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Multiple pregnancy.pptx
- 1. MRS.SHERLIN SAPTHICA.,MSC(N)., MBA., PG.Dip(Diabetes education) ASST.PROFESSOR, OBSTETRICS AND GYNECOLOGICAL NURSING GANGA INSTITUTE OF HEALTH SCIENCES, COIMBATORE.
- 2. Definition When more than 1 fetus simultaneously develops in the uterus… Twins??? Triplets??? Quadraplets??? Quintoplets???? Sextoplets???
- 3. Twins
- 4. Conti…
- 7. DETERMINATION OF ZYGOSITY PLACE- NTA COMM- UNICA- TING VESSEL INTERV- ENING MEMBR- ANE SEX GENET- IC FEATU- RE SKIN GRAF- TING FOLLOW UP MONOZ YGOTIC ONE PRESE NT 2 AMNION IDEN TICAL SAME ACCEP TANCE IDENTICA L DIZYGO TIC TWO ABSEN T 2 AMNION & 2 CHORIO N MAY DIFF ER DIFFER REJEC TION NOT IDENTICA L
- 8. Etiology Monozygotic – maternal environment Dizygotic – Race, heredity, advancing age, Parity, Iatrogenic Superfecundation Superfetation Fetus papyraceous/ Compressus Fetus acardiacus Vanishing twin
- 9. Maternal physiologcal changes Weight gain & CO Plasma volume – 500ml Hemodilution & anemia – exagerated α – fetoprotein, tidal volume & GFR LIE & PRESENTATION
- 10. Diagnosis History Symptoms General examination Abdominal examination Internal examination Investigation Chorionicity of the placenta Biochemical tests Differential diagnosis
- 12. Conti… Fetal Abortion Premature Discordant twin growth Twin- twin transfusion syndrome Placental insufficiency IUGR IUD of 1 fetus Locked twin Cord prolapse Fetal anomalies Asphyxia & still birth
- 13. Complication – monochorionic twin Twin – Twin transfusion syndrome
- 15. Twin reversed arterial perfusion
- 16. Management - Antenatal Diet – 300kcal more Antenatal rest Supplement therapy Interval of antenatal visits Fetal surveillance – serial sonography at 3-4 wks interval, fetal growth, AFV, AFI, NST & doppler velocimetry Hospitalization :- Results, Betaemetics/ circlage operation & Corticosteroids
- 18. Management Deliver first baby vaginally Cut the cord No methergin To note the lie of 2nd fetus IF TRANSVERSE LIE: External version If fails, internal podalic version and breech extraction under GA
- 19. CONTI… IF LONGITUTIDINAL LIE: ARM + Oxytocin If delay Vertex: low down – forceps, high up – ventouse Breech: breech extraction
- 20. Indications – Urgent delivery Severe bleeding Cord prolapse Inadverdent use of IV ergometrine 1st baby delivered under GA Fetal distress
- 21. Indications - LSCS Both/ 1st fetus in cephalic presentation IUGR Conjoint twins Monoamniotic twins Monochorionic twins with TTS Collision of head preventing engagement
- 22. Management of difficult cases Interlocking Vaginal manipulation If failed LSCS or decapitation of 1st baby if dead Occasionally two heads of vertex – Disengagement of higher head under GA Conjoined twins Extent & site of union Possibility of surgical seperation Size of the fetus Possibility of survival
- 23. Triplets, Quadruplets,etc… Diagnosis – u/s, radiography / during birth Preterm delivery – 50% (32-34wks) Selective reduction Intracardiac injection – Potassium chloride b/w 11-13wks Transabdominally Umblical cord is occluded by fetoscopic ligation/ laser/ bipolar coagulation Selective termination Structural/ genetic abnormality
- 24. Q’s???
- 25. THANK YOU