The presence of more than one fetus in the gravid
uterus is called
three fetuses (triplets)
five fetuses (quintuplets)
race:most commom in negroes.
age:increased maternal age.
parity:more common in multi para.
heridity:family history of multifetal gestation.
nutritional status:well nourished women.
art:ovulation induction with clomiphene citrate,gonadotrophins
conception :after stopping ocps.
TYPES OF TWINS
dizygotic twins :commonest (2/3rd)
upto 3 days :diamniotic –dichorionic.
b/w 4th & 7th day:diamniotic monochorionic (most common type).
b/w 8th & 12th day:monoamniotic monochorionic.
after 13th day: conjoint/siamese twins.
1.1 ova+1 sperm 1.2 ova +2 sperms
2.same sex 2.same or opposite sex
3.identical features 3. fraternal resemblance
4.single or double placenta 4.double or s/t fused
5.same genetic features 5.different genetic features
6.dna microphobe same 6.dna microphobe
1.history of ovulation inducing drugs specially gonadotrophins.
2.family history of twinning (maternal side).
2.cardio-respiratory embarrassment-palpitation or shortness
3.tendency of swelling of legs.
6.excesssive abdominal enlargement.
7.excessive fetal movements .
1.prevalence of anemia is more than in singleton pregnancy.
2.unusual weight gain,not explained by pre-eclampsia or obesity.
3. evidence of pre-eclampsia (25%) is a common association.
the elongated shape of a normal pregnant uterus is changed to a more”
barrel shaped” and the abdomen is unduly enlarged.
fundal height more than the period of amenorrhea
girth more than the normal
palpation of too many fetal partspalpation of two fetal heads
palpation of three fetal poles
two distinct fetal hearts sounds with
zone of silence
10 beat difference
D/D OF INCREASED FUNDAL HEIGHT
fibroid with pregnancy
ovarian tumour with pregnancy
adenexal mass with pregnancy
ascities with pregnancy
in multifetal pregnancy it is done to obtain the following information
1.suspecting twins-2 sacs with fetal pole and cardiac activity
2.confirmation of diagnosis
3.viability of fetuses –vanishing twins
4.chorionicity -9 to14wks (single or double placenta.twin peak sign in
d/d gestation or t sign in m/d)
LIE AND PRESENTATION
longitudinal lie (90%)
1.both vertex 40%
2.vertex +breech (28%)
Dr nazeed suhaib