Multiple pregnancy
د. نجمه محمودكلية الطبجامعة بغدادفرع النسائية والتوليدTypes of multiple gsetation: Dizygotic Monozygotic Diamniotic Dichorionic monoamniotic monochorionic
Incidence &epidemiology : Account for 1% of all pregnancy. Incidence varies with : 1) Ethnic group.
2)Maternal age. 3)parity. 4)method of conception. 5)family history. Determination of zygosity &chorionicity: 1) zygosity : by DNA fingerprinting
2)Chorionicity : a)Fetal gender By uss & relies on: b) No. of placenta. c)Characteristic of membrane between the two amniotic sacs.
Pregnancy complications according to chorionicity
1) miscarriage & severe preterm delivery. 2) perinatal mortality in twin pregnancy. 3) IUGR 4) Fetal abnormalities. 5) chromosomal defect. 6) Death of one fetus in twin pregnancy 7) TTTSClinical features &diagnosis of twin :pregnancy (1) History (2) clinical examination. (3) Investigations-uss. USS can determine No. of fetuses / chorionicity/ accurate dating of pregnancy/detect fetal abnormalities /detect fetal growth &wellbeing in3rd trimester /determine presentation /detect TTTS in monochorionic twins
Pregnancy complications & their management :
1) Hyperemesis gravidarum. 2) Hypertensive disease. 3) Gestational DM. 4) Anemia. 5) Minor symptoms of pregnancy. 6) APH. 7) PPH. 8) Thromboembolism.Labour & delivery: Malpresentation Oxytocin Locked twin ECV & IPV IV line FHR monitoring. Epidural analgesia Blood preparation Indication of C/S in twin pregnancy: 1- Malpresentation of 1st twin. 2- monochorionic twin. 3- Evidence of IUGR in one or both twin. 4- Second twin is larger than the first. 5- Hx of fertility treatment.