Multiple pregnancy

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Multiple pregnancy

  1. 1. Multiplepregnancy…
  2. 2. HELLIN’S RULETwins 1 in 80Triplets 1 in 80^2Quadruplets 1 in 80^3gemellology
  3. 3. Types of twins………DIZYGOTIC MONOZYGOTIC
  4. 4. DIZYGOTIC 2 chorions amnion amnionAlways dichorionic & diamnionic
  5. 5. Factors affecting dizygotictwinningEthnic groupIncreasingmaternal age
  6. 6. Increasing parityFamily h/o twinning, espmaternalOvulation induction
  7. 7. MONOZYGOTIC 4-7 days
  8. 8. >8days
  9. 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. 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. 11. DIZYGOTIC
  12. 12. LAMBDA SIGN
  13. 13. MONOCHORIONIC & DIAMNIONIC T SIGN
  14. 14. MONOCHORIONIC MONOAMNIOTIC
  15. 15. Importance of chorionicity ?????
  16. 16. MATERNAL COMPLICATIONSAntepartumhyperemesishydramnios
  17. 17. Pre eclampsia(3 fold times),eclampsia(6 fold times)Pressure symptomsAnaemiaAnte partum hemorrhage- AbruptionPlacenta preavia
  18. 18. Intrapartum complications Dysfunctional labour Malpresentations Increased chance for operative delivery Post partum hemorrhage Retained placenta
  19. 19. FETAL COMPLICATIONS………… Antepartum complicationsI. Prematurity
  20. 20. 2. IUGR Poor placentation,unequal placental sharing,fetal anomalies……
  21. 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. 22. 4. Cord entanglement
  23. 23. 5. TWIN-TWIN TRANSFUSION SYNDROME
  24. 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. 25. Uss of TTS…. STUCK TWIN
  26. 26. Serial amnio reduction,fetoscopic laser ablation ofanastomosis 6. Vanishing twin Cessation of cardiac activity in a previously viable foetus Fetus papyraceous…
  27. 27. 7. Congenital anomaliesStructural Chromosomalmalformations anomaliesConjoint twins Down’s syndromeAcardiac fetusAnencephalyTalipesDislocation of hipetc..
  28. 28. Conjoint twinsAlways monozygoticclassification Thoracopagus Craniopagus omphalopagus
  29. 29. Pygopagusischiopagus Prenatal diagnosis-to counsel the parents for mtp / to plan site & mode of delivery…
  30. 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. 31. Acardiac twins
  32. 32. Anencephaly
  33. 33. Intrapartum complicationsPROM & cordprolapseAbruption in the 2ndtwinInterlocking of twins

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