MULTIPLE PREGNANCIES Flashcards
A pregnancy in which the
woman is carrying two or
more fetuses
• Considered a complication
of pregnancy
Multiple Pregnancy
1.) It is sometimes difficult to determine by _______ or at birth whether twins are identical or fraternal
2.) The higher a woman’s _____ and ____, the more likely she is to have a multiple gestation
3.) ______ appears to play a role in natural dizygotic twinning; this has a familial maternal pattern of occurrence
1.) Sonogram
2.) Parity and age
3.) Inheritance
1.) Multiple (typically two) Fetuses produced by the splitting of a single zygote
2.) Multiple (typically two) fetuses produced by 2 zygotes
3.) Multiple fetuses produced by two or more zygotes
4.) The offspring produced by a multiple birth in non human placentals
1.) Monozygotic
2.) Dizygotic
3.) Polyzygotic
4.) Litter
TWIN TERMS:
2 =
3 =
4 =
5 =
6 =
7 =
8 =
9 =
10 =
11 =
12 =
13 =
14 =
15 =
16 =
17 =
18 =
19 =
2 = Twins
3 = Triplets
4 = quadruplets
5 = Quintuplets
6 = Sextuplets
7 = Septuplets
8 = Octuplets
9 = Nonuplets
10 = Decaplets
11 = Undacaplets
12 = Duodecaplets
13 = Tredecaplets
14 = Quattrodecaplets
15 = Quindecaplets
16 = Sexdecaplets
17 = Sepdecaplets
18 = Octdecaplets
19 = Nondecaplets
•Also known as Siamese twins
•Identical twins whose bodies are joined in utero
•Higher incidence (Southwest Asia & Africa)
•Overall survival rate: approx. 25%
•Frequently found among females
Conjoined twins
1.) Older and most generally accepted theory in which the fertilized egg splits partially
2.) A fertilized egg completely separates, but stem cells find like stem cells on the other twin and fuse the twins together
1.) Fission
2.) Fusion
✓Two faces on opposite sides of a
single, conjoined head
✓Upper portion of the body is fused while the bottom portions are separate
✓Generally cannot survive
✓Also known as janiceps or
syncephalus.
Cephalopagus
✓Bodies fused in the
head and thorax
✓Has two faces facing in
opposite directions or
sometimes a single
face and an enlarged
skull.
Cephalothoracopagus
✓2 bodies fused from the
upper thorax to lower
belly.
✓The heart is always
involved in these cases.
Thoracopagus (18.5)
✓ Two bodies fused at the lower chest
✓ Unlike thoracopagus, the heart is
never involved
✓ Twins share a liver, digestive
system, diaphragm and other
organs.
Onphalopagus
✓28% of cases
✓2 bodies fused from the upper
chest to the lower chest
✓Twins usually share a heart, and
may also share the liver or part of
the digestive system
Thoraco-omphalopagus
✓2 bodies fused in the
xiphoid cartilage – these
twins almost never share
any vital organs, with the
exception of the liver
Xiphopagus
✓Fused lower half of the two
bodies, with spines conjoined
end-to-end at a 180° angle.
These twins have four arms;
two, three or four legs; and
typically one external set of
genitalia and anus.
Ischiopagus
✓ Fused in a similar fashion as
ischiopagus twins, but facing each
other with a joined abdomen akin
to omphalopagus. These twins
have four arms, and two, three, or
four legs.
Omphalo-Ischiopagus
- Fused side-by-side with a shared pelvis.
- has 3 sub-types:
a)dithoracic parapagus - fused at the abdomen and pelvis, but not the thorax
b)diprosopic parapagus - have one trunk and one head with two faces
c)dicephalic parapagus - have one trunk and two heads, and two-four arms
Parapagus
✓Fused skulls, but separate bodies
✓Can be conjoined at the back of the head, the frontof the head, or the side of the head, but not on the face or the base of the skull
Craniopagus
✓ Two bodies joined at the pelvis
Pygopagus (Iliopagus)
✓ Fused dorsally above the sacrum &
lumbar spine, involving different
segments of the column
✓ rare occurrence
Rachipagus
✓Twins that are asymmetrically conjoined, resulting in one twin that is small, less formed, and dependent on the larger twin for survival.
Parasitic Twins (10%)
✓Situation in which an
undeveloped fetus is encased
in the body of its twin
✓Often presents as a cyst
Fetus in fetu
✓One head w/ a single face
but four ears, and two
bodies
Synecephalus
Multiple Pregnancy Risk factors
➢ Parity
➢ Age
➢ inheritance (natural dizygotic)
➢ Race (↑ in non-whites)
➢ In-vitro fertilization
➢ Use of fertility drugs
Maternal Implications
✓Physical discomfort: SOB, dyspnea on
exertion, backaches & pedal edema
✓Urinary tract infections
Complications of pregnancy such as:
✓PIH
✓Hydramnios
✓Anemia
✓Postpartum bleeding
✓Preeclampsia
✓Preterm labor
✓Placenta previa
Complications during labor
✓Abnormal fetal presentations
✓Uterine dysfunction
✓Prolapsed cord
✓Hemorrhage at birth or shortly after
Assessment
➢visualization of two or more gestational sacs
5-6 wks
➢fundal height greater than expected
➢auscultation of HRs that differ by at least 10 bpm
➢multiple sets of fetal heart sounds maybe heard upon
auscultation
➢uterus begins to ↑ in size a faster rate than usual
➢flurries of action at different portions of her abdomen
➢severe anemia
