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multiple pregnancy-multifetal pregnancy-twin pregnancy

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    MUTIPLE PREGNANCY

      MUTIFETAL PREGNANCY

DEFINITION:

The presence of more than one fetus in the gravid

uterus is called

multiple pregnancy.

two fetuses(twins)

three fetuses (triplets)

four fetues(quadruplets)

five fetuses (quintuplets)

six fetuses(sextuplet)

CAUSES:

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

and ivf.

conception :after stopping ocps.

TYPES OF TWINS

VARIETIES

dizygotic twins :commonest (2/3rd)

monozygotic twins:(1/3rd)

conjoint twins:

monozygotic twins

syn,identical,unilovular:

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.

monozygotic                                           dizygotic

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

different.

DIAGNOSIS

HISTORY:

1.history of ovulation inducing drugs specially gonadotrophins.

2.family history of twinning (maternal side).

SYMPTOMS:

1.hyperemesis gravidarum.

2.cardio-respiratory embarrassment-palpitation or shortness

of  breath.

3.tendency of swelling of legs.

4.varicose veins.

5.hemorrhoids.

6.excesssive abdominal enlargement.

7.excessive fetal movements .

EXAMINATION:

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.

 

ABDOMINAL EXAMINATION:

the elongated shape of a normal pregnant uterus is changed to a more”

barrel shaped” and the abdomen is unduly enlarged.

 

PALPATION :

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

AUSCULTATION

two distinct fetal hearts sounds with

zone of silence

10 beat difference

D/D OF INCREASED FUNDAL HEIGHT

full bladder

wrong dates

hydramnios

macrosomia

fibroid with pregnancy

ovarian tumour with pregnancy

adenexal mass with pregnancy

ascities with pregnancy

molar pregnancy

INVESTIGATIONS

sonography

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)

5.pregnancy dating

sonography (ctd)

  1. fetal anomalies
  2. fetal growth monitoring (at every 3-4 wks interval )for iugr.
  3. presentation and lie of fetuses.
  4. twin transfusion (doppler studies )
  5. placental localization
  6. amniotic fluid volume

 

LIE AND PRESENTATION

longitudinal lie (90%)

1.both vertex  40%

2.vertex +breech  (28%)

  1. breech+vertex (9%)
  2. both breech (6%)

 

others

vertex +transverse

breech+transverse

both transverse

 

Dr nazeed suhaib

 

 

 

 

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