The uterus is growing too quickly

If the uterus grows more than 2 finger-widths a month, or more than 1 cm a week, several different causes are possible:

• The mother may have twins.
• The mother may have diabetes.
• The mother may have too much water (amniotic fluid) in the uterus.
• The mother may have a molar pregnancy (a tumour instead of a baby).

The mother may have twins

It can be very difficult to know for sure that a mother is pregnant with twins. Signs of twins are that:

• The uterus grows faster or larger than normal.
• You can feel two heads or two bottoms when you feel the mother's abdomen.
• You can hear two heartbeats. This is not easy to detect, but it may be possible in the last few months.

We will show you how to listen to the fetal heartbeat through the mother's abdomen in Study Session 11. For now, we are focusing on twins as a possible reason for the uterus being larger than expected. Here are two ways to try to hear the heartbeats of twins:

1. Find the heartbeat of one baby. Ask a helper to listen for other places where the heartbeat is easy to hear. If she hears a heartbeat, ask her to listen to one place while you listen to the other. Each of you can tap the rhythm of the heartbeat with your hand. If the rhythms are the same, you may be listening to the same baby. If the rhythms are not exactly the same, you may be hearing two different babies (Figure 10.6).
2. If you do not have a helper, but you have a watch with a second hand, or a homemade timer, try timing each heartbeat separately. If the heartbeats are not the same, you may be hearing two different babies.

Because twin births are often more difficult or dangerous than single births, it is safer for the woman to go to a hospital to give birth. Since twins are more likely to be born early, the mother should try to have transportation ready at all times after the 6th month. If the hospital is far away, the mother may wish to move closer in the last months of pregnancy. Be sure to have a plan for how to get help in an emergency.

The mother may have diabetes

You learned about the warning signs of diabetes in Study Session 9.

She had diabetes in a past pregnancy. One of her past babies was born very big (more than 4 kilograms), or was ill or died at birth and no one knows why. She is fat. She is thirsty all the time. She has frequent itching and a bad smell coming from her vagina. Her wounds heal slowly. She has to urinate more often than other pregnant women. Her uterus is bigger than normal for how many months she has been pregnant. She has sugar in her urine when you do the dipstick test (Section 9.8.1 of Study Session 9).

Too much water in the uterus

Too much water (amniotic fluid) is not always a problem, but it can cause the uterus to stretch too much. Then the uterus cannot contract enough to push the baby out, or to stop the bleeding after the birth. In rare cases, it can mean that the baby will have birth defects. Try to refer the woman to the nearest health facility that can give her a sonogram (ultrasound examination) if the uterus is measuring too big and you do not suspect twins.

Molar pregnancy (tumour)

Sometimes a woman gets pregnant, but a tumour grows instead of a baby. This is called a molar pregnancy (Figure 10.7). Blood spotting and tissue (sometimes shaped like grapes) may be discharged from her vagina.

Other signs of a molar pregnancy are that:

• No fetal heartbeat can be heard.
• No baby can be felt.
• The woman has had nausea all through the pregnancy.
• She has spotting of blood, and tissue shaped like bunches of grapes coming from her vagina.