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    Multiple Fetal Pregnancy: Riza Sufriadi

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    Rizur Sufison
    The document discusses the types, incidence, risks, and management of multiple fetal pregnancies, noting that twins can be either monozygotic (identical) or dizygotic (fraternal) and that complications of multiple pregnancies include preterm birth, growth issues, and maternal risks such as preeclampsia. Close monitoring and medical intervention may be needed for complications like twin-twin transfusion syndrome, and delivery is often via cesarean section due to risks of breech or transverse lie presentations.

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    Multiple Fetal Pregnancy: Riza Sufriadi

    Uploaded by

    Rizur Sufison
    69 views20 pages
    The document discusses the types, incidence, risks, and management of multiple fetal pregnancies, noting that twins can be either monozygotic (identical) or dizygotic (fraternal) and that complications of multiple pregnancies include preterm birth, growth issues, and maternal risks such as preeclampsia. Close monitoring and medical intervention may be needed for complications like twin-twin transfusion syndrome, and delivery is often via cesarean section due to risks of breech or transverse lie presentations.

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    The document discusses the types, incidence, risks, and management of multiple fetal pregnancies, noting that twins can be either monozygotic (identical) or dizygotic (fraternal) and that complications of multiple pregnancies include preterm birth, growth issues, and maternal risks such as preeclampsia. Close monitoring and medical intervention may be needed for complications like twin-twin transfusion syndrome, and delivery is often via cesarean section due to risks of breech or transverse lie presentations.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    69 views20 pages

    Multiple Fetal Pregnancy: Riza Sufriadi

    Uploaded by

    Rizur Sufison
    The document discusses the types, incidence, risks, and management of multiple fetal pregnancies, noting that twins can be either monozygotic (identical) or dizygotic (fraternal) and that complications of multiple pregnancies include preterm birth, growth issues, and maternal risks such as preeclampsia. Close monitoring and medical intervention may be needed for complications like twin-twin transfusion syndrome, and delivery is often via cesarean section due to risks of breech or transverse lie presentations.

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    Multiple Fetal

    Pregnancy

    Riza Sufriadi
    Content:

    1- Incidence and epidemiology.


    2- Etiology of multiple fetus.
    3- Types of twins:-
    a- Determination of zygosity.
    b- Risk of zygosity:
    * Risk of fetuses.
    * Maternal complications.
    * Problem specific to monochorionic twins
    4- Management of twins:-
    a- Antenatal.
    b- In labor.
    Incidence and epidemiology
    • Rate of twins increase by Assisted production
    technique(ART)and ovulation induction.
    • The natural rate of twinning dizygot is 1:90,
    monozygot 1:250
    • In USA the incidence is 3%, African> white
    • Depend on race, hereditary, age, parity and fertility
    drugs
    Types
    • Monozygotic • Dizygotic
    • 70-80%
    • 20-30% • Fertilization of 2 seperate ova
    • Fertilization of a single ovum, • Its actual prevalence is
    increasing due to:
    • Similar sex. • Induction of ovulation
    • Identical in every way including the • Change of the ages of women
    experiencing their first
    HLA genes pregnancy and delivery ( > 35
    years age).
    • Not genetically determined
    • Constant in all races; its prevalence:
    1/250.
    Dizygotic Twins

    (8 – Simpson & Creehan)


    Monozygotic Twins

    (8 – Simpson & Creehan)


    Monozygotic
    Dichorionic/diamniotic monozygotic twins:
    Cleavage in the first 3 days after fertilization
    Each fetus will be surrounded by amnion & chorion(
    each fetus has its own placenta)like dizygotic twins
    Has the lowest mortality rate of monozygotic twins
    <10% of all monozygotic twins
    Monochorionic/diamniotic:
    Cleavage between day 4 and 8 after fertilization
    Share single placenta but separate amniotic sac
    The mortality is 25%
    Monochorionic/monoamniotic:
    < 1% of cases
    Cleavage after the 8th day (day 9-12)
    Share single placenta & single sac
    Mortality is 50-60%, usually before 32 weeks
    Zygosity
    Conjoined twins:
    Cleavage after day 12
    Incidence is 1: 70,000deliveries
    The fetuses may fuse in a number of ways, most
    commonly chestand/or abdomen
    Assessment of chorionicity
    T sign
    Twin Peak Sign (Lambda)
    Monochorionic twin
    Dichorionic twins

    Conjoined twins
    Clinical Examination

    • Late in first trimester by Doppler  two fetal


    hearts.

    • Uterine palpation can feel two fetal heads or


    multiple fetal parts.

    • Uterine size is larger than expected for the


    gestational age determined from menstrual data.
    Complications of multiple pregnancy
    -High perinatal mortality & morbidity (3-4 times higher than singleton pregnancy)
    -Abortion
    -Preterm labour (50%) Decrease duration of gestation:
    a- 57% of twins  at 35 weeks.
    b- 92% of triplets  at 32 weeks.
    c- all quadruplets  at 29–30 weeks
    -IUGR
    -Congenital anomalies
    -Placental abruption, placenta previa
    -Discordant twin growth ( more than 20%discrepacy in fetal weights)
    -Malpresentation
    -Postpartum hemorrhage
    - Preeclampsia
    -C-Section
    Twin to Twin transfusion
    Occur in 20-25% of monochorionic twins
    Almost exclusively occurs in monochorionic (1
    placenta) diamniotic (2 amniotic sacs) pregnancies
    -One fetus donate blood to the other due to vascular
    anastomosis
    • Twins are often of different sizes:
    • Donor twin = small, pallied, dehydrated
    (IUGR), oligohydramnios (due to
    oliguria), die from anemic heart failure.
    • Recipient twin = plethoric, edematous,
    hypertensive, ascites, kernicterus (need
    amniocentesis for bilirubin), enlarged
    liver, polyhydramnios (due to polyuria),
    die from congestive heart failure, and
    jaundice.
    TTTS
    Reduction Amniocentesis Septostomy

    Selective Vessel Laser Ablation Umbilical Cord Occlusion/Ablation


    Quintero Staging
    Presentation
    ☻Cephalic - Cephalic 42%
    ☻Cephalic - Breech 27%
    ☻Cephalic - Transverse 18%
    ☻Breech - Breech 5%
    ☻Other 8%
    Management in First stage
    Second stage
    Third stage (PPH)
    C.S. for Multiple Pregnancy:
    Indications of C.S. (Chervenak, 1985):
    • More than 2 viable fetuses, if:
    • weight < 2 kg,
    • discordant growth ( i.e.; IUGR or twin-twin transfusion, or disproportionate
    twins, twin B larger than A (BPD > 2 mm),
    • twin A: is non-vertex.
    • Conjoined Twins
    • Single amniotic cavity (as diagnosed by U/S or amniogram).
    • Previous Uterine scar.
    • During Labor: if delayed progress, fetal distress, or if twin B transverse
    and cervix is thickened (retained second twin).
    • Associated pregnancy complication i.e.; severe PIH, placenta previa.
    • Contracted Pelvis
    • Lack of expertise
    Post-natal care
    • Hemorrhage – Guard against postpartum hemorrhage
    • Fundal checks!
    • Uterine Contraction
    • Breastfeeding
    • Psychological support.
    • Advise for contraception.

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