Gravidanza gemellare
La gravidanza gemellare è un evento raro, ma non troppo. Negli ultimi anni, infatti, se n’è registrato un aumento, dovuto essenzialmente a due fattori: l’età media delle neo-mamme sempre più alta (più l’età avanza e più aumentano il livello di ormone follicolo stimolante e il numero di ovuli da fecondare) e il ricorso sempre più frequente a fecondazione assistita e a tecniche per stimolare la fertilità. Non tutte le gravidanze gemellari, però, sono uguali, bisogna distinguere tra la gravidanza gemellare che porta alla nascita di gemelli eterozigoti, ovvero diversi, e quella il cui frutto sono dei gemelli monozigoti, identici tra loro. Ma quali sono i sintomi che ci fanno capire di aspettare dei gemelli? E come procede settimana per settimana una gravidanza gemellare? Scopriamolo insieme.
Gravidanza gemellare settimana per settimana
- Primo trimestre di gravidanza: nel corso del primo trimestre di gravidanza gemellare, si iniziano ad avvertire i tipici sintomi di concepimento, come nausea, spossatezza e seno gonfio. Inoltre, l’aumento di volume dell’utero è maggiore rispetto ad una gravidanza singola, quindi anche il ventre tende subito ad essere più pronunciato. I sintomi iniziano ad attenuarsi intorno alla fine del primo trimestre. Lo sviluppo degli embrioni in questa fase è uguale a quello di una gravidanza singola. Grazie all’ecografia è possibile scoprire di che tipo di gravidanza gemellare si tratta.
- Secondo trimestre di gravidanza: in questa fase possono comparire nuovi sintomi, come cali di pressione, stitichezza, macchie sul viso, seno ingrossato e con areole scure. Intorno alla ventesima settimana compare la linea alba, una linea scura che parte dall’ombelico e arriva fino al pube, che scompare dopo il parto. Ovviamente, aumenta sempre di più la circonferenza del pancione, così come il peso della mamma, che va tenuto sotto controllo, anche per evitare il rischio di diabete gestazionale. Tra la fine del secondo trimestre e l’inizio del terzo, ovvero tra la 26° e la 32° settimana, si può presentare il rischio di parto prematuro. È per questo necessario stare a riposo, non stressarsi e avvisare il ginecologo in caso di perdite di liquido e contrazioni.
- Terzo trimestre di gravidanza: il rischio di parto prematuro aumenta e il peso del pancione affatica molto la futura mamma, che necessita di riposo. Soprattutto in caso di gravidanza gemellare bicoriale, già dalla 37° settimana si inizia il monitoraggio pre-natale e, in base allo stato dei feti e alla loro posizione, si programma il parto. Se i bambini non sono podalici e non ci sono complicazioni si può tentare un parto naturale, ma in caso di gravidanza monocoriale monoamniotica, bisogna necessariamente ricorrere ad un parto cesareo, di solito tra la 34° e la 36° settimana.
Gravidanza gemellare sintomi
Per avere la certezza di aspettare due gemelli bisogna effettuare un’ecografia, tuttavia quasi sempre fin dalle prime settimane compaiono alcuni sintomi abbastanza chiari, ovvero:
- forte nausea,
- aumento di peso,
- addome molto pronunciato,
- livelli di Beta HCG molto elevati e che aumentano rapidamente,
- spossatezza.
A volte, comunque, i sintomi di gravidanza gemellare possono non essere così accentuati, ma essere in tutto e per tutto simili a quelli di una normale gravidanza singola.
Gravidanza gemellare rischi
La gravidanza gemellare è sicuramente più impegnativa rispetto a quella singola e presenta anche un maggior numero di rischi. Innanzitutto, i comuni disturbi della gravidanza sono accentuati. L’aumento di peso e il volume del pancione sono maggiori, di conseguenza la mamma è più affaticata e presenta spesso dolori lombo-sacrali e disturbi respiratori. Altri rischi che compaiono più frequentemente in una gravidanza gemellare rispetto ad una singola sono:
- malformazioni fetali,
- alterazioni cromosomiche,
- mortalità perinatale,
- ridotta crescita del feto,
- sindrome di trasfusione feto-fetale (complicazione della gravidanza gemellare monocoriale, nella quale uno dei due feti riceve più sangue rispetto all’altro),
- patologie materne (come anemia, ipertensione, diabete gestazionale),
- parto prematuro.
Gravidanza gemellare: bicoriale o monocoriale?
I gemelli, come abbiamo detto più sopra, possono essere omozigoti (detti anche monozigoti) oppure eterozigoti (detti anche bizigoti). In caso di gemelli omozigoti, viene fecondato un solo ovulo, quindi si ha un solo zigote, che poi entro qualche giorno si divide in due diversi embrioni. I gemelli monozigoti hanno lo stesso DNA, quindi sono identici e dello stesso sesso. Nei gemelli eterozigoti, invece, vengono fecondati due ovuli da due spermatozoi, quindi i gemelli bizigoti non hanno lo stesso DNA, non sono identici e possono essere di sesso diverso. Importante è distinguere le gravidanze gemellari anche in base al sacco amniotico: se lo zigote si divide subito dopo la fecondazione, si avrà una gravidanza gemellare bicoriale biamniotica, nella quale i feti avranno sacche amniotiche e placente separate. Se lo zigote si separa qualche giorno dopo la fecondazione, si avrà una gravidanza gemellare monocoriale biamniotica, con sacchi amniotici separati, ma placenta in comune. Se passano ancora più giorni, si avrà una gravidanza gemellare monocoriale monoamniotica, con sacca amniotica e placenta in comune. Ovviamente, in caso di gemelli eterozigoti, la placenta e la sacca amniotica saranno sempre divisi.
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