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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