Multiple Pregnancies

Multiple Pregnancies

Multiple Pregnancies

Twin gestation:

Types of twining:

1- monozygotic ( identical): are identical because they develop from fertilization of one ovum " the same sex " occurs at random in about 3 to 4 / 1000.

2- dizygotic ( fraternal): twining occurs more frequently in some families " heredity is important on mother side".

- Occurs in response to greater levels of FSH.

- Increased in women greater than 35 years of age and in obese women.

- More common among Africans.

- Maybe different sexes.

- Always have 2 chorines, 2 amnions.

- The result of fertilization of 2 separate ova.

Note:
Conjoined twins with shared organs occur as a monozygotic twin through a division of the fertilized ovum after the 13th days post conception.

- A greater increase in blood volume, pulse, cardiac output and weight gain.

- Increased rate of preterm labour, hypertension, abruption, anaemia, hydramnios, UTI, cesarean section and postpartum haemorrhage.

Infant complications:

Prematurity – the average age of delivery, 37 weeks.

Discordance: defined as a difference of greater than 20% to 25% in weight.

Aetiology:

- The difference in the placental surface area.

-Twin to twin transfusion syndrome.

- Donor twin small, pale, anaemia.

- Recipient twin large, plethoric, polycythemia, hyperbilirubinemia.

- Fetal anomalies occur more often in multiple pregnancies.

Clinical manifestations:

1- Uterus larger than expected for the length of gestation.

2- Two fetal heart tones can be counted simultaneously.

3- Abdominal palpation yields many small parts by 6-7 month.

4- U/S usually used to confirm the diagnosis.

5- Oversized uterus and increased abdominal pressure often lead to:

- Digestion difficulty.

- Constipation.

- Dyspnea.

- A backache.

- Haemorrhoids and other varicosities.

Triplets:

- Average weight gains 45 to 50 pounds.

- Usual spontaneous time for delivery is 32-34 weeks.

- Average weight 1800 -1900 grams.

- Most delivered by cesarean section.

Quadruplets or more:

- Average weight gains 50 to 55 pounds.

- Average gestational age 30 to 31 weeks.

- Average weight 1200 – 1500 grams.

- The multifetal reduction has been shown to improve perinatal survival rate.



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