multiple pregnancy2.pptx

8/17/2019 Multiple Pregnancy2.pptx

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MULTIPLE PREGNANCY Hari Dev

2008 MBBS


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MULTIPLE PREGNANCY

• Presence of more than one fetus inthe gravid uterus

• 1% of all pregnancies• Hellin’s Rule

– Twins : 1 in 80

– Triplets : 1 in 80 × 80 – Quadruplets : 1 in 80 × 80 × 80….

• Ge ell!l!"# : tud! of twins


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• $YG%SITY " #efers to the T!pe of$onception.

" onl! determined ! &'(

testing

• CH%RI%NICITY " T!pe of Placentation " prenatall! ! ultrasound " postnatall! ! e)amining

mem ranes.


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&' $YG%SITY

&i*!gotic+ono*!gotic Twins


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&'DI$YG%TIC T(INS)BIN%*ULAR

+,-

,ertilisation of - ova ! di erent spermato*oa.

/ach twin has its own placenta chorion amnion.

ence alwa!s dichorionic diamniotic .

,actors a ecting " ethnic group " increasing maternal age " increasing parit! " ,amil! histor! of twinning " ovulation induction with clomiphene

citrate2 gonadotrophins resulting in multiple ovulation.


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DI$YG%TIC T(INS)BIN%*ULAR


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2'M%N%$YG%TIC ) BIN%*ULAR)IDENTICAL

2,- #esult from splitting of a single fertili*ed ovum

(lwa!s same se) and loo3 ali3e. 4 5&/'T5$(6 7

#ate of mono*!gotic twinning is relativel! constant not a ected ! an! factors.

True etiolog! un3nown.

T!pe of placentation is determined ! the time ofsplitting


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M%N%$YG%TICT(INS


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M%N%$YG%TIC ) BIN%*ULAR)IDENTICAL


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2'CH%RI%NICITY

• T!pe of Placentation

• Postnatall!" /)amination of+em ranes

• Prenatall!" ! 9ltrasound

• 5deal time for assesment is efore 1

wee3s


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(.i/. is !re

i !r1an1 3#"!si1#!r /.!ri!ni/i1#44


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CH%RI%NICITY ………;h!


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CH%RI%NICITY ………;h!


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Ul1ras!un5 De1er ina1i!n !6C.!ri!ni/i1#

• Nu 7er !6 sa/s . 4 efore 10 wee3s 7 - sacs = dichorionic ingle sac " monochorionic

• Pla/en1a

• Se

• In1er19in e 7rane thic3er and more echogenic in dichorionic

.


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• Twin pea3 2 6am da sign " characteristic of dichorionic

pregnancies " chorionic tissue etween - la!ers

of intertwin mem rane at theplacental origin

• T ign = in monochorionic nochorionic tissue

• 5f no mem rane is seen in etween =


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Ul1ras!un5 5i:eren1ia1i!n !6

/.!ri!ni/i1# Cri1eri!n M!n!/.!ri!ni/ Di/.!ri!ni/

Placenta ingle &ou le

,etal e) -------- &iscordance+em rane ?- mm @- mm

'o: of la!ers inmem rane

- la!ers la!ers

Twin pea3 sign ( sent Present


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Ma1ernal C! li/a1i!ns

Antepartum Intrapartum1.Hyperemesis 1.Dysfunctional labour

2.Hydramnios 2.Malpresentation

3.Pre-eclampsia 3.Operative delivery

.Pressure symptoms .Postpartum!emorr!a"e

#.$naemia #.%etained Placenta

&.$ntepartum!emorr!a"e

&.Premature separationof placenta


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Ma1ernal C! li/a1i!ns ;An1e ar1u

H# ere esisH# ere esis


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1. Pre a1uri1#

• ingle most important cause ofperinatal mortalit! and mor idit!.

• /nsure deliver! in a tertiar! carecentre.>>


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2' IUGR$an a ect one or oth fetuses.


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B. 5'D6/ ,/T(6 &/+5 /&eath of one twin

NEUR%L%GICAL

DAMAGEin survivin"

T(IN


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B. 5'D6/ ,/T(6 &/+5 /M!n!/.!ri!ni/


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>'M!n!/.!ri!ni/ M!n!a ni!1i/19innin"

een in less than 1% of all twin pregnancies


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C. T9in 19in Trans6usi!n S#n5r! e? TTS@

Fccurs in monochorionicplacentation due to (G anastomoseswith resultant How in one direction.


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C. T9in 19in Trans6usi!n S#n5r! e? TTS@

$an e acute or chronic


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Ul1ras!un5 in TTS STUCT(IN SIGN


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• +anagement after deliver! = E /.an"e 1rans6usi!n

• $hronic TT = Serial a ni! re5u/1i!n =" #educes preterm la our " #educe h!drostatic pressure = " improves circulation and urine production.

•


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• (cute TT can occur in B rd trimesteror in la our = sudden death of onetwin

• Fverall mortalit! is I0%

• igh incidence of $P andneurological a normalities insurvivors.


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I. C!n"eni1al An! aliesT#9$T9#(6 +(6,F#+(T5F'


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'uchal Translucenc!

Mi5Tri es1er

A ni!/en1esis is 1.e "!l5s1an5ar5


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Mana"e en1 !6An! alies

DICH%RI%NIC PREGNANCY


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(nomalies 9niKue to twins..


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C!n !ine5 T9insAl9a#s !n!3#"!1i/


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T F#($FP(D9 5 $ 5FP(D9$#('5FP(D9

#($ LP(D9PLFP(D9F+P (6FP(D9


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A/ar5ia/


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MECHANISMPUMP T(IN ACARDIAC

T(IN


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T9in Reverse5 Ar1erialPer6usi!n Se uen/e

? TRAP 7•Pump twin = high output cardiac failureh!drops pol! h!dramnios and death•Fverall perinatal mortalit! of pump twin is C0%


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PUMPT(IN

ACARDIACT(IN


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multiple pregnancy2.pptx

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