Pregnancy Outcomes<br />Abortion<br />More likely with multiple fetuses<br />USG: two GSs with the subsequent disappearanc...
Death of one fetus<br />At delivery : death fetusfetuscompressus & fetus papyraceous.<br />Death fetus  mother coagulati...
Perinatal Mortality<br />Higher than single fetus (10-15%).<br />Monozygotic twins compared with dizygotic twins had highe...
Birthweight<br />Powers: 45-65% of twin infants had BW &lt; 2.501g.<br />Number of fetuses ↑,  BW ↓.<br />When two or more...
Malformations<br />Kohl & Casey: twice as great in twins as in singletons. Malformations are more common among monozygotic...
Subsequent Development<br />General intelligence did not appear to differ between twins & singleton.<br />Height, weight, ...
Superfetation & Superfecundation<br />Superfetation: fertilizations happened with an interval as long as or longer than an...
Maternal Adaptation<br />Greater maternal physiological change.<br />Veille& associates : Cardiac output was increased, bu...
Management of Pregnancies<br />Diet<br />Increasing daily requirements<br />Energy consumption ↑ 300kcal/day.<br />Iron Su...
Maternal Hypertension<br />Pregnancy-induced & pregnancy-aggravated hypertensions are much more likely to develop.<br />
Prevention of Preterm Delivery<br />Bed rest.<br />Progestin administration<br />Pulmonary Maturation<br />Prolonged Gesta...
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Tu Gemeli

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Tu Gemeli

  1. 1. Pregnancy Outcomes<br />Abortion<br />More likely with multiple fetuses<br />USG: two GSs with the subsequent disappearance of one or even both sacs is evidence that silent early abortion or resorption of one embryo is fairly common.<br />
  2. 2. Death of one fetus<br />At delivery : death fetusfetuscompressus & fetus papyraceous.<br />Death fetus  mother coagulation defects.<br />The placenta is the site of massive deposition of fibrin leads to decreasing of maternal fibrinogen and increasing of the FDP  heparin infusion.<br />The risk of the living fetus to had consumptive coagulopathy  if there’s anastomose between fetal circulations.<br />
  3. 3. Perinatal Mortality<br />Higher than single fetus (10-15%).<br />Monozygotic twins compared with dizygotic twins had higher chance (2.5x) to have monoamniotic sac or intertwining of umbilical cords.<br />Duration of gestation<br />Depends on the number of fetuses.<br />
  4. 4. Birthweight<br />Powers: 45-65% of twin infants had BW &lt; 2.501g.<br />Number of fetuses ↑, BW ↓.<br />When two or more fetuses are derived from a single ovum, the degree of GR is likely to be greater than from different ovum.<br />Two monozygotic infants  BW nearly the same.<br />Dizygotic twins  marked discordance in size.<br />
  5. 5. Malformations<br />Kohl & Casey: twice as great in twins as in singletons. Malformations are more common among monozygotic.<br />Persistent or chronic hydramnios associated with fetal anomalies of one or both.<br />Hashimoto et al : increased amniotic fluid in a fourth of twin pregnancies (9 over 10 pregnancies).<br />
  6. 6. Subsequent Development<br />General intelligence did not appear to differ between twins & singleton.<br />Height, weight, HC and apparently intellience often remain superior in the twin who weighted more at birth.<br />
  7. 7. Superfetation & Superfecundation<br />Superfetation: fertilizations happened with an interval as long as or longer than an ovulatory cycle.<br />Superfecundation: fertiolizations happened within a short period of time but not at the same coitus, nor necessarily by sperm from the same man (or ejaculate).<br />
  8. 8. Maternal Adaptation<br />Greater maternal physiological change.<br />Veille& associates : Cardiac output was increased, but end-diastolic ventricular dimensions were the same.<br />In pregnancies with multiple fetuses  hydramnios  obstructive uropathy  impaired maternal renal function.<br />
  9. 9. Management of Pregnancies<br />Diet<br />Increasing daily requirements<br />Energy consumption ↑ 300kcal/day.<br />Iron Supplementation : 60-100 mg/day.<br />Folic Acid : 1 mg/day.<br />
  10. 10. Maternal Hypertension<br />Pregnancy-induced & pregnancy-aggravated hypertensions are much more likely to develop.<br />
  11. 11. Prevention of Preterm Delivery<br />Bed rest.<br />Progestin administration<br />Pulmonary Maturation<br />Prolonged Gestation<br />

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