This document discusses the care of a 40-year-old woman with a BMI of 32 who is pregnant with twins conceived through donor oocytes. It outlines considerations for making her journey safe, including increased risks associated with her age, BMI, and twin pregnancy. It covers screening and surveillance recommendations from early to late pregnancy, highlighting additional complexities of twin gestations like vanishing twin, growth discordance, and complications in later pregnancy such as preterm labor and delivery, preeclampsia, and gestational diabetes. The goal is to optimize timing of delivery while minimizing risks.
Multiple gestation refers to pregnancies with two or more fetuses. The incidence has increased due to assisted reproductive technologies. There are two main types: dizygotic (fraternal) and monozygotic (identical). Diagnosis involves history, examination, and ultrasound showing two or more fetuses. Complications include preterm birth and its sequelae. Care involves frequent monitoring and individualizing delivery based on presentation and complications to optimize outcomes for the mother and all fetuses.
This document discusses the management of twin pregnancies. It begins by defining multiple gestation and describing the different types of twins. It then discusses the risks of twin pregnancies to both the mother and fetuses, including preterm birth and fetal growth issues. The document outlines the antenatal management of twins, including frequent ultrasound exams and monitoring for preterm labor. Issues around delivery are also covered, such as unstable fetal positions and the risk of locked twins requiring cesarean section. Overall it provides an overview of caring for twin pregnancies from diagnosis through delivery.
Multiple Pregnancy - Diagnosis ,Clinical Features & ComplicationsHari Dev
This document summarizes key aspects of multiple pregnancies, including:
- Types of multiple pregnancies are dizygotic (two egg/sperm pairs) or monozygotic (one egg that splits). Chorionicity (placentation) is more important than zygosity in determining risks.
- Complications for the mother include hyperemesis, preeclampsia, anemia. Complications for the fetuses include prematurity, IUGR, twin-twin transfusion syndrome for monochorionic twins.
- Rare complications discussed are conjoined twins, acardiac twins, and twin reversed arterial perfusion sequence. Prenatal screening and selective feticide may
With the use of fertility enhancing medications, advance maternal age pregnancies and just the natural order od twinning, this pregnancy presentation has become more common among providers. Here we explore the etiology, presentation and management of twin pregnancies.
This document defines twin pregnancy and discusses its incidence, types, etiology, complications, diagnosis, management, and statistics from deliveries at SCRH Lallaguda. Key points include:
- Twin pregnancy incidence is 1 in 89 births and increases with maternal age, race, parity and ovulation induction.
- Types include dizygotic (two eggs) and monozygotic (one egg splits). Complications affect both mother (preterm labor, preeclampsia) and babies (prematurity, growth issues).
- Diagnosis involves history, exam, ultrasound. Management consists of specialized antenatal care, monitoring, and planned delivery in a hospital equipped to handle complications.
This document discusses multiple pregnancy, also known as twin or higher-order pregnancies. Multiple pregnancies can occur through the segmentation of a single fertilized egg, resulting in identical twins, or through the fertilization of separate eggs, resulting in fraternal twins. Maternal and fetal complications are more common in multiple pregnancies and can include anemia, preeclampsia, prematurity, and fetal growth restriction. Clinical findings that may indicate a multiple pregnancy include an enlarged uterus, excessive weight gain, fetal heart tones, and ultrasound confirmation of multiple fetuses. Fetofetal transfusion syndrome is a complication where twins share a placenta and blood can transfuse unevenly between twins, potentially leading to fetal or newborn
This document discusses multiple gestation pregnancies, specifically twins. It notes that twins make up about 99% of multiple gestations and are either identical (monozygotic) or non-identical (dizygotic). Identical twins share a single placenta while non-identical twins have separate placentas. Multiple gestations carry higher risks than singletons such as preterm birth and fetal growth restriction. Complications are more common in monochorionic twins due to the risk of twin-to-twin transfusion syndrome and cord accidents. Care involves monitoring fetal growth and well-being as well as managing any complications that may arise.
This document discusses multiple pregnancies, specifically twins. It defines twins as the simultaneous development of more than one fetus in the uterus. The types of twins are discussed, including dizygotic/fraternal twins which develop from two separate eggs and monozygotic/identical twins which develop from one egg. The risks and complications associated with multiple pregnancies are summarized for both the mother and fetuses. The document concludes with describing the recommended management and care during antenatal, delivery, and postnatal periods for multiple pregnancies.
Multiple gestation refers to pregnancies with two or more fetuses. The incidence has increased due to assisted reproductive technologies. There are two main types: dizygotic (fraternal) and monozygotic (identical). Diagnosis involves history, examination, and ultrasound showing two or more fetuses. Complications include preterm birth and its sequelae. Care involves frequent monitoring and individualizing delivery based on presentation and complications to optimize outcomes for the mother and all fetuses.
This document discusses the management of twin pregnancies. It begins by defining multiple gestation and describing the different types of twins. It then discusses the risks of twin pregnancies to both the mother and fetuses, including preterm birth and fetal growth issues. The document outlines the antenatal management of twins, including frequent ultrasound exams and monitoring for preterm labor. Issues around delivery are also covered, such as unstable fetal positions and the risk of locked twins requiring cesarean section. Overall it provides an overview of caring for twin pregnancies from diagnosis through delivery.
Multiple Pregnancy - Diagnosis ,Clinical Features & ComplicationsHari Dev
This document summarizes key aspects of multiple pregnancies, including:
- Types of multiple pregnancies are dizygotic (two egg/sperm pairs) or monozygotic (one egg that splits). Chorionicity (placentation) is more important than zygosity in determining risks.
- Complications for the mother include hyperemesis, preeclampsia, anemia. Complications for the fetuses include prematurity, IUGR, twin-twin transfusion syndrome for monochorionic twins.
- Rare complications discussed are conjoined twins, acardiac twins, and twin reversed arterial perfusion sequence. Prenatal screening and selective feticide may
With the use of fertility enhancing medications, advance maternal age pregnancies and just the natural order od twinning, this pregnancy presentation has become more common among providers. Here we explore the etiology, presentation and management of twin pregnancies.
This document defines twin pregnancy and discusses its incidence, types, etiology, complications, diagnosis, management, and statistics from deliveries at SCRH Lallaguda. Key points include:
- Twin pregnancy incidence is 1 in 89 births and increases with maternal age, race, parity and ovulation induction.
- Types include dizygotic (two eggs) and monozygotic (one egg splits). Complications affect both mother (preterm labor, preeclampsia) and babies (prematurity, growth issues).
- Diagnosis involves history, exam, ultrasound. Management consists of specialized antenatal care, monitoring, and planned delivery in a hospital equipped to handle complications.
This document discusses multiple pregnancy, also known as twin or higher-order pregnancies. Multiple pregnancies can occur through the segmentation of a single fertilized egg, resulting in identical twins, or through the fertilization of separate eggs, resulting in fraternal twins. Maternal and fetal complications are more common in multiple pregnancies and can include anemia, preeclampsia, prematurity, and fetal growth restriction. Clinical findings that may indicate a multiple pregnancy include an enlarged uterus, excessive weight gain, fetal heart tones, and ultrasound confirmation of multiple fetuses. Fetofetal transfusion syndrome is a complication where twins share a placenta and blood can transfuse unevenly between twins, potentially leading to fetal or newborn
This document discusses multiple gestation pregnancies, specifically twins. It notes that twins make up about 99% of multiple gestations and are either identical (monozygotic) or non-identical (dizygotic). Identical twins share a single placenta while non-identical twins have separate placentas. Multiple gestations carry higher risks than singletons such as preterm birth and fetal growth restriction. Complications are more common in monochorionic twins due to the risk of twin-to-twin transfusion syndrome and cord accidents. Care involves monitoring fetal growth and well-being as well as managing any complications that may arise.
This document discusses multiple pregnancies, specifically twins. It defines twins as the simultaneous development of more than one fetus in the uterus. The types of twins are discussed, including dizygotic/fraternal twins which develop from two separate eggs and monozygotic/identical twins which develop from one egg. The risks and complications associated with multiple pregnancies are summarized for both the mother and fetuses. The document concludes with describing the recommended management and care during antenatal, delivery, and postnatal periods for multiple pregnancies.
Multiple pregnancies are pregnancies involving more than one fetus. Twins are the most common type of multiple pregnancy, comprising about 3% of all pregnancies. Multiple pregnancies can be either identical (monozygotic) twins originating from one fertilized egg or fraternal (dizygotic) twins from two separate eggs. Factors that increase the risk of multiples include assisted reproductive techniques, increased maternal age, high parity, family history, and certain drugs. Multiple pregnancies carry higher risks than singletons such as preterm birth, growth restriction, and complications unique to identical twins sharing a placenta. Care involves monitoring fetal growth, well-being, and complications through ultrasound screening. Vaginal delivery is aimed for
This document discusses multiple pregnancy, specifically twin pregnancy. It defines multiple pregnancy as more than one fetus and classifies twins based on number of fetuses, zygosity, chorionicity, and amnionicity. Twin pregnancy can be either dizygotic (fraternal) twins from two eggs or monozygotic (identical) twins from one egg that splits. Risk factors, complications, management, and delivery considerations are outlined for twin pregnancies. Conjoined twins, which result from a single fertilized egg failing to separate, are also briefly discussed.
This document discusses complications of multiple pregnancies. Twin pregnancies represent 2-3% of all pregnancies and have a perinatal mortality rate 5 times higher than singleton pregnancies. Complications for the mother include anemia, preeclampsia, premature labor, cesarean delivery, and postpartum hemorrhage. Complications for the fetus include prematurity, intrauterine growth restriction, malpresentation, and congenital anomalies. Monochorionic twins additionally face risks like twin-twin transfusion syndrome. Care involves frequent monitoring and delivery planning to reduce risks and prolong the pregnancy.
Multiple pregnancies are pregnancies carrying more than one fetus. The incidence of twins is 1 in 80 births according to Hellin's formula, with the incidence increasing with maternal age and use of ovulation-inducing drugs. There are two types of twins: monozygotic (identical) twins that develop from one egg and dizygotic (fraternal) twins that develop from two separate eggs. Risks of multiple pregnancies include anemia, pregnancy-induced hypertension, preterm labor, and delivery complications related to malpresentations. Management involves frequent checkups, proper diet, rest, and delivery in a hospital equipped to handle potential complications.
This document discusses multiple pregnancies and provides information about diagnosing and managing twin pregnancies. Some key points:
- Multiple pregnancies occur when more than one fetus develops simultaneously in the uterus. Twins are the most common type of multiple pregnancy.
- Twins can be either monozygotic (identical) or dizygotic (fraternal). Various tests can help determine zygosity.
- Risk factors for twin pregnancies include maternal age, race, heredity, fertility treatments, and assisted reproductive technologies.
- Complications of twin pregnancies include preterm birth, preeclampsia, fetal growth problems, and higher rates of cesarean section. Close monitoring is important
This document discusses multiple pregnancy and twin pregnancy. It defines types of twins including dizygotic and monozygotic twins. It describes maternal physiological changes, diagnosis through history, examination and investigations like ultrasound. Complications for both mother and fetus are discussed. Management involves monitoring for preterm labor, anomalies and growth restriction. Close antenatal care can help reduce mortality and morbidity rates for twin pregnancies.
Multiple pregnancies consist of two or more fetuses, with twins making up nearly all multiple gestations. Multiple pregnancies are associated with higher risks of maternal, fetal, and neonatal complications. The classification of multiple pregnancies is based on the number of fetuses, zygosity (number of fertilized eggs), chorionicity (number of placentae), and amnionicity (number of amniotic cavities). Monozygotic twins can either have separate or shared placentae and amniotic sacs depending on the timing of division after fertilization.
Twin Pregnancy by Taniya Mondal (Tutor, Shova Rani Nursing College)TaniyaMondal6
A detailed case study of a twin pregnancy, study of the condition, genesis of twins, types of twins, usg ananlysis , medical, surgical and nursing management, helath education, complication
This document discusses multiple pregnancies, specifically twins. It defines the different types of twins including monozygotic (identical) and dizygotic (fraternal) twins. It describes the incidence, aetiology, varieties, determination of zygosity, and some definitions for multiple pregnancy complications. The diagnosis, management, and maternal and fetal complications of twin pregnancies are outlined. Specific conditions discussed include discordant twins, twin twin transfusion syndrome (TTS), acardiac twins, conjoined twins, and monoamniotic twins. The document concludes with descriptions of breastfeeding holds that can be used for nursing twins.
This document discusses multiple pregnancy, specifically twins. It begins by outlining Hellin's Rule which describes the statistical likelihood of having multiples based on maternal factors. It then differentiates between dizygotic and monozygotic twins and describes the key differences. Factors that can increase the chances of dizygotic twins are also outlined. The rest of the document details various maternal and fetal complications that can arise in twin pregnancies such as preeclampsia and preterm birth. Specific complications of monozygotic twins like twin-twin transfusion syndrome are also explained.
1) Multiple pregnancies occur when more than one fetus develops simultaneously in the uterus. The main types are dizygotic (non-identical) twins, which account for 80% of twins, and monozygotic (identical) twins, which make up 20%.
2) Risk factors for dizygotic twins include being between 30-40 years old, above average height and weight, previous pregnancies, and certain fertility treatments.
3) Managing a twin pregnancy involves regular monitoring for complications like prematurity, anemia, preeclampsia, and intrauterine growth restriction. Labour involves close fetal monitoring and the potential for a higher rate of interventions.
This document discusses types of multifetal pregnancies including dizygotic, monozygotic, monochorionic, and monoamniotic twins. It describes how chorionicity and amnioticity are determined and complications that can arise depending on whether twins share a placenta and amniotic sac such as twin-twin transfusion syndrome. The risks to the surviving twin if one twin dies are also summarized. Specific complications of monozygotic twins like twin reversed arterial perfusion are defined. Rare cases of conjoined twins are also mentioned.
This document discusses twin pregnancy, including its definition, types (dizygotic and monozygotic), characteristics of each type, risks to mother and fetuses, causes, and management. It notes that twin pregnancy means carrying two fetuses and accounts for dizygotic or monozygotic twins. Dizygotic twins result from two eggs fertilized by separate sperm, while monozygotic twins result from the splitting of a single fertilized egg. Twin pregnancy poses higher risks of complications for both mother and fetuses like prematurity and growth restriction. Careful monitoring and management is needed during pregnancy.
This document discusses multiple pregnancies, also known as twins, triplets, etc. It defines multiple pregnancies as when two or more fetuses are present in the uterus at the same time. Multiple pregnancies are considered a pregnancy complication due to the increased risks of preterm birth and mortality for both mother and fetuses. The document covers terminology, incidence rates, complications, diagnosis, and management of multiple pregnancies.
Multifetal gestation refers to the simultaneous development of more than one fetus in the uterus. The most common types are twins, occurring in 1 in 80 births, while higher order multiples like triplets and quadruplets are much less frequent. Multifetal gestations can occur through the fertilization of two separate eggs (dizygotic) or the splitting of a single fertilized egg (monozygotic). Pregnancies with multiple fetuses carry increased risks of complications for both the mother and fetuses, such as preterm birth, low birth weight, and preeclampsia. Careful prenatal monitoring and management of risks like growth restriction and preterm labor are important to optimize outcomes.
This document discusses multiple pregnancy, also known as twin or higher order pregnancies. It defines multiple pregnancy as the presence of more than one fetus in the abdomen of a pregnant woman. Multiple pregnancies can be categorized based on the number of fetuses as twins, triplets, quadruplets, etc. The document outlines risk factors, classifications, complications, diagnosis, and management of multiple pregnancies. It describes how multiple pregnancies can occur and the different types, and emphasizes the importance of preventing preterm birth in managing these high-risk pregnancies.
This document provides guidelines for managing twin pregnancies, including determining chorionicity and amnioticity. It recommends that all twins undergo an NT ultrasound before 14 weeks to validate chorionicity/amnionicity and detect early complications. Management of monochorionic twins requires more intensive surveillance due to increased risks of complications affecting fetal growth and well-being. Dichorionic twins generally require less frequent monitoring while monochorionic twins should be monitored more closely, with delivery planned before 37 weeks.
This document discusses twin pregnancies and provides information on:
1. The types of twins based on chorionicity and zygosity.
2. The maternal and fetal complications that can occur in twin pregnancies including preeclampsia and preterm birth.
3. The diagnosis and management of twin pregnancies including ultrasound examination and increased surveillance of monochorionic twins.
ROLE OF ULTRASOUND IN MULTIFETAL GESTATION - WHAT AN OBSTETRICIAN SHOULD KNOW ?Bharti Gahtori
Ultrasound plays an indispensable role in managing multifetal gestations. It is crucial for determining chorionicity and zygosity early in the first trimester, as this predicts complications. Ultrasound can also assess nuchal translucency, screen for anomalies, monitor growth and detect complications like twin-twin transfusion syndrome that are more common in monochorionic twins. Serial ultrasound examinations are important for detailed evaluation of the placenta, umbilical cords, fetal growth and well-being in order to guide management and improve outcomes in these high risk pregnancies.
Multiple gestations can be either dizygotic (fraternal) twins resulting from two separate eggs fertilized by two separate sperm or monozygotic (identical) twins from the splitting of a single fertilized egg. Risk factors for twinning include race, family history, fertility treatments, and more. Complications can be fetal like prematurity or maternal like preeclampsia. Diagnosis involves history, exam, imaging and placental/fetal examination after delivery. Management consists of increased prenatal monitoring and timing delivery based on chorionicity and any complications.
Multiple pregnancies are pregnancies involving more than one fetus. Twins are the most common type of multiple pregnancy, comprising about 3% of all pregnancies. Multiple pregnancies can be either identical (monozygotic) twins originating from one fertilized egg or fraternal (dizygotic) twins from two separate eggs. Factors that increase the risk of multiples include assisted reproductive techniques, increased maternal age, high parity, family history, and certain drugs. Multiple pregnancies carry higher risks than singletons such as preterm birth, growth restriction, and complications unique to identical twins sharing a placenta. Care involves monitoring fetal growth, well-being, and complications through ultrasound screening. Vaginal delivery is aimed for
This document discusses multiple pregnancy, specifically twin pregnancy. It defines multiple pregnancy as more than one fetus and classifies twins based on number of fetuses, zygosity, chorionicity, and amnionicity. Twin pregnancy can be either dizygotic (fraternal) twins from two eggs or monozygotic (identical) twins from one egg that splits. Risk factors, complications, management, and delivery considerations are outlined for twin pregnancies. Conjoined twins, which result from a single fertilized egg failing to separate, are also briefly discussed.
This document discusses complications of multiple pregnancies. Twin pregnancies represent 2-3% of all pregnancies and have a perinatal mortality rate 5 times higher than singleton pregnancies. Complications for the mother include anemia, preeclampsia, premature labor, cesarean delivery, and postpartum hemorrhage. Complications for the fetus include prematurity, intrauterine growth restriction, malpresentation, and congenital anomalies. Monochorionic twins additionally face risks like twin-twin transfusion syndrome. Care involves frequent monitoring and delivery planning to reduce risks and prolong the pregnancy.
Multiple pregnancies are pregnancies carrying more than one fetus. The incidence of twins is 1 in 80 births according to Hellin's formula, with the incidence increasing with maternal age and use of ovulation-inducing drugs. There are two types of twins: monozygotic (identical) twins that develop from one egg and dizygotic (fraternal) twins that develop from two separate eggs. Risks of multiple pregnancies include anemia, pregnancy-induced hypertension, preterm labor, and delivery complications related to malpresentations. Management involves frequent checkups, proper diet, rest, and delivery in a hospital equipped to handle potential complications.
This document discusses multiple pregnancies and provides information about diagnosing and managing twin pregnancies. Some key points:
- Multiple pregnancies occur when more than one fetus develops simultaneously in the uterus. Twins are the most common type of multiple pregnancy.
- Twins can be either monozygotic (identical) or dizygotic (fraternal). Various tests can help determine zygosity.
- Risk factors for twin pregnancies include maternal age, race, heredity, fertility treatments, and assisted reproductive technologies.
- Complications of twin pregnancies include preterm birth, preeclampsia, fetal growth problems, and higher rates of cesarean section. Close monitoring is important
This document discusses multiple pregnancy and twin pregnancy. It defines types of twins including dizygotic and monozygotic twins. It describes maternal physiological changes, diagnosis through history, examination and investigations like ultrasound. Complications for both mother and fetus are discussed. Management involves monitoring for preterm labor, anomalies and growth restriction. Close antenatal care can help reduce mortality and morbidity rates for twin pregnancies.
Multiple pregnancies consist of two or more fetuses, with twins making up nearly all multiple gestations. Multiple pregnancies are associated with higher risks of maternal, fetal, and neonatal complications. The classification of multiple pregnancies is based on the number of fetuses, zygosity (number of fertilized eggs), chorionicity (number of placentae), and amnionicity (number of amniotic cavities). Monozygotic twins can either have separate or shared placentae and amniotic sacs depending on the timing of division after fertilization.
Twin Pregnancy by Taniya Mondal (Tutor, Shova Rani Nursing College)TaniyaMondal6
A detailed case study of a twin pregnancy, study of the condition, genesis of twins, types of twins, usg ananlysis , medical, surgical and nursing management, helath education, complication
This document discusses multiple pregnancies, specifically twins. It defines the different types of twins including monozygotic (identical) and dizygotic (fraternal) twins. It describes the incidence, aetiology, varieties, determination of zygosity, and some definitions for multiple pregnancy complications. The diagnosis, management, and maternal and fetal complications of twin pregnancies are outlined. Specific conditions discussed include discordant twins, twin twin transfusion syndrome (TTS), acardiac twins, conjoined twins, and monoamniotic twins. The document concludes with descriptions of breastfeeding holds that can be used for nursing twins.
This document discusses multiple pregnancy, specifically twins. It begins by outlining Hellin's Rule which describes the statistical likelihood of having multiples based on maternal factors. It then differentiates between dizygotic and monozygotic twins and describes the key differences. Factors that can increase the chances of dizygotic twins are also outlined. The rest of the document details various maternal and fetal complications that can arise in twin pregnancies such as preeclampsia and preterm birth. Specific complications of monozygotic twins like twin-twin transfusion syndrome are also explained.
1) Multiple pregnancies occur when more than one fetus develops simultaneously in the uterus. The main types are dizygotic (non-identical) twins, which account for 80% of twins, and monozygotic (identical) twins, which make up 20%.
2) Risk factors for dizygotic twins include being between 30-40 years old, above average height and weight, previous pregnancies, and certain fertility treatments.
3) Managing a twin pregnancy involves regular monitoring for complications like prematurity, anemia, preeclampsia, and intrauterine growth restriction. Labour involves close fetal monitoring and the potential for a higher rate of interventions.
This document discusses types of multifetal pregnancies including dizygotic, monozygotic, monochorionic, and monoamniotic twins. It describes how chorionicity and amnioticity are determined and complications that can arise depending on whether twins share a placenta and amniotic sac such as twin-twin transfusion syndrome. The risks to the surviving twin if one twin dies are also summarized. Specific complications of monozygotic twins like twin reversed arterial perfusion are defined. Rare cases of conjoined twins are also mentioned.
This document discusses twin pregnancy, including its definition, types (dizygotic and monozygotic), characteristics of each type, risks to mother and fetuses, causes, and management. It notes that twin pregnancy means carrying two fetuses and accounts for dizygotic or monozygotic twins. Dizygotic twins result from two eggs fertilized by separate sperm, while monozygotic twins result from the splitting of a single fertilized egg. Twin pregnancy poses higher risks of complications for both mother and fetuses like prematurity and growth restriction. Careful monitoring and management is needed during pregnancy.
This document discusses multiple pregnancies, also known as twins, triplets, etc. It defines multiple pregnancies as when two or more fetuses are present in the uterus at the same time. Multiple pregnancies are considered a pregnancy complication due to the increased risks of preterm birth and mortality for both mother and fetuses. The document covers terminology, incidence rates, complications, diagnosis, and management of multiple pregnancies.
Multifetal gestation refers to the simultaneous development of more than one fetus in the uterus. The most common types are twins, occurring in 1 in 80 births, while higher order multiples like triplets and quadruplets are much less frequent. Multifetal gestations can occur through the fertilization of two separate eggs (dizygotic) or the splitting of a single fertilized egg (monozygotic). Pregnancies with multiple fetuses carry increased risks of complications for both the mother and fetuses, such as preterm birth, low birth weight, and preeclampsia. Careful prenatal monitoring and management of risks like growth restriction and preterm labor are important to optimize outcomes.
This document discusses multiple pregnancy, also known as twin or higher order pregnancies. It defines multiple pregnancy as the presence of more than one fetus in the abdomen of a pregnant woman. Multiple pregnancies can be categorized based on the number of fetuses as twins, triplets, quadruplets, etc. The document outlines risk factors, classifications, complications, diagnosis, and management of multiple pregnancies. It describes how multiple pregnancies can occur and the different types, and emphasizes the importance of preventing preterm birth in managing these high-risk pregnancies.
This document provides guidelines for managing twin pregnancies, including determining chorionicity and amnioticity. It recommends that all twins undergo an NT ultrasound before 14 weeks to validate chorionicity/amnionicity and detect early complications. Management of monochorionic twins requires more intensive surveillance due to increased risks of complications affecting fetal growth and well-being. Dichorionic twins generally require less frequent monitoring while monochorionic twins should be monitored more closely, with delivery planned before 37 weeks.
This document discusses twin pregnancies and provides information on:
1. The types of twins based on chorionicity and zygosity.
2. The maternal and fetal complications that can occur in twin pregnancies including preeclampsia and preterm birth.
3. The diagnosis and management of twin pregnancies including ultrasound examination and increased surveillance of monochorionic twins.
ROLE OF ULTRASOUND IN MULTIFETAL GESTATION - WHAT AN OBSTETRICIAN SHOULD KNOW ?Bharti Gahtori
Ultrasound plays an indispensable role in managing multifetal gestations. It is crucial for determining chorionicity and zygosity early in the first trimester, as this predicts complications. Ultrasound can also assess nuchal translucency, screen for anomalies, monitor growth and detect complications like twin-twin transfusion syndrome that are more common in monochorionic twins. Serial ultrasound examinations are important for detailed evaluation of the placenta, umbilical cords, fetal growth and well-being in order to guide management and improve outcomes in these high risk pregnancies.
Multiple gestations can be either dizygotic (fraternal) twins resulting from two separate eggs fertilized by two separate sperm or monozygotic (identical) twins from the splitting of a single fertilized egg. Risk factors for twinning include race, family history, fertility treatments, and more. Complications can be fetal like prematurity or maternal like preeclampsia. Diagnosis involves history, exam, imaging and placental/fetal examination after delivery. Management consists of increased prenatal monitoring and timing delivery based on chorionicity and any complications.
USMLE GENERAL EMBRYOLOGY 017 Twins monozygotic monozygotic monozygotic.pdfAHMED ASHOUR
Twins are siblings born during the same pregnancy and are classified into different types based on how they develop.
The two primary types of twins are identical (monozygotic) twins and fraternal (dizygotic) twins.
The experience of having twins can vary, and each pregnancy is unique.
Expectant parents of twins should work closely with healthcare providers to ensure a healthy and well-managed pregnancy.
Dr. Poonam Loomba is an experienced obstetrician and gynecologist specializing in infertility and fetal medicine. She has over 30 years of experience and has held leadership roles in several professional organizations. She directs Loomba Hospital and IVF Centre in Ambala Cantt, Haryana, where she established the first IVF/ART center in the state in 2003. She has received advanced training in areas such as IVF/ICSI, ultrasound, and laparoscopy.
Multiple pregnancies consist of two or more fetuses. Twins make up 97-99% of multiple gestations, while triplets or higher order multiples are less common. Risk factors for multiples include assisted reproduction, increased maternal age, high parity, and family history. Twins can be either monozygotic (identical) or dizygotic (fraternal) depending on the number of eggs fertilized and placentas/amniotic sacs. Monochorionic twins share a placenta and blood flow, increasing risks of complications. Multiple pregnancies face higher risks of prematurity, growth issues, anomalies, and mortality compared to singletons.
This document discusses different types of twins, including:
- Identical (monozygotic) twins, which develop from one fertilized egg that splits into two embryos. They are always the same gender and share DNA.
- Fraternal (dizygotic) twins, which develop from two separate eggs fertilized by two separate sperm, similar to normal siblings. They may be different genders.
- Rare types like mirror twins, whose features appear symmetrically opposite, and conjoined twins, who are physically joined.
The document also explains that twins may share a placenta, amniotic sac, or chorion, or have their own, and outlines the differences between diamniotic-d
This document discusses the role of ultrasound in managing twin pregnancies. It covers several topics:
1) Ultrasound can accurately determine chorionicity and amnionicity as early as 8-14 weeks, which is important for risk assessment and monitoring.
2) Twin pregnancies have higher risks of complications and congenital anomalies than singletons. Ultrasound screening can detect some anomalies.
3) The risks of chromosomal abnormalities are different for dizygotic and monozygotic twins based on chorionicity. Ultrasound and biochemical screening have lower detection rates for abnormalities in twins compared to singletons.
Multiple Gestation prepared and presented by Dr.Mohsen Al-solaimani.pptxMohsen AL-solaimani
twin birth rate in 2019 was 32.1 per 1,000 live births
The rate of MZ twinning has remained relatively constant (3.5 per 1,000 births).
The rate of DZ twinning is approximately 1 in 100 births
The birth rate of triplet and higher order multiples peaked in 1998at 194 per 100,000 live births and has declined steadily to 87.7 per 100,000 live births in 2019.
Classification.1. Twin placentation is classified according to the placental disk (single, fused,or separate), number of chorions (monochorionic or dichorionic), and number of amnions (monoamniotic or diamniotic)2. Heterosexual (assuredly dizygotic) twins always have a dichorionic placenta.3. Monochorionic twins are always of the same sex. All monochorionic twins are believed to be monozygotic. In 70% of monozygotic twin pregnancies, the placentas are monochorionic, and the possibility exists for commingling of the fetal circulations. Less than 1% of twin pregnancies are monoamniotic.
B. Placental complications. Twin gestations are associated with an increased frequency of anomalies of the placenta and adnexa, for example, a single umbilical artery or velamentous or marginal cord insertion The cord is more susceptible to trauma from twisting. The vessels near the insertion are often unprotected by Wharton jelly and are especially prone to thrombosis when compression or twisting occurs. Intrapartum fetal distress from cord compression and fetal hemorrhage from associated vasa previa are potential problems with velamentous insertion of the cord.
Determination of zygosity. The most efficient way to identify zygosity is as follows:1. Gender examination. Male-female pairs are dizygotic. The dichorionic placenta may be separate or fused.2. Placental examination. Twins with a monochorionic placenta (monoamniotic or diamniotic) are monozygotic. If doubt exists on a gross inspection of the dividing membranes, a transverse section should be studied. The zygosity of twins of the same sex with dichorionic membranes cannot be immediatelyknown. Genetic studies are needed (eg, blood typing, human leukocyte antigen typing, DNA markers, and chromosome marking) to determine zygosity.
Twins are more likely to have prematurity, fetal growth restriction, congenital anomalies, and twin-twin transfusion.A. Prematurity and uteroplacental insufficiency are the major contributors to perinatal complications. In 2015, 1% of singletons, 10% of twins, and 36% of triplets had birthweights of <1500 g.B. Fetal growth restriction. The incidence of low birthweight in twins is approximately 50% to 60%, a 5 to 7 times higher than the incidence of low birthweight in singletons. In general, the more fetuses in a gestation, the smaller is their weight for gestational age Twins tend to grow at normal rates up to about 30 to 34 weeks’ gestation when they reach a combined weight of 4 kg. Thereafter, they grow more slowly.
Two-thirds of twins show some signs of growth restriction at birth.
Uteroplacental insufficiency. End
Ivf commercialization in element in gynaecologydrhemantzaveri
IVF has become more common and accepted as a treatment for infertility. Previously seen as a last resort, it is now often a first choice for many couples. The success rates of IVF, while lower than natural conception, have increased over time due to improvements in technology and techniques. However, there are still risks associated with IVF treatment, including potential side effects of fertility drugs, higher risk pregnancies, and birth defects. The future of IVF may include new technologies like robotic sperm, but it also raises ethical issues around human cloning and commercialization of fertility treatment.
Fetal surveillance in twin pregnancies is important due to increased risks of complications. Ultrasound is used to determine chorionicity and amnionicity, monitor growth, check for anomalies, and screen for conditions unique to twins like twin-twin transfusion syndrome. Dichorionic twins are monitored every 4 weeks after 16 weeks while monochorionic twins are monitored every 2 weeks due to higher risks. Complications require specialized management and timely intervention can help reduce poor outcomes for twins.
This document provides an overview of multiple gestation pregnancies. It defines multiple gestation as a pregnancy with more than one fetus, which can arise from one or more zygotes. Twins are further classified based on zygosity, chorionicity, and amnionicity. The risks of complications are higher for both mother and babies with multiple gestations, including preterm labor and delivery, preeclampsia, and postpartum hemorrhage. Ultrasound is used to diagnose and monitor multiple pregnancies. Conditions like twin-twin transfusion syndrome and umbilical cord entanglement also present additional risks.
This document discusses multiple pregnancies, including twins and higher order multiples. It covers the types of twins (dizygotic and monozygotic), risk factors, complications specific to monozygotic twins, maternal physiological adaptations, diagnosis, antenatal care including fetal surveillance and method of delivery. Outcomes are outlined such as the perinatal mortality rate being 5 times higher for twins compared to singletons, and congenital anomalies accounting for 15% of twin pregnancy mortality. Intrauterine death of one twin increases other risks, and higher order multiples have very high mortality risks due to extreme prematurity.
This document discusses complications of multiple pregnancies. Twin pregnancies represent 2-3% of all pregnancies and have a perinatal mortality rate 5 times higher than singleton pregnancies. Complications for the mother include anemia, preeclampsia, premature labor, cesarean delivery, and postpartum hemorrhage. Complications for the fetus include prematurity, intrauterine growth restriction, malpresentation, and congenital anomalies. Monochorionic twins additionally face risks like twin-twin transfusion syndrome. Care involves frequent monitoring and delivery planning to reduce risks and prolong the pregnancy.
Recurrent miscarriage is defined as 3 or more consecutive spontaneous pregnancy losses under 20 weeks gestation. It affects 1% of women and can be caused by many potential genetic, anatomical, hormonal, and immunological factors. Evaluation involves testing the parents' chromosomes through karyotyping of their blood, testing the chromosomes of miscarried fetal tissue when possible, and examining the uterus and fallopian tubes through ultrasound, hysterosalpingogram, hysteroscopy, or laparoscopy to check for anatomical abnormalities. Finding the cause helps guide treatment such as surgery to remove uterine anomalies which may improve future pregnancy outcomes.
Doctor, will I be able to have a baby ? Fertility after cancer Dr Aniruddha Malpani
This document discusses fertility preservation options for cancer patients. It notes that chemotherapy and radiation can damage fertility, but fertility preservation techniques exist to help mitigate this, including freezing eggs, sperm, ovarian tissue or testicular tissue. It recommends that oncologists discuss these options proactively with patients to give them hope for biological children after cancer. Specific techniques are described such as in vitro fertilization with eggs or sperm frozen before treatment. Referral to fertility specialists is advised so patients can explore preservation options before starting cancer treatment.
Multiple pregnancies consists of two or more fetuses ,there are exceptions to this such as twins gestations made of a singleton viable fetus & a complete mole.
This document discusses multifetal pregnancies involving twins or more. It notes that twins can be either dizygotic (fraternal) or monozygotic (identical) based on whether one or two fertilization events occurred. Monochorionic twins in particular carry higher risks than dichorionic twins due to shared placental blood flow, including twin-to-twin transfusion syndrome and twin anemia-polycythemia syndrome. Accurately determining chorionicity and zygosity is important for managing these multifetal pregnancies and counseling patients on risks. Ultrasound plays a key role in assessing chorionicity, growth, and complications in a multiple gestation.
1. This document defines twins and multiple pregnancies and discusses their increasing incidence due to assisted reproductive technologies. It also outlines the risks of monozygotic and dizygotic twins.
2. Prenatal screening and surveillance for twins includes ultrasounds to determine viability, chorionicity, and structural anomalies as well as monitoring growth and complications like twin-to-twin transfusion syndrome.
3. Management of twins may include planned delivery at 37-38 weeks, counseling on diet/health, and planning for delivery depending on presentation and any complications. Vaginal delivery of twins is possible if criteria are met but C-section may be recommended depending on risk factors.
This document discusses multifetal pregnancies, including twins, triplets, and higher order multiples. It defines key terms, describes the types and incidence of twins. Complications are more common in multifetal pregnancies and include preterm birth, preeclampsia, and increased risk of stillbirth. Specific complications discussed include twin-twin transfusion syndrome and conjoined twins. The management of multifetal pregnancies during antenatal, intrapartum, and postpartum periods is also summarized.
The 4 chamber view of the fetal heart allows visualization of the situs, size, and anatomy of the atria and ventricles. It is easy to obtain and can be included in routine mid-trimester scans. However, it only detects around 40% of congenital heart defects. Some defects are not visible in the 4 chamber view due to progressive evolution or lack of effects on cardiac chambers. Improving imaging techniques like measuring chambers, using color Doppler, and examining throughout the cardiac cycle may increase detection rates. Abnormal 4 chamber views can indicate issues like septal defects, arrhythmias, and structural abnormalities.
This document discusses early signs of spina bifida that can be detected on ultrasound as early as the first trimester. It identifies two key signs - the "lemon sign" and "banana sign" - that present differently depending on the trimester. The lemon sign represents abnormal frontal bone development and can be seen as a decreased fronto-maxillary facial angle in the first trimester or scalloping of the frontal bones in the second trimester. The banana sign represents cerebellar herniation and can be seen as proximity of the midbrain to the occiput or anteriorly curved cerebellar hemispheres in the first and second trimesters respectively. These signs allow for early diagnosis of spina
The document provides guidelines for pelvic ultrasound examination. It describes evaluating the ovaries and using them as reference points. If pathology is seen, its size and sonographic features should be documented. Spectral Doppler should be performed to examine vessels. The fallopian tubes and other structures should also be examined. Characteristics of different types of ovarian cysts and masses are outlined. The document also discusses features suggestive of malignancy on ultrasound and risk of malignancy indices.
This document discusses the case of a 32-year-old woman, primigravida, who was seen for antenatal care. Ultrasound showed measurements consistent with intrauterine growth restriction (IUGR). Doppler studies of the umbilical artery and other vessels were performed to assess fetal well-being and progression of IUGR. The roles of various tests like biophysical profile and fetal monitoring in managing high-risk pregnancies with IUGR are discussed.
1) The document proposes a new model of prenatal care based on a comprehensive assessment at 11-13 weeks of gestation. This assessment uses maternal characteristics, ultrasound findings, and biochemical testing to determine patient-specific risks for various pregnancy complications.
2) Most major fetal aneuploidies, structural abnormalities, and a variety of pregnancy complications can potentially be identified or assessed at high risk during the 11-13 week assessment.
3) Based on the risk assessment, most women would be classified as low risk and require fewer prenatal visits, while high risk women would receive specialized monitoring and treatment. This shifts prenatal care from routine visits to a personalized, disease-specific approach.
A 40-year-old primigravida with a BMI of 32 conceived twins through donor oocytes and is now in a twin pregnancy. Due to her advanced maternal age and twin gestation, her pregnancy requires careful monitoring to help ensure a safe journey. Key aspects of her care include screening for fetal abnormalities, monitoring fetal growth and well-being, and watching for potential complications associated with twin pregnancies such as twin-twin transfusion syndrome. Proper labeling and identification of the twins is also important.
The document discusses examination of the fetal heart. It describes basic screening using the four chamber view as part of routine mid-trimester scans, noting it can identify around 40% of congenital heart defects. Extended basic screening adding views of the outflow tracts increases detection rates. Detailed fetal echocardiography provides comprehensive anatomical and morphological assessment of the heart and is recommended when risk of defects is above average.
1. 40 year old primi, BMI of 32,conceived
twins with donor oocytes: how to make
her journey safe?
Dr.Sameer Dikshit
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2. Wadia Hospital
S L Raheja Fortis Irla Nursing Home
Hospital Belle Vue Nursing
BSES MG Global Home
Hospital Sanket Sonography
Boisar Fetal Medicine Centre
Centre
Fetal Medicine Consultant
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5. Found pinned on the nursing station of a 5
star hospital in Mumbai…….
The doctors complain
that the patients are
more courteous to
nurses than to them.
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6. 40 year old
Height 162 cm, weight 84 kg, BMI 32
G1 P0
Donor oocytes
Twin Pregnancy
History…..
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7. Early Pregnancy Mid Pregnancy Late Pregnancy
First Trim Screening Abnormalities Clinical
Chorionicity Growth Complications
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11. Age 40 years Age 25
Prior risk 1:83 Prior risk 1:950-1001
The recipient The donor
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12. The background risk is the risk at
the age of the “Donor” and NOT at
the age of the “Recipient”
In this case, prior risk is NOT 1:83,
but it is 1:1001
In case of donor oocytes..
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18. The posterior risk of the two
twins is the same, and it is
calculated by taking a mean of
the two NTs……..
In Monochorionic
Twins…
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19. Let us add First Trimester
Biochemistry……..
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20. Biochemistry in
Twins is less
accurate than in
Singletons
Some advocate
doing only NT
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21. The biochemistry risk is
calculated taking into
consideration, the age of the
recipient into account
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22. SYSTEMATIC
LABELING OF
TWINS
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24. Biometric measurements from serial
scans should be consistently allocated
to the same twin (Yo Yo phenomenon)
When doing invasive testing, the
“correct” twin has to be sampled
Necessary to communicate correctly
with the neonatologist, in case a twin
develops an abnormality postnatally
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25. Not applicable in monochorionic
twins or dichorionic twins with
fused placenta
Placenta changes position
#1) Labeling of twins by position of
placenta
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26. PNDT law
Not possible in same sex twins
Ultrasonographic identification of
fetal sex in early pregnancy may not
be conclusive
#2) Labeling of twins by fetal sex
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27. The laterality of the gestational sac relative to
the cervix remains the same because the base of
the inter twin membrane remains fixed
The rest of the inter twin membrane can move
about, allowing the twins to swap position
#3) Labeling by position of base of inter
twin membrane
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28. Up or Down
Right or Left
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30. Implicit that Twin 1 delivers before
Twin 2
Fetuses designated as Twin 2
delivered first in 25% of cases of
LSCS
Twin 1 (A) & Twin 2 (B)
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31. Fetus designated
as Twin 2
delivered first in
5% of vaginal
delivery
Perinatal switch
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34. When live twins are detected prior to 7 weeks,
only 71% resulted in birth of Twin neonates
This percentage increased to 84% when the
gestational age reached 7-9 weeks
The chance of taking home, twin neonates is
markedly reduced in the presence of
threatened abortion, with only 63% take home
baby rate
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35. There is significant relationship between
CRL discrepancy at 7 + 0 to 9 + 0 weeks
and the likelihood of single fetal demise
Discrepancy of 40% is associated with
vanishing twin
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37. IVF pregnancies with vanished co-
twin had a higher rate of SGA than
singletons from single gestation
and the risk of SGA increased with
increasing GA at the time of
vanishing
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38. Use of biochemical markers in cases of
vanishing twin is inaccurate and best avoided
The risk is calculated using ONLY NT
FIRST TRIMESTER SCREENING IN CASE OF
VANISHING TWIN…..
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39. Incidence of hyperemesis is higher in twin
pregnancy as compared to singleton pregnancy
After 11-14 weeks scan, rate of subsequent fetal
loss before 24 weeks is 1% in singletons, 2% in
DC twins and 10% in MC twins
Other possible complications…
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42. DC - High risk pregnancy
MC DA - Very high risk pregnancy
MC MA – Extremely high risk
pregnancy
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43. “Twin gestations should be followed routinely with
serial ultrasonographic follow-up for growth at
appropriate (currently, non evidence based) intervals,
irrespective of chorionicity. If growth discordance is
detected, surveillance should be intensified.”
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44. Obesity
Difficulty in scanning the twin farther from the
transducer
Double Movements
Difficulty in maneuvering of the transducer
Difficulties encountered in
screening for malformations…
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45. A challenge to trace
the anatomic parts
to the respective
Twin
Labeling of Twin
Constantly moving
inter-twin
membrane adds to
confusion
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46. Twin to twin
transfusion
syndrome Selective IUGR
TRAP (Twin Death of one of
Reversed Arterial the Twins
Perfusion)
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47. Twin to Twin transfusion
Syndrome
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48. Polyhydramnios
and large bladder in
recipient twin
Oligohydramnios
and absent bladder
in donor twin
“Stuck Twin”
Folding of inter
Twin membrane
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49. Increased NT in one or both the Twins
Abnormal DV waveform in one or both the
Twins
Inter-twin discrepancy in CRL is NOT
predictive of TTTS
Inter-twin membrane folding
Early markers for TTTS..
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51. In singleton pregnancies the incidence of IUGR
is 5%
In Dichorionic Twins it is 20%
In Monochorionic Twins it is 30%
In 2% of dichorionic and 8% of monochorionic
Twins BOTH the twins have IUGR
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52. In singleton pregnancies, the reasons for IUGR are
either abnormal placental function or genetic growth
potential
In Dichorionic twins, IUGR is due to unequal
genetic potential or disparity in placentation
In Monochorionic twins it is due to unequal splitting
or due to unequal sharing of blood flow
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55. Type I (Normal UA Doppler) Good Prognosis
Type II (absent or reversed end diastolic
velocity flow) High incidence (50-60%) of
perinatal mortality
Type III (intermittent ARDF or iARDF) due
to Feto-fetal transfusion. Risk to BOTH IUGR
(20%) and non IUGR (15%) twin
Prediction of adverse outcome- UA
waveform of sIUGR Twin
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57. There is risk of CNS damage to the survivor
There is risk of perinatal mortality to the
survivor
Decision to deliver
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58. Vascular communication between the two
twins
Surviving twin demonstrates severe multi
organ damage
Either due to thromboembolic episodes or due
to bleeding of survivor into the vasculature of
the dead twin
Monochorionic Twins
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59. The risk to the survivor is significantly less
However, isolated cases of vascular
communication have been reported in
dichorionic twins too
Case reports of neurological damage in
survivor of dichorionic twins
Dichorionic Twins
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60. sIUGR is more common before sIUFD
Fetal surveillance should not be less in
dichorionic twins with sIUFD
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61. Would you still call them “weaker
sex”….?????
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64. Cervical lengths obtained between 16
and 31 weeks correlate with the risk of
PT birth
Length <2.4 cm suggests high risk of
PT birth
Could not come to any conclusion
about treatment (cerclage,
progesterone, tocolytics, rest)
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66. Treatment with micronized
Progesterone did not prevent PT
delivery in twins
Micronized Progesterone is NOT
harmful to mother or twins
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68. Uterine Artery doppler has an overall
low sensitivity in predicting adverse
obstetric outcome
Suggested that there are additional patho
-mechanism causing PIH and IUGR in
twins that is unrelated to uteroplacental
insufficiency
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70. PI in twin pregnancies is consistently lower
than singleton pregnancies
There is no difference in MC and DC twin Ut A
characteristics
ABNORMAL Ut A findings in twins has a
HIGHER positive predictive value
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71. The patients with ABNORMAL Ut A values
represent those patients who are likely to have
worst outcome
Hence screening for Ut A abnormalities should
be carried out
The negative predictive value NORMAL Ut A
findings is LOWER
Thus even NORMAL Ut A cases can have PIH/
IUGR
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77. The incidence of PIH in Twin pregnancy 18%
compared to 5% in Singletons
The incidence of complications ( PT delivery,
LSCS, Abruptio Placenta, PPH) was higher in
PIH
The PIH is more likely to be severe
The adverse maternal outcome is also more
common
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79. The presence of GDM in Twin
pregnancy was associated with
higher risk of
Hypertensive complications
Prematurity
RDS
Macrosomia
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84. Wish there were spell check in daily life
too…..
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85. OPTIMUM
TIMING FOR
DELIVERY
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86. When the pregnancy is uncomplicated,
the twins continue to grow and mature
with the advancement of the gestational
age
In the absence of maternal complications,
it is advisable to deliver twins at 38
weeks
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87. Elective induction of labour v/s Expectant
management
No statistically significant difference between
two groups in the incidence of LSCS
No statistically significant difference between
two groups in the incidence of adverse
outcome
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89. Both vertex twins Allow vaginal delivery
First breech/ Second vertex Elective LSCS
First vertex/ Second non vertex 84% LSCS
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91. There was no association between birth order
and risk of perinatal mortality before 36 weeks
Second twin born at term were at increased risk
of perinatal death related to delivery
Vaginally delivered second twin had four fold
increase in risk of death
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94. What is the dose for Twins?
Should it be double to cover the two?
Do Twins mature earlier than Singletons?
If so, should you decrease the dose required?
In Triplets and higher order pregnancies,
steroids are associated with intra uterine
contractions and cervical changes….do these
happen in Twins too?
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