|
 Triplet
pregnancies deserve special care during the prenatal period
because some conditions are more frequent in multiple gestation.
A subject of considerable controversy is
the need to perform cervical cerclage (stitching around the
uterus cervix) in
multiple gestation. Although some physicians perform it as
a routine procedure in these circumstances, much of the scientific
research shows that the treatment is not indicated when the
pregnancy progresses normally. Therefore, it must be performed
only in selected cases.
During triplet pregnancy hypertension and
diabetes are more frequent, therefore, these two conditions
must be carefully
monitored during the prenatal period, by specific blood tests
and ultrasonography. Small doses of acetylsalycilic acid
must be given to every pregnant woman as of the 14th week
of gestation to prevent the high risk of preeclampsia.
The major complications of triplet pregnancy
are preterm birth and low birth weight. To minimize these
problems, the
follow-up consultations of these pregnant women must be more
frequent after the sixth month. Bed rest may be necessary,
as well as the administration of corticosteroids at the end
of the pregnancy to help mature the babies’ lungs.
Early detection of genital and urinary
tract infections is of utmost importance to prevent premature
rupture of membranes.
Transvaginal ultrasonography to measure
the uterus cervix is also useful to prevent premature delivery.
Preventive bed rest increases myometrium
(uterus) irrigation (blood flow), thus decreasing uterine
contractility.
The preventive use of tocolytic drugs is
also controversial, and is not recommended as a routine.
In the third trimester the following exams
are important: cardiotocography, fetal biophysical profile
and ultrasonography
with color Doppler.
In regard to the route of delivery (vaginal
or cesarean), we prefer the cesarean section, because
usually one
or more babies are in an unfavorable position
for a vaginal
delivery.
However vaginal delivery may sometimes be performed.
Physical exercises may be practiced under supervision.
The ideal
exercises are practiced under water (underwater
gymnastics), because
they do not put weight on the uterus cervix.
Nutritional requirements are increased
in triplet pregnancy, therefore, a follow-up with a nutritionist
is recommended
whenever feasible.
The ideal weight gain in these cases ranges
from 15 to 18 kg. Anemia, as well as conditions
resulting
from
the
lack
of other elements is more frequent in multiple
gestation when compared to singleton gestation,
therefore the
intake of a balanced diet and of vitamin
supplements is essential.
- Hyperemesis gravidarum (vomiting)
- Anemia
- Hypertension (preeclampsia) – twice more frequent
than in singleton pregnancy
- Gestational diabetes
- Premature rupture of membranes – three times more
frequent than in singleton pregnancy
- Polyhydramnios (excess amniotic fluid)
- Post-partum hemorrhage (due to intense uterus distension,
contractility is impaired) |
