Multiple Pregnancy -By Dr. Poly.

Information about Multiple Pregnancy -By Dr. Poly.

Published on July 18, 2014

Author: hassankamrul007



PowerPoint Presentation: WEL COME TO ALL MULTIPLE PREGNANCY: MULTIPLE PREGNANCY DR POLY BEGUM MBBS; FCPS (OBST & GYNAE) ASSISTANT PROFESSOR DEPARTMENT OF OBSTETRICS & GYNAECOLOGY DIABETIC ASSOCIATION MEDICAL COLLEGE MULTIPLE PREGNANCY: MULTIPLE PREGNANCY When more than one fetus simultaneously develops in the uterus it is called Multiple Pregnancy. Twin pregnancy represents 2 to 3% of all pregnancies. Factors affecting it’s incidence: Factors affecting it’s incidence Induction of ovulation, 10% with clomide and 30% with gonadotrophins . Increase maternal age ? Due to increase gonadotrophins production. Increases with parity. Heredity usually on maternal side. Race; Nigeria 1:20, North America 1:90, India 1:80. DIZYGOTIC TWINS: DIZYGOTIC TWINS Most common represents 2/3 of cases. Fertilization of more than one egg by more than one sperm. Non identical ,may be of different sex. Two chorion and two amnion. Placenta may be separate or fused. MONOZYGOTIC TWINS: MONOZYGOTIC TWINS Constant incidence of 1:250 births. Not affected by heredity. Not related to induction of ovulation. Constitutes 1/3 of twins. PowerPoint Presentation: Results from division of fertilized egg : 0-72 H. Diamniotic dichorionic . 4-8 days Diamniotic monochor . 9-12 days Monoamnio.monochor . >12 days Conjoined twins. MONOZYGOTIC TWINS: MONOZYGOTIC TWINS 70% are diamniotic monochorionic. 30% are diamniotic dichorionic. Determination of zygosity: Determination of zygosity Very important as most of the complications occur in monochorionic monozygotic twins. During pregnancy by USS: During pregnancy by USS Very accurate in the first trimester, two sacs, presence of thick chorion between amniotic memb. Less accurate in the second trimester the chorion become thin and fuse with the amniotic memb. PowerPoint Presentation: Different sex indicates dizygotic twins. Separate placentas indicates dizygotic twins Determination of zygozity After Birth: Determination of zygozity After Birth By examination of the MEMBRANE, PLACENTA,SEX , BLOOD group . Examination of the newborn DNA and HLA may be needed in few cases. Complications of Multiple Gestation: Complications of Multiple Gestation Anemia Hydramnios Preeclampsia Preterm labour Postpartum hemorrhage Cesarean delivery Malpresentation Placenta previa Abruptio placentae Premature rupture of the membranes Prematurity Umbilical cord prolapse Intrauterine growth restriction Congenital anomalies Maternal Fetal Specific Complications in Monochorionic Twins: Specific Complications in Monochorionic Twins TWIN-TWIN transfusion . Results from vascular anastemosis between twins vessels at the placenta. Usually arterio (donor) venous (recipient). Occurs in 10% of monochorionic twins. PowerPoint Presentation: TWIN-TWIN transfusion Chronic shunt occurs ,the donor bleeds into the recipient so one is pale with oligohydraminose while the other is polycythemic with hydraminose . If not treated death occurs in 80-100% of cases. PowerPoint Presentation: Possible methods of treatment: Repeated amniocentesis from recipient. Indomethacin. Fetoscopy and laser ablation of communicating vessels. PowerPoint Presentation: Other Complications in Monochorionic Twins: Congenital malformation. Twice that of singleton. Umbilical cord anomalies. In 3 – 4 %. Conjoined twins. Rare 1:70000 deli varies. The majority are thoracopagus . PNMR of monochorionic is 5 times that of dichorionic twins(120 VS 24/ 1000 births) Maternal Physiological Adaptation: Maternal Physiological Adaptation Increase blood volume and cardiac output. Increase demand for iron and folic acid. Maternal respiratory difficulty. Excess fluid retention and edema. Increase attacks of supine hypotension. DIAGNOSIS OF MULTIPLE PREGNANCY: DIAGNOSIS OF MULTIPLE PREGNANCY +ve family history mainly on maternal side. +ve history of ovulation induction. Exaggerated symptoms of pregnancy. Marked edema of lower limb. Discrepancy between date and uterine size. Palpation of many fetal parts. PowerPoint Presentation: Auscultation of two fetal heart beats at two different sites with a difference of 10 beats USG Two sacs by 5 weeks by TV USS. Two embryos by 7 weeks by TV USS. Antenatal Care: Antenatal Care AIM Prolongation of gestation age, increase fetal weight. Improve PNM and morbidity. Decrease incidence of maternal complications. Antenatal Care: Antenatal Care Follow Up Every two weeks. Iron and folic acid to avoid anemia. Assess cervical length and competency. Antenatal Care: Antenatal Care Fetal Surveillance Monthly USS.from 24 weeks to assess fetal growth and weight. A discordinate weight difference of >25% is abnormal (IUGR). Weekly CTG from 36 weeks. Method Of Delivery : Method Of Delivery Vertex- Vertex (50%) Vaginal delivery, interval between twins not to exceed 20 minutes. Vertex- Breech (20%) Vaginal delivery by senior obstetrician Method Of Delivery: Method Of Delivery Breech- Vertex( 20%) Safer to deliver by CS to avoid the rare interlocking twins( 1:1000 twins ). Breech-Breech( 10%) Usually by LUCS. Perinatal Outcome : Perinatal Outcome PNMR is 5 times that of singleton (30-50/1000 births). RDS accounts for 50% 0f PNMR.2 nd twin is more affected. Birth trauma . 2 ND twin is 4 times affected than 1 st . Incidence of SB is twice that of singleton. Perinatal Outcome: Perinatal Outcome Congenital anomalies is responsible for 15% of PNMR. Cerebral haemorrhage and birth asphyxia are responsible for 10% of PNMR. Cerebral palsy is 4 times that of singleton . 50% of twins babies are borne with low birth(<2500 gms .) from prematurity & IUGR. INTRAUTERINE DFATH OF ONE TWIN: INTRAUTERINE DFATH OF ONE TWIN Early in pregnancy usually no risk. In 2 nd or 3 rd trimester : Increase risk of DIC . Increase risk of thrombosis in the a live one The risk is much higher in monochorionic than in dichorionic twins COMPLICATIONS OF MULTIPLE PREGNANCY: COMPLICATIONS OF MULTIPLE PREGNANCY A] MATERNAL: Anemia due to increase demand. Increase incidence of PET(5 times). Polyhydramniose in monochorionic monozygotic twins. Increase incidence of premature labour. PowerPoint Presentation: Increase incidence of CS. And operative delivary. Increase incidence of placenta previa and abruptio placenta. Increase incidence of atonic postpartum hemorrhage. PowerPoint Presentation: B] FETAL : Increase perinatal morbidity and mortality. Prematurity with or without rupture of membrane. Increase incidence of malpresentation. PowerPoint Presentation: Increase incidence of cord prolapse. Higher incidence of IUGR. Increase incidence of congenital anomalies. PowerPoint Presentation: THANK YOU

Related presentations