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Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
Multiple pregnancy
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Multiple pregnancy

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  • 1. Multiplepregnancy…
  • 2. HELLIN’S RULETwins 1 in 80Triplets 1 in 80^2Quadruplets 1 in 80^3gemellology
  • 3. Types of twins………DIZYGOTIC MONOZYGOTIC
  • 4. DIZYGOTIC 2 chorions amnion amnionAlways dichorionic & diamnionic
  • 5. Factors affecting dizygotictwinningEthnic groupIncreasingmaternal age
  • 6. Increasing parityFamily h/o twinning, espmaternalOvulation induction
  • 7. MONOZYGOTIC 4-7 days
  • 8. >8days
  • 9. ChorionicityType of placentationPrenatal detection by USSClinical implications in antepartum & intrapartummanagement… Monochorionic MZ Dichorionic+discordant sex DZ Dichorionic+concordant sex MZ or DZ
  • 10. USS DETERMINATION OF CHORIONICITY Number of sacs Placenta Sex Intertwin membrane Lambda sign & T signIdeal time for assessing of chorionicity is before 14 weeks
  • 11. DIZYGOTIC
  • 12. LAMBDA SIGN
  • 13. MONOCHORIONIC & DIAMNIONIC T SIGN
  • 14. MONOCHORIONIC MONOAMNIOTIC
  • 15. Importance of chorionicity ?????
  • 16. MATERNAL COMPLICATIONSAntepartumhyperemesishydramnios
  • 17. Pre eclampsia(3 fold times),eclampsia(6 fold times)Pressure symptomsAnaemiaAnte partum hemorrhage- AbruptionPlacenta preavia
  • 18. Intrapartum complications Dysfunctional labour Malpresentations Increased chance for operative delivery Post partum hemorrhage Retained placenta
  • 19. FETAL COMPLICATIONS………… Antepartum complicationsI. Prematurity
  • 20. 2. IUGR Poor placentation,unequal placental sharing,fetal anomalies……
  • 21. 3. Single fetal demise monochorionic Shift of blood Normal Death of one twin twin25% risk of co-twin death /25% risk of neurologicaldamage in surviving twin
  • 22. 4. Cord entanglement
  • 23. 5. TWIN-TWIN TRANSFUSION SYNDROME
  • 24. Arterio venous anastomoses with netflow in one direction..A/c or C/c… •Severe IUGR •poor renal perfusionDonor(arterial side) •Anuria •severe oligohydramnios •Hypervolemia recipient •Polyuria with polyhydramnios •CCF…..hydrops…death
  • 25. Uss of TTS…. STUCK TWIN
  • 26. Serial amnio reduction,fetoscopic laser ablation ofanastomosis 6. Vanishing twin Cessation of cardiac activity in a previously viable foetus Fetus papyraceous…
  • 27. 7. Congenital anomaliesStructural Chromosomalmalformations anomaliesConjoint twins Down’s syndromeAcardiac fetusAnencephalyTalipesDislocation of hipetc..
  • 28. Conjoint twinsAlways monozygoticclassification Thoracopagus Craniopagus omphalopagus
  • 29. Pygopagusischiopagus Prenatal diagnosis-to counsel the parents for mtp / to plan site & mode of delivery…
  • 30. Acardiac foetus A-A anastamoses Umb. A in placenta UmbDe oxygenated .Ablood Minimal oxy. extracted by lower Normal fetus/pump twin part of Acardiac fetus Fully de oxygenated Umb.V V-V anastomoses Umb.V Upper part of fetus ,no growth in placenta
  • 31. Acardiac twins
  • 32. Anencephaly
  • 33. Intrapartum complicationsPROM & cordprolapseAbruption in the 2ndtwinInterlocking of twins

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