How do people have triplets

Triplets and quadruplets : "Multiple pregnancies are risky"

Mr. Hellmeyer, how do twins come about?

To put it very roughly: On the one hand, there are identical twins. An egg cell jumped and exactly one egg cell was fertilized. Then this divides. When you have dizygoti twins, two eggs pop out of the follicle at once. They are fertilized by two different sperm. That could even be boys and girls.

Do identical twins really have that special connection that one hears about so often?

I know from experience that identical twins have a special relationship with each other and say: I can feel when my sister or brother is doing badly, even over a distance. Of course, you can shape them differently as you grow up, but their genetics are basically the same. Medically, however, this particular connection cannot be proven, it is a matter of feeling.

How often does a woman get pregnant with twins?

There is what is known as Hellin's rule. This says that the probability of a twin pregnancy is 1 in 85, the chance of a triplet pregnancy is 1 in 85 to the power of two, for quadruples it is 1 in 85 to the power of three, and so on - very rarely. The number is falsified by the artificial insemination.

So the growing number of multiple births is due to this?

That's right, there were even too many triplets for a while. You always have to keep in mind that it is a total risk pregnancy, even with a twin pregnancy you have a high risk of premature birth. Also, if you have triplets, there's a 20 percent chance that one of the children will be disabled. Therefore one is now a little more restrictive and cautious. Where in the past three egg cells were inserted into the uterus, today two egg cells are more likely to be inserted, or even just one, so that twins cannot even develop. And the number of twins as well as the number of triplets is falling a bit.

In 2009, a woman in the United States gave birth to eight healthy children ...

During the artificial insemination of this woman, the doctors used a large number of egg cells or stimulated them in a different way, something that is not allowed in Germany. The likelihood that one or even several children will be disabled in such a case is huge. This is actually a malpractice on the part of the doctor, a situation that should never exist in Germany. The children all weighed around 600 grams, so these are children who are at maximum risk of secondary damage. From the children's point of view, it is a disaster and selfish for a woman to carry eightlings. In sterility therapy - i.e. fertility treatment - it can happen that you reset three egg cells and one divides by chance. Then suddenly you have quadruplets. And there it happens that in the embryonic phase or early fetal phase one aborts a child in order to increase the chances of the others. But thank God that is rare.

At what point can you tell that you are pregnant with more than one child?

You can see that very early. At the first ultrasound you can tell that you are going to have two children. The pregnancy can still be lost up to the tenth week. Only from then on do most women tell that they are pregnant.

Do women who are pregnant with two children have to behave differently from other pregnant women?

You don't have to eat for three, the children get what they need.

Do you experience any particular complaints during the twin pregnancy?

Women are more likely to have severe vomiting because the pregnancy hormone HCG is released to a greater extent. In the first place, however, is the risk of premature birth. Otherwise it is not much different from other pregnancies.

Why do the children come earlier?

The reason for this is simply the mechanical stress on the cervix. You have to imagine that everything is double: there are two children, two mother cakes and then the amniotic fluid from both children. This weight can put a lot of pressure on the cervix, especially in delicate women, and open it too early.

So the woman carries around twice the weight?

Most of the time the twins are smaller. Since two children have to find space, both are not huge. The average weight for twins is 2350 grams, for triplets it is only 1680 grams, but this is also due to the fact that they are born after 36 weeks. Other children have a birth weight of 3200 to 3500 grams.

Unlike single births, multiple births must necessarily take place in the hospital. Why?

A twin birth is an absolute risk pregnancy and must therefore take place in a clinic. There are many complications that play a role. This is why it is so important to determine early in pregnancy whether each of the twins has their own placenta, or whether they share a placenta or even a sac. A lot depends on it. If each twin has their own placenta, the overall prognosis is more favorable. If they share one, one child will be better cared for than the other. If left unchecked, the chances that these children will die in the womb are relatively high. So the plaster cake is the key point. Because dizygoti twins each have their own placenta, their overall chances are better. Identical twins can also have their own placenta if the egg divides very early - but this is the rarer case. If it divides a little later, the children only have one placenta, if it divides even later, then they even have only one sac. Then you have to fetch the children eight weeks earlier. If the egg separates even later, you have Siamese twins that have grown together.

Today, three out of ten women give birth by caesarean section. Do you always recommend this type of procedure for twins?

No, not generally. It depends on how the children are lying. You can give birth normally if the first is upside down and not much smaller than the second - only then. The rate of Caesarean sections is higher in twins.

The interview was conducted by Hauke ​​Hohensee. Lars Hellmeyer is chief physician in gynecology at Vivantes Klinikum in Friedrichshain with a focus on obstetrics. This interview and other interesting articles about the desire to have children, pregnancy and childbirth can be found in the health guide “Tagesspiegel Mutter & Kind 2018/2019”. The booklet is dedicated to the following topics, among others: artificial insemination, mother from 35, postnatal gymnastics, birthing centers, postpartum depression, gay and lesbian parents and the first pearly whites. It also contains a column by Harald Martenstein on late fatherhood and a comparison table of all maternity clinics in Berlin and Brandenburg. The magazine costs 12.80 euros and is available in the Tagesspiegel shop, www.tagesspiegel. de / shop, Tel. 29021-520 and in newsagents.

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