Pregnancy Portal Provides Comprehensive Maternity Care Information

www.totalpregnancycare.com


Multiple Pregnancy
Dr Shantala Vadeyar
MD, FRCOG, DM (UK)
Advanced Obstetric Ultrasound (RCO/RCR)
Subspecialist in Maternal-Fetal Medicine (RCOG)
Consultant Obstetrics, Fetal & Maternal Medicine
Kokilaben Dhirubhai Ambani Hospital, Mumbai


Incidence
• Increased with Assisted Reproduction
• Clomiphene citrate / Letrozol/ HMG, hCG
• Advanced Age
• Race – Afro-carribeans
• 1:80-100


Risks in
Multiple Pregnancy


DC twins - lambda
sign


MC twins - T sign


Chorionicity v/s Zygosity


Techniques for invasive
testing


Loss rates: Amniocentesis in Twins


Chorionic Villous Sampling in Twins


Selective Fetocide / ER


Management:
Antenatal

Maternal and Fetal Surveillance


Ultrasound in Multiples
• Diagnosis and Chorionicity determinaiton
• Dating, Chromosomal & Structural Normality
• Growth, Dopplers
• Amniotic fluid assessment
• Twin twin transfusion syndrome
• Invasive procedures – amniocentesis, CVS
• Cervical length and funnelling
• Prediction of preterm labour
• Timing of delivery – Dopplers, BPS in IUGR, etc


Complications in Twins:
Based on Chorionicity
EVENT DICHORIONIC MONOCHORIONIC
Miscarriage (11-23 weeks) 2% 10%
Perinatal Death (>23 weeks) 2% 4%
Fetal Growth Restriction (one /both) 20% 30%
Preterm delivery (<32 weeks) 5% 10%
Major birth defects 1% 4%


Preterm delivery
Early screening for

Cervical cerclage
or Progesterone

25% reduction (4%
Prevalence of spontaneous early preterm birth

of total)
Delivery <34 wks
Delivery <34 wks 1.8%
1.8%
Iatrogenic
Iatrogenic Spontaneous
Spontaneous
1/3rd
1/3rd 2/3rd
2/3rd
Previous affected pregnancy
• Previous affected pregnancy (15%
(15%
Nulliparous / No previous PTD
• Nulliparous / No previous PTD (85%
(85%

Twin Twin Transfusion Syndrome
• Monochorionic twins Anastomoses in TTTS
• Donor twin is small, growth
restriction
• Recepient twin is big
• Oligo / polyhydramnios
• Big bladder, heart enlarged in
recepient
• Oliguria, donor
• Abnormal Dopplers


Prognosis - TTTS
• Staging (Quintero)
– Stage I
• Recipient hydramnios
• Donor bladder visible/present
– Stage II
• Recipient hydramnios
• Donor bladder remains empty (“stuck twin”)
– Stage III
• Abnormal Doppler studies:
– absent or reversed end-diastolic flow in Donor UA OR
– abnormal venous Doppler pattern in Recipient UA (reverse
flow in the ductus venosus or pulsatile umbilical venous flow)
– Stage IV
• Fetal hydrops means stage IV and the end
– Stage V
• Fetal death of one or both twins. www.totalpregnancycare.com

Treatment of TTTS by selective
laser ablation of A-V
Anastamoses
Laser ablation

Stuck ‘donor twin’
wrapped in membrane

Feely floating ‘recipient twin’
In hydramnios


Electronic
Fetal Heart
Rate
monitoring
in labour


Epidural Analgesia
(painless labour)


Timing and Mode of
Delivery
• Dichorionic twins – 38 weeks
• Monochorionic twins – 36 wks
• Vaginal delivery in uncomplicated DC or MC twins if
cephalic, cephalic presentations
• Precious pregnancy, abnormal presentations,
complications like IUGR, preterm, maternal DM/HT
usually delivered by LSCS
• Increased risk of placenta praevia and APH, PPH


Complications
• Post-partum haemorrhage

– Bimanual massage
– Uterotonics
– Prophylactic Misoprostol PR
– Syntocinon infusion
– B Lynch Suture
– Uterine Artery Ligation
– Uterine Artery Embolisation
– Hysterectomy

Profile
• Total Pregnancy Care is an online guide for pregnancy, childbirth and motherhood related
information. Women wanting to conceive, pregnant women, expecting parents, and new mothers
can use this pregnancy portal for a healthy pregnancy, fulfilling childbirth and joyful motherhood.
With pregnancy at its core, this portal covers various important aspects and especially addresses
those matters that the Indian Woman always wanted to know but did not know whom to ask.

• This website is compiled by Dr. Shantala, an Indian Obstetrician and Gynaecologist. She has over 20
years of extensive medical and diagnostics experience in areas commonly related to the Maternity
and Pregnancy fields. She has studied and practiced in India as well as in the United Kingdom and
thus brings about the fusion of best practices of the Oriental East and the Progressive West.

• A mother of three children, she has complete understanding of the emotional, mental and physical
needs of the New Age Pregnant Woman. Her patients appreciate her empathic approach and
wholeheartedly express their gratitude for her generosity and care. Dr.Shantala is presently a full
time Obstetrics and Gynaecology Consultant at the Kokilaben Dhirubhai Ambani Hospital and
Medical Research Institute, a premier health care initiative of the Reliance ADA Group. Dr.Shantala
has a clear vision to promote a holistic pregnancy approach and her mission is to provide
comprehensive maternity care. This website, www.TotalPregnancyCare.com, is her first step
towards this future.


Services Offered
• Pre-pregnancy counseling
• Genetic counseling
• Antenatal care, Labour Delivery
• Specialist Ultrasound scans
– Viability scan
– The First trimester scan / Nuchal translucency scans
– Detailed anatomy / anomaly scans
– Fetal Echocardiograph
– 3D / 4D scans
• Assessment of the High risk Fetus and Mother
• Amniocentesis
• Chorionic Villous sampling
• Cordocentesis
• Intra-uterine transfusions
• Embryo Reduction / Selective fetocide
• Second opinion scans


Topics covered
• Pre-Conception
– Working on getting pregnant or just starting to think about a family, this is
the place for you
• Pregnancy
– From trying to conceive to the first trimester to labor, learn what to
expect during your pregnancy and more
• Labor Delivery
– From that first contraction to the final push, here's what to expect
during labor and delivery
• Post-Pregnancy
– Learn more about your diet and workouts, shopping, feeding and your
child's health


Interactive Corner
• Month by Month happenings
• Articles
• FAQs
• Gestation Calendar


Society Memberships
• British Maternal & Fetal Medicine Society
• Fetal Medicine Centre
• Kokilaben Dhirubhai Ambani Hospital &
Medical Research Institute
• Royal College of Obstetricians and
Gynaecologists
• International Society of Ultrasound in
Obstetrics and Gynecology


Contact Us
• Email: shantala@totalpregnancycare.com
• Mobile: +91 9324304212
• KDAH Board line: +91 22 30999999


THANK YOU

Pregnancy Portal Provides Comprehensive Maternity Care Information

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