Multiples

from Wikipedia, the free encyclopedia
The identical Dionne quintuplets as toddlers ...
... and at the age of 13

Multiples are two or more children of one mother and one father who grew up within the same pregnancy and are usually born during the same birth process . The term is usually only used if there is no special case of twin pregnancy .

Emergence

The formation of triplets and higher-grade multiples corresponds to the formation of twins :

  • Identical twins (monozygotic)
  • Fraternal twins (dizygotic)

In multiple pregnancies with identical (= monozygous) twins, depending on the time at which the embryoblast divides, there are four ways in which the twins divide the placenta and amniotic sac:

  1. The dichorionic-diamniote twin pregnancy up to the third day after fertilization is by far the most common form with around 70 out of 100 pregnancies with identical twins. Each twin has its own placenta and its own fruit cavity and is surrounded by two membranes ( amnion and chorion ) so that the partition between them consists of four membranes.
  2. The monochorionic-diamniotic twin pregnancy between the 3rd and 7th day after fertilization occurs in about 30 out of 100 pregnancies with identical twins. The twins share a placenta, but each child has its own fruit cavity, which is covered by an egg membrane, so that the partition between them consists of two egg membranes, namely the amnion of each twin.
  3. The monochorionic-monoamniotic twin pregnancy between the 9th and 12th day after fertilization occurs in about 1 in 100 pregnancies with identical twins. The twins share a placenta and a fruit cavity, so that there is no membrane between them.
  4. The monochorionic-monoamniotic Siamese twin pregnancy occurs in approximately 1 in 300 pregnancies with identical twins. Due to an incomplete division of the embryoblast, the children have grown together on one or more parts of the body. The twins share a placenta and a fruit cavity.

Triplets are created naturally when a division occurs again after twinning. All forms of the second twin formation occur, but are more common in certain forms.

With in vitro fertilization , several fertilized egg cells are usually implanted. Since these nest separately, if the fetuses survive long enough, their own membranes and placenta form.

In very rare cases it can happen that one or even more fetuses of identical multiples develop severely atrophied within a normally developing fetus. This fetus in foeto usually develops in the abdomen and causes symptoms there early on. The multiple fetus can also be trapped in other organs and mistaken for a brain tumor, for example. The parts are rarely discovered late or never during their lifetime. In total, fewer than a hundred cases have been described in the literature.

frequency

According to their biological formation, the frequency of multiple pregnancies can be estimated according to the Hellin hypothesis (also known as Hellin's rule ) as the power of the frequency of twin births, with the exponent being the number of children minus one.

With an assumed frequency of twin pregnancies of 1:85, the following frequencies result for multiple births:

Number of children appraisal frequency in percent
Twins 1: 85 1 approx. 1: 85 approx. 1.2%
triplets 1: 85 2 approx. 1: 7,000 approx. 0.01%
Quadruplets 1: 85 3 approx. 1: 600,000 approx. 0.000 2%
Quintuplets 1: 85 4 approx. 1: 50,000,000 approx. 0.000 002%

Due to hormone treatment and artificial insemination , the rates for multiple multiple births are higher today.

The probability of having identical twin births is 1 in 250.

The probability of identical quadruplets is given as 1:13 million.

The probability of identical triplets is given as 1: 200 million. Since these are "prevented" quadruplets, these are rarer.

Statistics Germany

The Federal Statistical Office publishes current and historical information annually in the series 1 series 1.1 under item 2.19 under the heading "Multiple births and multiple children".

In 1950, 2.3% of children born in Germany were multiple children. Then the number drops to the low of 1.8% in 1977 and then rises to 3.8% by 2015.

From 1950 to 2015 inclusive there were 6 sextuplet births and 33 quintuplet births in Germany. 62 quadruplet births from 1950 to 1984, 143 from 1985 to 1994, 170 from 1995 to 2015. Triplet births in each year 60 (1978) to 491 (1998).

In 2014 every 27th newborn child in Germany was a multiple child, in 2011 every 29th, in 1991 every 42nd, in 1977 every 56th child.

A total of 11,500 multiple births were registered in Germany in 2011, 98% of which were twin births, 230 were triplet births and in six cases there were quadruplet births.

Of the more than 700,000 newborns in Germany in 2014, 25,954 were twins, 846 triplets and 44 quadruplets.

The lowest proportion of multiple children in Germany was in 1977: of the 800,000 children born, just under 15,000 were multiple children, around every 56th child.

Signs of a multiple pregnancy

The clues for a multiple pregnancy can be broken down into safe and unsafe signs.

Unsafe signs

  • noticeably high HCG concentration in the blood
  • oversized waist circumference,
  • markedly raised fundus (upper edge of the uterus ),
  • noticeably many child movements,
  • more than two "big" and "hard" child parts, which could be head or rump ,
  • noticeably many small parts of the child.

Safe signs

In contrast, there are sure signs

The occurrence of multiple pregnancies in the family must also be taken as an indirect indication. This only applies to pregnancies with multiple multiples; monozygous multiple births do not occur in families. A disposition to multiple pregnancies is inherited exclusively through the maternal family.

An increased likelihood of a multiple pregnancy is to be expected after artificial insemination .

Risks

A multiple pregnancy represents a risk pregnancy for the mother and the children. The pregnant women themselves have a three-fold higher mortality. In early pregnancy, it is more common to occur gravidarum hyperemesis , in later pregnancy to occur gestoses . The premature birth rate is significantly increased. Towards the end of pregnancy there is a delay in growth of the fetuses - in twin pregnancies from the 34th to 35th year. Pregnancy week (SSW), triplets from 28 weeks . In order to be able to determine a different growth of the individual fetuses, 14-day check-ups are recommended up to the 28th week of pregnancy, then weekly.

The following complications can often occur in a multiple pregnancy:

Particularly in the case of triplet pregnancies and pregnancies with higher-grade multiples, there is the possibility of selective fetocide , i.e. H. the prenatal reduction of multiples. At least one of the unborn children is killed because of a medical indication , either because it is disabled or in order to increase the chances of survival and development of the other fetuses. Typically, the decision to use selective fetocide is preceded by prenatal diagnostic tests , which assess whether a child may have a medical condition or disability that might facilitate the choice of the child to be killed. If nothing of the kind can be determined, the smallest child is usually selected and killed either by a lethal injection or by ligating supplying vessels. There is a risk of ultimately losing all children as a result of a miscarriage caused by the procedure.

Particularly high number

An extremely high number of fetuses always leads to premature births - often also by caesarean section - and means associated correspondingly increased risks (see the risks of multiple births described above in general). The improved medical care for premature babies has also increased the chances of survival significantly in recent years. There have been reports of high multiple pregnancies without hormone therapy for quintuplets, sextuplets and even sevenlings, although in some cases a period of over 100 years must be considered.

Higher chances of survival through further development of medicine

  • Born three months early in Canada in 1934, the Dionne quintuplets are the first quintuplets to survive toddlerhood together. In addition, they are the only identical quintuplets to reach adulthood.
  • In 1968 sextuplets were born alive for the first time in England. One baby died shortly after birth, and two more within the next two weeks. The mother had received hormone treatment. The first British surviving sextuplets were born in 1983.
  • Sextuplets born in South Africa in 1974 are the first known to have survived toddlerhood. They have also reached adulthood.
  • In 1985, sevenlings were born in the United States in the 28th week of pregnancy, one of which was stillborn, three more died within 19 days, and the other had developmental disorders.
  • Sevenlings were born alive in Saudi Arabia in September 1997, although six died shortly after birth.
  • In November 1997, the first live-born sevenlings were born in Iowa, USA. The four boys and three girls came by caesarean section in the 31st week of pregnancy and their chances of survival were rated as good despite the serious situation. According to press reports, they should all have been alive in 2001. Several doctors criticized the doctors who treated hormones. In addition, the parents, devout Baptists, refused to have two of the fetuses aborted. Many donations such as diapers, free milk, a minibus and scholarships make it easier for the family to survive. In 2015 they all reached the age of 18.
  • In January 1998, a woman gave birth to three girls and four boys in Saudi Arabia. It is said to be the second family with sevenlings in which all children survived for a long time.
  • In December 1998, the first live-born eightlings were born in Texas, USA, with one child dying after a week. The others celebrated their tenth birthday in 2008.
  • Sevenlings were born alive in Washington in July 2001 after 28½ weeks gestation by caesarean section. The parents of the five boys and two girls had come to the United States from Saudi Arabia three years earlier.
  • In August 2008, a woman in Egypt gave birth to healthy sevenlings by caesarean section. What is special about the birth of the four boys and three girls is that it did not take place until the end of the eighth month of pregnancy. The premature babies were distributed to four different hospitals. According to the doctor, the mother had not received any hormone treatment.
  • Also in August 2008, sextuplets were born in Iraq, two of which died very soon due to a lack of medical facilities. According to the doctor's information, which cannot be verified, these were the first sextuplets in Iraq.
  • In January 2009, a woman in California gave birth to the second live-born eightlings by caesarean section in the 30th week of pregnancy. The woman became pregnant through artificial insemination using donor sperm. Since the mother already had six children (who were also conceived with donor sperm), was single, unemployed and had financial problems, the press accused her of irresponsibility and parts of the public protested against the woman. The attending doctor was accused of negligence. According to the guidelines of the US Society for Reproductive Medicine, a woman who is 33 years old should have a maximum of two embryos implanted at one time. Investigations have been started by the responsible medical association.

High multiples

In 1971, nine babies were born in Australia. Two were dead at birth, the others died within six days. In 1999, nine babies were born in Malaysia, but they did not survive for more than six hours. In September 2004 in Ethiopia, nine babies were born alive in the seventh month within 24 hours, but all died within half an hour.

According to the Guinness Book of Records , a maximum of ten children were born in one birth. This number is recorded in Brazil in 1946, in China in 1936 and in Spain in 1924. However, the reports are not supported by medical records and there is no information on whether and, if so, how long they survived. In 1996 there was a report of a woman in Cyprus with eleven embryos in the ninth week of pregnancy. However, due to the risks, it was planned to abort seven of the embryos. According to research by the Tunisian Ministry of Health, an allegedly advanced twelve-baby pregnancy turned out to be a false report, which may have been initiated by a temporarily mentally impaired woman with two miscarriages to date.

Germany

For Germany, the Federal Statistical Office shows 33 quintuplet births and five sextuplet births from 1950 to 2007. In October 2008, sextuplets were born in Berlin for the sixth month. According to the press, this was the first sextuplet birth in Germany after 20 years. Identical quadruplets were born on January 6, 2012 in the Leipzig University Clinic . The probability of such a birth was given by the medical experts as 1:13 million.

Multiple pregnancy and termination of pregnancy

Selective termination of pregnancy in the case of multiple pregnancies is also referred to as a so-called reduction in the unborn child or as a fetal reduction . From a medical point of view, this is discussed because the chances of survival for all fetuses in extremely high multiple pregnancies are low. There may be a medical indication or a pediatric indication.

criticism

Most births with more than two children today could be the result of hormone treatment. Because of the high risk of multiple pregnancies for the mother's life, these hormone treatments are viewed critically.

From an economic point of view - calculated per child - multiple births cause considerable additional costs for delivery and for the subsequent clinical care. The economic effects are unaffected.

Unusual twin birth

In very rare cases, multiple births are born after a longer period of time, for example in the case of an Irish mother who gave birth to a twin child in the 5th month of pregnancy and the other 87 days later.

Web links

Commons : Multiples  - collection of images, videos and audio files

Individual evidence

  1. ↑ Heike Le Ker: A puzzling patient: The child within the child. In: Spiegel Online - Gesundheit. April 20, 2013, accessed April 23, 2013 .
  2. ↑ Increase in twin births: More luck in a double pack. In: Spiegel Online . December 29, 2011, accessed August 10, 2012 .
  3. ↑ Miracle in Leipzig: 31-year-old gives birth to identical quadruplets. In: Spiegel Online . January 9, 2012, accessed August 10, 2012 .
  4. ↑ Medical rarity: Identical triplets born in New York. In: Spiegel Online . March 5, 2008, accessed August 10, 2012 .
  5. ↑ a b c destatis Fachserie 1.1 with numbers up to and including 2015
  6. ↑ a b c d destatis press release
  7. ↑ a b 11 500 multiple births in Germany in 2011 (press release by the Federal Statistical Office)
  8. ↑ Media reports in Tunisia. Gynecologist doubts Zwölflingen , Frankfurter Rundschau online, August 19, 2009.
  9. ↑ Cynthia Wright, They Were Five: The Dionne Quintuplets Revisited , Journal of Canadian Studies, Winter 1994, pp. 5-14
  10. ↑ 1968: Birth of sextuplets stuns Britain , news.bbc.co.uk, 2005
  11. ^ The Chiel - THE Six are 30 , dispatch.co.za, January 10, 2004
  12. ^ A b c Daniel Haney: Sevenlings were born healthy , Die Welt, November 21, 1997
  13. ↑ Sevenlings very small . In: Die Zeit , No. 57/1997
  14. ↑ a b c d e dpa: Sevenlings are showered with gifts , netdoktor.at, July 16, 2001
  15. ↑ Andrea Stadler: USA / BABYBOOM - The Magnificent Seven? , Focus, No. 49, December 1, 1997
  16. ↑ Sevenlings should not be marketed. Berliner Zeitung, November 27, 1997. berliner-zeitung.de
  17. ↑ a b Doctors Criticize Multiple Births , Die Welt, December 24, 1998
  18. ↑ a b Californian eightlings are doing well , focus.de, January 29, 2009
  19. ^ Egyptian gives birth to sevenlings , NZZ online, August 16, 2008
  20. ↑ AP: Sevenlings - 27-year-old Egyptian woman in stable condition , focus.de, August 16, 2008
  21. ^ Egypt - woman gives birth to sevenlings , focus.de, August 16, 2008
  22. ↑ Rare sextuplets born in Iraq, four survive . reuters.com, August 16, 2008
  23. ↑ US eightlings set a new record , oe24.at, February 4, 2009
  24. ↑ Eightling becomes a scandal . oe24.at, January 31, 2009
  25. ↑ Mother of the eightlings refused "selective abortion" , oe24.at, January 30, 2009
  26. ↑ Eightling birth - family threatens foreclosure of the house . Spiegel Online , February 20, 2009
  27. ↑ USA: Eightlings are marketed by their mother . ( Memento from November 28, 2012 in the Internet Archive ) Kleine Zeitung , July 28, 2009
  28. ↑ Doctor threatens to be banned from the profession after an eightling birth . Spiegel Online , February 5, 2010
  29. ↑ a b How did the eightlings come about? , Eltern.t-online.de, January 30, 2009
  30. ↑ Death threats: Eightlings had to go into hiding . ( Memento from May 30, 2014 in the Internet Archive ) Kleine Zeitung , February 12, 2009
  31. ^ Australian Woman Gives Birth to Nine, Seven of Them Alive , The New York Times, June 13, 1971
  32. ↑ Last of the Nonuplets This at Sydney Hospital The New York Times, June 20, 1971
  33. ↑ Stacey Pinchuk: A difficult choice in a different voice: Multiple Births, selective reduction and abortion , Duke Journal of Gender and Law Policy No. 29, 2000, footnote 4
  34. ↑ Guinness Book of Records 1994, quoted at ende-genealogy.de ( Memento of the original from October 1, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.ende-genealogy.de
  35. ↑ That’s never happened before: Zoe (23) from Cyprus is expecting elflings . Berliner Kurier , December 20, 1996
  36. ^ APA: Tunisia - Imaginary pregnancy . derstandard.at, August 19, 2009
  37. ↑ Berlin - Woman gives birth to sextuplets , focus.de, October 20, 2008
  38. ^ Sextuplets in Berlin. ( Memento of the original from February 10, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. sueddeutsche.de, October 20, 2008; Retrieved August 28, 2009 @1@ 2Template: Webachiv / IABot / www.sueddeutsche.de
  39. ^ Quadruplets in Leipzig.  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. lvz-online.de, January 9, 2012; Retrieved January 10, 2012@1@ 2Template: Dead Link / www.lvz-online.de  
  40. ^ G. Klinkhammer: Prenatal diagnosis: No abortion after the 20th week. In: Dtsch Arztebl. Volume 95, Number 11, 1998, pp. A-573 / B-481 / C-457
  41. ↑ K. Zimmer: "The Reduction" of Mehrlingen . In: Die Zeit , No. 21/1988
  42. ↑ TL Callahan, JE Hall et al. a .: The economic impact of multiple-gestation pregnancies and the contribution of assisted-reproduction techniques to their incidence. In: The New England Journal of Medicine . Volume 331, Number 4, July 1994, pp. 244-249, ISSN  0028-4793 , doi: 10.1056 / NEJM199407283310407 , PMID 8015572 .
  43. ↑ Anoopa Singh: Twins Born 87 Days Apart: Amy And Katie Elliot Break World Record. In: Medical Daily. May 1, 2013, accessed April 8, 2018 .