16.1. DEFINITION
Multiple pregnancy is a pregnancy where more than one fetus develops simultaneously in the womb.
16.2. CLASSIFICATION
ICD-10 codes XV Pregnancy, childbirth and the puerperium (O00-O99).
• O30 Multiple gestation.
- O30.0 Twin pregnancy.
- O30.1 Triplet pregnancy.
- O30.2 Quadruplet pregnancy.
• O31 Complications specific to multiple pregnancy.
- O31.0 Papyraceous fetus.
- O31.1 Continuing pregnancy after abortion of one fetus or more.
- O31.2 Continuing pregnancy after intrauterine demise of one fetus or more.
• O43 Placental disorders.
- O43.0 Twin-to-twin placental transfusion syndrome.
• O84 Multiple delivery.
- O84.0 Multiple delivery, all spontaneous.
- O84.1 Multiple delivery, all by forceps and vacuum extractor.
- O84.2 Multiple delivery, all by cesarean section.
- O84.8 Other multiple delivery.
- O84.9 Multiple delivery, unspecified.
• Z37 Outcome of delivery.
- Z37.2 Twins, both liveborn.
- Z73.3 Twins, one liveborn and one stillborn.
- Z37.4 Twins, both stillborn.
- Z37.5 Other multiple births, all liveborn.
16.3. HISTORICAL ASPECT
At all times a multiple delivery was surrounded by superstition and mysticism. It was believed that twin infants could in some way affect nature, in particular, change the weather. In some American Indian tribes twins were made to offer up their prayers to the wind and rain. People believed that each wish of twins was gratified and they could curse their enemies, bring about plenty of fish in the river and even heal sickness (Fig. 16.1).
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Fig. 16.1. Ancient sculptures representing Siamese twins
The word for twins meant «providers of plenty». In some African tribes the twins' mother was referred to as heaven, the twins themselves - offspring of heaven. However, these are all myths and superstition, and here are historical facts: in 1775 Jacob Kirillov, a peasant from Vvedenskoye village, was introduced to the court. He was 60 years old then and was married for the second time. His first wife was pregnant 21 times and gave birth to 57 live offspring (4 quadruplets + 7 triplets + 10 twins); the other wife gave birth to 15 children after 7 deliveries (1 triplet + 6 twins). Put together, this makes him father of 72 children. On February 27, 1782 a statement was sent to Moscow from Nikolsky monastery from Shuisk county that Fedor Vassiliev, a peasant, twice married, had 87 children by both marriages. The first wife gave birth 27 times producing 69 offspring (4 quadruplets + 7 triplets + 16 twins), the second one - 18 children (2 triplets and 6 twins). In that year Vassiliev was 75; 83 of his children were still living. These unique incidents are confirmed by documents.