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Ppt multiple pregnancy
- 1. Multiple Pregnancy PRESENTED BY MITAL S PATEL LECTURER CL II GCON ,BHAVNAGAR
- 2. Definition A multiple pregnancy is a pregnancy in which more than one fetus develops in the uterus at the same time. Multiple pregnancies occur in 1–2% of pregnancies. Simultaneous development of two fetuses (twins) is commonest although rare, development of three fetuses (triplets), four fetuses (quintuplets) or six fetuses (sextuplets) may also occur.
- 4. Monozygotic Twins: • It is around 33% or 1/3 of all twins. • It results from fertilization of single ovum by one sperm. • Two embryo will develop and closed by single chorion, single placenta , two seperate amniotic sac.
- 6. Dizygotic Twins • Most common represents 2/3 of cases. • Fertilization of more than one egg by more than one sperm. • Non identical ,may be of different sex. • Two chorion and two amnion. • Placenta may be separate or fused.
- 8. Difference: Characteristic Monozygotic Dizygotic Placenta One with vascular communication Two may be fused but with no vascular communication Membrane 2 amnion & 1 chorion 2 amnion & 2 chorion Sex Always same Same/ different Genetic feature Same Different Abo-Rh Same Different Finger print Different Different Skin grafting Acceptance Rejection Follow up Usually identical Not identical
- 9. Difference:
- 10. Etiology • Hereditary mother important than father. • Age peak at 37 years of age. • Parity increase more than six times. • Ovulation inducing drug
- 11. Diagnosis 1. History. 2. Clinical Examination. 3. Investigations.
- 12. History • Family history. • Advanced age. • High parity. • Medication.
- 13. Clinical Examination • Symptoms: – minor ailments aggravated, increased nausea and vomiting in early months – Cardio-respiratory embarrassment which is in later months palpitation or shortness of breath – Tendency of swelling of legs – Unusual rate of abdominal enlargement • General Examination: – Prevalence of Anemia, unusual weight gain not explained by preeclampsia or obesity
- 14. Continue…. • Abdominal Examination- – Inspection: Barrel shaped and unduly enlarged abdomen – Palpation: The height of uterus is more than period of amenorrhea. The girth of abdomen at the level of umbilicus is more than the normal average at term (100 cms.) Fetal bulk seems disproportionately larger. Palpation of too many fetal parts – Auscultation: 2 FHS at difference of 10 beats / min are heard by two observers at two sites. • Internal examination: In some cases, one head is felt deep in the pelvis, while other one is located by abdominal examination.
- 15. Continue…. • Investigation: – Sonography: two gestational sac as early as 5 to 6 wks. – Chorionicity of the placenta – Radiography: it’s done after 30 wks to confirm diagnosis and to diagnose triplet & conjoint twins. – Biochemical tests
- 16. Differential Diagnosis: • Hydramnios • Big baby • Fibroid or ovarian tumors with pregnancy • Ascitis with pregnancy
- 17. COMPLICATION OF MULTIPLE PREGNANCIES Maternal Fetal Nausea ,vomiting Abortion Anemia Vanishing twins PIH Preterm Birth Polyhydramnions/ oligohydramnios Fetal anomalies Preterm labor Discordant growth Malpresentation Intrauterine death of one fetus APH Twin transfusion syndrome Mechanical distress Cord prolapsed Prolong labor Locked twins Operative interference Increased Perinatal mortality PPH ---------
- 18. Locked twins
- 19. Complication Of Monochorionic Twins • Twin Transfusion Syndrome • Conjoin Twin
- 20. Conjoined Twins • Anterior (thoracopagus) • Posterior (pygopagus) • Cephalic (craniopagus) • Caudal (ischiopagus)
- 21. Conjoined Twins THORACOPGUS WITH OMPHALOCELE SHARING A HEART AND A LIVER
- 23. Antenatal Management Advice: • Diet • Increased rest • Supplement therapy • Interval of antenatal visit • Fetal surveillance
- 24. Antenatal Management Hospitalization: • Routine :Rest improves utero-placental circulation. This results in –Increased birth weight of babies –Prolongation of the duration of pregnancy • Emergency : Development of complicating factors necessitates urgent admission irrespective of the period of gestation.
- 26. THANK YOU