MULTIPLE PREGNANCY
Definition
The pregnancy is which a woman carries more than one fetuses in her uterus, is known is multiple pregnancy.
Multiple Pregnancy refers to a pregnancy where two or more fetuses develop simultaneously in the uterus, also known as multifetal pregnancy.
INCIDENCE RATE
- Hellins rule
- The frequency of Multiple pregnancy.
- Twins :- 1/80
- Triplets :- 1/80 x 80
- Quadruplets :- 1/80 x 80 x 80
INCIDENCE OF TWINNING
- Family H/o of twinning
- Maternal age above 35 Y
- Increase parity / Multipara
- Using ovulation including drug
- IVF
- Maternity obesity
CAUSES AND RISK FACTOR
- Maternal age
- Assisted reproductive techniques :- IVF
- Family history of dyzygotic twin
- Multipara
- Races
TYPE OF MULTIPLE PREGNANCY
1. Twin Pregnancy :- No of fetus is 2
2. Triplets Pregnancy :- No of fetus is 3
3. Quadruplets Pregnancy :- No of fetus is 4
4. Quintuplets Pregnancy :- No of fetus is 5
5. Sextuplets Pregnancy :- No of fetus is 6
CLASSIFICATION BY ZYGOSITY
1. Monozygotic :- After the Fertilization process develop in zygote the splits into two embryos. It always same sex and genetically identical. It is also known as Identical twins.
- Most common twins
- Congenital anomalies are more common
- 1/250 Pregnancies
- Same genes
- Same phenotype
- Identical twince
- Same Blood type
- Same HLA typing
- Different fingerprint
- Bad Prognosis
2. Dizygotic :- Two seperate ovam are fertilized by two different sperm. May be of the same or different sexes and are genetically different. It is also known as Fraternal twins.
- 1/80 Pregnancy
- Max incidence in Nigerian women
- Always DCDA (Diachorionic Diamniotic)
- Good progress
- Least complication
1. Dichorionic Diamniotic :- Each fetus has its own chorion and amnion ( Can be monoygotic or dizygotic ). It splits happening within 1-3 days.
2. Monochorionic Diamniotic :- Shared chorion but seperate amnion (Always monozygotic ). It is most common type. IIt splits happening within 4-8 day.
3. Monochorionic Monoamniotic :- Shared chorion and amnion. Always monozygotic.
It splits happening within 9-13 days.
4. Conjoined Twins :- Incomplete division of a single zygote, spliting after 13 days.
Type of Conjoind twins.
A. Paraphagus :- Attach with side
B. Thoracophagus :- Thorax is attached with both baby.
C. Omphalophagus:- Attach with abdomen
D. Pyophagus :- Attach with Buttocks.
E. Ischiophagus :- Attach with Ischial bone.
F. Chraniophagus :- Attach with Head.
SIGN AND SYMPTOMPS
- Uterine size large than gestational age
- Excessive gravidarum
- Multiple fetal heart beats
- Increase maternal discomforts
- Dyspnea
- Back pain
DIAGNOSTIC EVALUATION
- History taking
- Physical examination
- USG
- Beta-hcG
- Doppler studies
- Fetal heart rate monitor
- Antenatal care
- Monitoring fetal or maternal well being
- Extra calories, proteins. Vitamins, minarals.
- Prevention and treatment of minor element.
- Bed rest after 24 weeks of pregnancy.
- IFA supplementation, Iron rich diet.
Management during dilivery
- Delivery of the first baby should be conducted.
- IV fluids (RL)
- ARM + oxytocin drip if required
↓
- Birth of first baby
- Do Not give IV ergometrine
- Clamp and cut the cord
- Note the time of delivery and sex of baby
↓
- Performe abdominal examination to identify presentation and position of 2nd baby.
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⬇️ ⬇️
If lie of second baby If lie of second
is longitudinal. Baby is transverse.
is longitudinal. Baby is transverse.
⬇️ ⬇️
Amniotomy with ECV or podalic
Or without oxytocin version performe
Drip.
⬇️ ⬇️
If there is delay If fails
⬇️ ⬇️
⬇️ Internal podalic
⬇️ Version
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