12th week it can be quite noticeable due to the increase in the size of the uterus
Starting from the 17th week, it becomes quite difficult to sleep. It is recommended to lie or sleep on your left side with your knees slightly bent. Helps reduce painful sensations a special pillow for pregnant women or just a rolled blanket placed under the stomach and between the legs
In the third trimester, the belly begins to grow very actively, which leads to the appearance of stretch marks. It is recommended to use moisturizing creams or oils from the beginning of the second trimester to increase skin elasticity. For example, wheat germ oil or baby oil
Around week 20, your doctor may recommend wearing a back and abdominal support band.

Development of twins by week: first trimester of pregnancy

A multiple pregnancy is a little different from a normal pregnancy. One of these differences is several accelerated development fruits I offer you an approximate description of what is happening to your body and to your babies:

4-7 weeks - fruit growth is 20-30mm, brain development begins and internal organs. The expectant mother may feel the first signs of pregnancy: breasts swell, mild nausea appears
7th week - embryo growth is 8-10mm, the outlines of the head and limbs appear, eyes, mouth and ears appear on the head. There is a possibility of miscarriage, it is determined during examination
12th week - babies grow to 5-6cm, the risk of miscarriage decreases. You can already get to know them by undergoing an ultrasound. The fruits have the outlines of nails and teeth, their height can reach 15cm, and their weight can reach 1g. They can already respond to stimuli by clenching their fists and make their first attempts to swallow

Development of twins by week: second trimester of pregnancy

20th week - by this time the growth of the fruit reaches 25 cm, the weight is already 250-300 grams. Babies begin to respond to sounds, the urinary system and intestines of the fetus begin to work. The expectant mother already clearly feels movements and tremors
24th week - height about 30 cm, weight - 600g, hair appears on the body, the outlines of eyebrows and the first eyelashes are already noticeable on the face, noses are formed. The head is still disproportionately large
27th week - starting from this period, the fetuses are considered viable in case of premature birth. Vital processes in the lungs are formed, weight can reach 1 kg, height 35 cm. Since twins grow quickly, the pregnant woman feels discomfort due to big belly and lower back pain. Due to the increased load on the legs, it becomes difficult to walk a lot

Development of twins by week: third trimester of pregnancy

32nd week - the formation of the skeleton is completed. The twins weigh about 1.5 kg, height up to 40 cm. Each fetus has its own sleep cycle. The bodies begin to catch up with the head in proportions, the pancreas begins to work
34th week - the expectant mother feels pain in almost the entire body, fatigue appears. If one of the babies falls head down, there is a slight relief because the stomach drops and stops putting pressure on the diaphragm and internal organs
36th week - nails protrude beyond the edges of the fingers, the formation of fat under the skin ends. Weight 2-2.5 kg, height up to 45 cm. Twins are smaller in size than one baby at this stage, but often their lungs and other body systems are more developed

Features of multiple pregnancy

Get ready for frequent visits to the antenatal clinic; twin pregnancy requires careful monitoring
Take vitamin complexes and folic acid
Eat right, get outdoors more often
You may have an increased appetite, because carrying two babies requires a lot of energy
Your figure may change its shape slightly, and there is a high probability of stretch marks appearing later in life.
Get ready for early birth. Twins are rarely carried to term until the 40th week; delivery usually occurs at 36-38 weeks
There is a high probability caesarean section

Video: Pregnancy with twins

Despite the fairly high modern level of development of obstetrics and obstetric care, women with multiple births are still at high risk. Management of a multiple pregnancy and childbirth itself are significantly different from a normal pregnancy with a single fetus. They require medical personnel to have experience and in-depth knowledge of the condition.

Relevance of the topic

Features of multiple pregnancy determine the relevance of the problem for obstetrics in general and, in particular, for obstetrics of the perinatal period (from 22 weeks intrauterine development up to 28 weeks postpartum period). These features are a high percentage of complications, prematurity and the risk of premature birth, severe form of fetoplacental insufficiency, fetal hypotrophy and intrauterine hypoxia, the possibility of severe developmental defects, etc.

Perinatal mortality in multiple pregnancies, compared with singleton pregnancies, is about 10% and is largely related to the body weight of the fetuses. Malformations are registered 2 times more often, intrauterine mortality is 3-4 times higher, and over the past 30 years it has practically not decreased. Frequency of development cerebral palsy In a child, twins are 3-7 times more likely, triplets are 10 times more likely, and the number of complications in the mother throughout the entire pregnancy period is 2 or more times (up to 10).

Causes of multiple pregnancy

Development of two or more fruits in female body called multiple pregnancy. Over the past 20 years, it has doubled, and women with multiple births among all pregnant women amounted to 0.7-1.5%, the birth of twins in relation to the number of all births - 1: 87, triplets - 1: 6,400, quadruplets - 1: 51,000.

Many causes of multiple pregnancy have been noted, which indicates that this issue is still insufficiently studied. The likelihood of multiple pregnancy is largely determined by the following factors:

Heredity, that is, if the spouses or one of them comes from multiple pregnancies or in their families, especially in the female line, there have been similar cases.
An increased level of follicle-stimulating hormone in a woman’s blood, which promotes the development and maturation of two or more eggs at the same time. This may be due to heredity, taking drugs that stimulate ovulation during the treatment of infertility, pregnancy immediately after discontinuation of ok (), especially against the background of the use of ovulatory stimulation agents.
Carrying out in vitro fertilization (), the program of which includes drug hyperstimulation of the ovaries to obtain a large number of mature eggs. Multiple pregnancy with IVF is also due to the implantation of several fertilized eggs into the uterine cavity, the possibility of implantation and development of more than one.
Number of births: with repeated pregnancy and childbirth, the likelihood of multiple births increases.
A woman over 35 years of age. It is believed that this is due to decreased fertility at this age due to the lack of monthly ovulation. As a result, there is an accumulation of hormones and their effect in the form of ovulation of two or more eggs.
Anomalies in the development of internal genital organs.

The many reasons for multiple pregnancies, the main ones listed above, indicate that this issue is still insufficiently studied.

Classification of multiple births

In deciding questions about the tactics of managing such pregnancy and childbirth, zygosity, chorionicity and the number of amniotic cavities are of considerable importance. A zygote is a cell formed from the fusion of an egg with a sperm and containing a double complete set of chromosomes. The chorion is one of the three (outer) membranes of the fetus. The amniotic cavity is a cavity bounded by an aqueous membrane (amnion) and filled with amniotic fluid.

Monozygotic

According to the number of fetuses, pregnancies are differentiated into twins, triplets, etc. About 30% of twins are formed from one fertilized egg. Subsequently, as a result of its division, two similar structures develop, which have the opportunity to develop independently, individually. This type of twins is called monozygotic, or identical, and the children are called twins. They have the same gender, eye and hair color, skin pattern of fingers, blood type, location and shape of teeth.

Dizygotic

Simultaneous maturation and release of two or more eggs can occur either in one ovary or in both within one menstrual cycle. Bizygotic, or dizygotic, embryos develop from two fertilized eggs and account for an average of 70%. The children are called "twins". They can be both same-sex and different-sex, with the same or different blood groups and be in the same genetic connection. In cases of a larger number (triplets, quadruplets, etc.), both monozygosity and dizygosity in various combinations are possible.

Each of the dizygotic embryos has its own chorionic/placental and amniotic membranes. Each embryo has its own placenta. Thus, a four-layer septum is formed between the two embryos, consisting of sections of two chorionic/placental membranes and two amniotic membranes. Therefore, such embryos in the classification are called di- (or bi-)-chorionic, diamniotic dizygotic twins.

The formation of identical twins occurs during the early stages of development, division and transformation of the fertilized egg and depends on the timing of these processes:

If the division of the egg occurs during the first 72 hours, counting from the moment of fertilization, that is, before the formation of the inner cell layer and the change in the cells of the outer layer of the egg, then two chorions and two amniotic cavities develop. As a result, dichorionic, diamniotic monozygotic twins are formed, in which one placenta is possible, formed from the fusion of two placentas, or two separate placentas.
If the division of the egg occurs in the interval of 4-8 days after its fertilization, when the formation of the inner cell layer has already completed, and the chorion has formed from the outer layer, but the amniotic membranes have not yet been laid, then each embryo will develop in a separate amniotic cavity. Thus, embryos with individual water sacs will be surrounded by one common chorion, resulting in the development of diamniotic, monochorionic monozygotic twins.
If the laying of the amniotic membrane has already occurred at the time of separation ovum, which usually occurs by the 8th day after the fusion of the egg with the sperm, this will lead to the development of embryos with a common water sac and one chorion - monoamniotic, monochorionic monozygotic twins.
The division of the fertilized egg at a later date (after 13 days), when the embryonic disc has already formed, will be only partial. This will lead to the development of twins conjoined.

The easiest way to determine if you are monozygotic or dizygotic is to be examined by an obstetrician after the children are born. The septum between twins consists of two water (amniotic) membranes, and between “twins” - of four: two amniotic and two chorionic.

Features of the course of multiple pregnancy

Possible complications for the mother

Pregnancy with two or more fetuses, especially when different groups blood, compared to a singleton, places higher demands on the woman’s body. In addition, the course of the dichorionic type is more severe than that of the monochorionic type. The average gestation period for twins is about 37 weeks, for triplets - 35 weeks.

In a pregnant woman’s body, the volume of circulating blood increases (by 50-60%), which creates an additional load on cardiac function, while with one fetus this figure does not exceed 40-50%. Due to hemodilution (blood dilution), anemia and an increased need for vitamins, macro- and microelements, especially folic acid and iron, are often observed.

Women are much more likely to report shortness of breath, fatigue, painful heartburn, urinary problems and constipation. These phenomena especially worry them latest dates. In addition, toxicoses are more common among them, develop earlier, and their course is more severe. Large sizes the uterus reaches not only due to multiple pregnancy, but also as a result of cases of frequent development of polyhydramnios, which can cause impaired renal function. The number of premature births is directly dependent on the number of fetuses and ranges from 25 to 50%.

A very common problem is isthmic-cervical insufficiency (ICI) during multiple pregnancies. It develops much more often than with a singleton, especially in the presence of triplets or more, which is associated with the influence of a mechanical factor (increased pressure in the uterine cavity and its stretching). ICI usually begins to develop after the 22nd week and is characterized by rapid progression. If with twins surgical treatment while strengthening the cervix is effective, then as the triplets grow, etc., the sutures applied often cannot withstand the load and are cut through. Therefore, in some cases, the additional use of a special pessary helps.

With multiple pregnancies, chronic somatic diseases also develop more often, become aggravated and become more severe. Special attention and strict constant dynamic monitoring requires multiple pregnancy after cesarean section, due to the large number of risks for both the fetus and the woman. The main risks with high frequency include:

disorders of the placental circulation due to disruption of the vascular network of the uterus after surgery, which leads to intrauterine growth retardation and/or intrauterine asphyxia;
placenta previa;
threat of miscarriage;
incorrect position of the fruits;
failure of the scar on the uterus and its rupture, which is the most dangerous.

In some cases, with a multiple pregnancy, as with a singleton pregnancy, on the 8th day it is possible bloody issues from the vagina, lasting about 4 days - this is, as a rule, minor implantation bleeding that accompanies the introduction (implantation) of a fertilized egg into the uterine mucosa. However, when two or more such eggs are implanted, it can be longer, more repeated and more abundant and lead to spontaneous miscarriage. In these cases, it is necessary to carry out differential diagnosis and treatment in a hospital setting, where assistance is provided in the form of hemostatic therapy, rest, prescription of antispasmodics, etc.

Risks to the fetus(es)

Compared with a singleton pregnancy, developmental delay of one fetus in a multiple pregnancy is 10 times more common and is 20% for dichorionic twins, 30% for monochorionic twins, and developmental delay for twins as a whole is 1.7% and 7.5%, respectively.

Of fundamental importance when detecting congenital malformations in one of the fetuses is the determination during the prenatal period of zygosity, since in the case of dizygotic twins, the second fetus may be without pathology, and in the case of monozygotic twins, the probability of defects in one of them is quite high. The likelihood of developing fetal structural abnormalities in singleton pregnancies and dizygotic twins is the same, and in the case of monozygotic twins it is 2-3 times higher.

In order to detect fetal trisomy, which includes Down syndrome, Edwards syndrome and Patau syndrome, a non-invasive prenatal test is performed, which has significant reliability. Its essence lies in the genetic study of fetal DNA particles in the venous blood of a woman at 9–24 weeks. In case of a positive result, additional, but already invasive, genetic studies are carried out. If the results are confirmed, the tactics for further management of pregnancy is to artificially terminate it.

In a monochorionic placenta, and much less frequently in a bichorionic placenta, there are frequent cases of the formation of an arterio-arterial or arterio-venous anastomosis (a connection between two arteries or between an artery and a vein). The second type is the most unfavorable, since in this case there is an outflow of blood from the artery of one fetus into the vein of another. In these cases, if the pressure in the placental vascular system is symmetrical, the development of the fetus occurs under equal conditions. But with monozygotic twins, these conditions can be disrupted due to asymmetric blood circulation in the placenta, as a result of which the supply of arterial blood to one of the fetuses is reduced, it does not receive sufficient nutrition and its development is delayed.

A significant imbalance in the placental vascular system is the reason that almost all blood circulation goes to one of the twins - the development of feto-fetal transfusion syndrome (FFTS) is possible, which is noted especially in cases of monochorionic multiple pregnancies (from 5 to 25%), hypertension , enlargement of the heart, etc. in one of the fetuses. The second may develop deformity, cessation of heart function, or he gradually dies and undergoes mummification (spontaneous reduction of the fetus). This process may be complicated by the development of DIC syndrome (disseminated intravascular coagulation) in a woman, which threatens her life.

Fetal reduction in multiple pregnancies

In some cases, fetal reduction is carried out artificially. The need for this often occurs after IVF. Artificial reduction is associated with certain risks and complications, and therefore is performed only if there are strict indications:

The need to reduce the number of fetuses implanted after IVF.
They have pathological changes.
Risk of miscarriage.
The presence of contraindications for a woman to carry a multiple pregnancy.

The artificial reduction procedure is usually carried out no earlier than 7 and no later than 13 weeks. It involves stopping the heart of an unpromising fetus (or fetuses) by puncturing a special drug or air into his/their heart. To do this, a puncture of the uterine cavity is performed transvaginally (at 7-8 weeks) or transabdominally (at 8-13 weeks) after local anesthesia with a needle under the control of an ultrasound device. Subsequently, fetal tissue is reabsorbed.

How to sleep during multiple pregnancy?

The so-called inferior vena cava syndrome, which occurs in the third trimester in almost half of women with one fetus, can complicate the course of pregnancy. In case of multiple pregnancy, it occurs earlier and can be much more severe.

All venous blood from the lower half of the body is collected in the vein and abdominal cavity, then it enters the right atrium, etc. The cause of this syndrome is high blood pressure in the abdominal cavity due to an enlarged uterus. When a woman lies horizontally on her back or on her right side, compression of the inferior vena cava occurs between the uterus and the spine.

Against the background of an increased volume of circulating blood and a woman’s increased need for blood supply to the brain and heart, the supply of the required volume of blood to them when the inferior vena cava is compressed is sharply reduced due to a decrease in the return of arterial blood, and the blood supply to the fetus also suffers. For most, this goes unnoticed, but in about 10%, symptoms such as a sharp decrease in blood pressure, dizziness, pallor, nausea, vomiting, and in severe cases, loss of consciousness and collapse, and the appearance of convulsions are possible.

Blood circulation is quickly restored when the uterus is shifted by hand to the left or as a result of the woman turning on her left side, which helps relieve the inferior vena cava from compression. Therefore, while in a horizontal position, you need to lie on your left side.

Signs of multiple pregnancy and its management

Early multiple pregnancy

Diagnostics

Widespread use in clinical practice of obstetrics and gynecology has made it possible to diagnose multiple pregnancy in the early stages. Before ultrasound, this diagnosis often proved difficult. Basically, it was more or less reliable in the later stages, and sometimes only during childbirth.

At what stage is a multiple pregnancy determined?

In the early stages, an assumption about the presence of two or more fetuses can be made based on a set of signs:

history that the couple or their immediate family are one of twins or “twins”;
availability of data on ovulation hyperstimulation and IVF;
early development and more severe course of induced hypertension, symptoms of toxicosis (vomiting, nausea), swelling of the mammary glands;
discrepancy in the first trimester of the size of the uterus with the duration of pregnancy, which also occurs with hydatidiform mole.

At later stages, in making a presumptive diagnosis, importance is attached to such data as:

early movement during a multiple pregnancy, which can be felt by a woman from the 15th week, while in the first singleton - from the 20th, and in subsequent ones - from the 18th week;
the size of the abdominal circumference and the height of the uterine fundus, which exceed the expected duration of a singleton pregnancy;
palpation through the anterior abdominal wall in the second half of gestation of floating large parts of the fetus (heads and pelvis) in different parts of the abdomen;
palpation of a large number of small parts;
the presence in the middle sections of the fundus of the uterus of a depression formed by the protrusion of its corners by large fetal parts (in case of twins);
auscultatory determination of two points of the heartbeat, especially if there is a zone of absence of tones between them (the “silence” zone);
different (10 beats difference) heart rate at different points, which can also be determined using cardiac monitors.

How to determine multiple pregnancy in the early stages more reliably?

In making such a diagnosis, to a certain extent, one can focus on the concentration in blood hCG(human chorionic gonadotropin) and placental lactogen. This laboratory biochemical testing is not completely reliable, but is relatively informative. So, hCG level in case of multiple pregnancy at each stage of the gestational period it exceeds the norm for a single pregnancy.

Determining the content of progesterone in the blood is of similar importance. Increased progesterone during multiple pregnancy , compared to the norms determined for a singleton, will be in each corresponding trimester.

The main method of early diagnosis and a means of helping to prevent many complications of multiple pregnancy is ultrasound. The accuracy of this diagnostic method, including the most early dates, is more than 99%. It is based on the visual identification of several fertilized eggs or embryos from the 5th - 6th week.

In addition, echography allows in the second and third trimesters to determine the nature of fetal development and the contours of the fetuses, which helps to identify conjoined twins, FFTS, the location and number of placentas and amniotic (water) cavities, identify congenital malformations, antenatal death, etc. According to echometric biometry, the following five types of twin development are distinguished:

Physiological - of both fruits.
Signs of malnutrition with uneven (dissociated) development.
Uneven development of both fetuses with a difference of 10% from the body weight of the larger one.
The presence of congenital developmental pathology.
Intrauterine death of one fetus.

Options for fetal presentation

Ultrasound also allows you to determine the presentation of the fetuses and their position, which is especially important before the onset of labor.

In addition to some of the above points (reduction, prevention of compression syndrome of the inferior vena cava, etc.), it provides for the prevention of gestosis, their early detection and treatment in a hospital setting, control of the blood coagulation system, function of the cardiovascular system and kidney function.

Recommendations are also given on a woman's proper balanced and sufficiently high-calorie diet; folic acid intake of 0.001 grams per day and iron supplements (up to 100 mg) are prescribed. In addition, in order to prevent premature birth, it is recommended to limit physical activity- staying in bed during the day 3 times for 1-2 hours, taking tocolytics and bed rest in case of threat of premature birth.

One of the ways to predict the resolution of pregnancy is the use of non-stress testing of the state of fetal heart function in response to their movement. The test should be done every week after 30 weeks. If possible, a blood flow study is also carried out on each fetus separately.

In case of uncomplicated pregnancy, hospitalization in the maternity ward is necessary before the expected due date 2-3 weeks in the presence of twins and a month before the expected date of birth for triplets. In the absence of the onset of labor at 37 weeks, it is advisable to perform labor stimulation, and in some cases, a planned cesarean section at 37-38 weeks. The presence of a scar on the uterus during multiple pregnancy is a direct indication for a cesarean section.

The optimal method of delivery in the case of monochorionic and monoamniotic twins is a cesarean section at 33-34 weeks (due to the high risk of umbilical cord torsion), and in case of pregnancy with 3 or more fetuses - at 34 weeks.

Childbirth and its management

The normal course of labor is often accompanied by complications. In the first stage of labor, on average, 30% of women in labor experience premature or earlier rupture of amniotic fluid. Moreover, it is often accompanied by the loss of small parts - umbilical cord loops, legs or arms.

Due to the overstretched uterus, weakness of labor forces develops, and the dilation of the cervix is significantly delayed. The duration of the period of expulsion of the first fetus often increases. The presenting part of the second tends to be inserted into the pelvis simultaneously with the first, and this takes a long time. The muscles of the anterior abdominal wall are weakened and overstretched, causing the period of pushing to lengthen or become impossible. All this leads to protracted labor, which threatens infection of the uterine cavity and the development of hypoxia (oxygen starvation) of the fetus.

During the period of expulsion of premature fetuses, there is a risk of rapid labor and perineal rupture. Prevention of this complication requires timely pudendal (perineal) anesthesia and dissection of the perineum.

A serious complication during the expulsion period is premature placental abruption, especially after the birth of the first child, which is associated with a sharp decrease in pressure inside the uterus and a decrease in its volume. This complication threatens heavy bleeding and the development of hypoxia in the second child. To prevent it, the obstetrician performs an emergency opening of the second amniotic sac.

A very rare, but severe complication is the adhesion of the heads to each other, as a result of which they tend to the entrance to the small pelvis at the same time.

Management of childbirth during multiple pregnancy

It consists of careful monitoring of the cardiac activity of the fetuses using cardiac monitors and the condition of the woman in labor. It is advisable to conduct them in the first period on the left side to prevent inferior vena cava syndrome. With the development of weakness of labor forces, the latter are stimulated by intravenous drip administration of a solution of glucose with oxytocin and pain relief using epidural analgesia.

In case of development of weakness of labor and fetal hypoxia during the expulsion period, obstetric surgical aids are carried out in the form of applying obstetric forceps to the head (for cephalic presentation) or extraction (for breech) at the pelvic end.

Ligation of the umbilical cord is carried out not only at the fetal end, but also at the maternal end, since after its dissection in monochorionic twins, the death of the second fetus is possible as a result of bleeding from the umbilical cord.

The birth of the second child should occur no later than 10-15 minutes after the first. Otherwise, the obstetrician opens the amniotic sac, and the amniotic fluid is slowly released, after which the birth is carried out naturally (in a longitudinal position).

In the case of a transverse position or incorrect insertion of the head of the second fetus into the small pelvis, under general anesthesia, the baby is turned onto the leg and removed. If it is impossible to give birth naturally (impossibility of turning, large baby, cervical spasms, signs of acute hypoxia of one of the fetuses, prolapse of the umbilical cord and small parts, persistent secondary labor weakness), delivery is carried out by cesarean section. The best option delivery of triplets or more, as well as in the case of fusion of twins - cesarean section.

The succession period (before the separation of the placenta - the placenta with membranes) proceeds in the same way as in a singleton pregnancy. However, due to an overstretched uterus and a decrease in its tone, the frequency of delayed separation of the placenta and the associated heavy bleeding is much higher and more dangerous. Therefore, at the end of the second period, methylergometrine is administered intravenously, and after the birth of children, oxytocin is injected intravenously for 2 hours. If there is no effect, manual separation of the placenta and subsequent massage of the uterus on the fist are performed.

The incidence of complications is also significantly higher in the postpartum period. They are manifested by late postpartum hemorrhage, delayed reverse development of the uterus to its previous state (subinvolution), and postpartum bleeding. Therefore, after childbirth, anti-inflammatory drugs and uterine contractions are prescribed.

Thus, despite the fact that multiple pregnancy is not a pathological condition, it requires increased attention and a specific approach to each woman at each stage from conception to the postpartum period. In addition, special observations and care of newborn babies are required.

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