multiple pregnency Flashcards
whats the dizygotic twin ?
from 2ova and 2 sperm
they have dichorionic and dizygotic placentation
same or diifer sex
2/3 the most common type of twins
ehatre the factors that affecting the D Z twins incidence ?
1-natural
from the herditory of th emother
or increase the maternal age
or increase the parity
2- induction of the ovulation bygonadotrophin by 30% and 10%clomide
what the monozygotic twin ?
they arise from 1ova &1sperm the split
they are the same sex and same gentic somsitution
they ‘re rare 1/3
cause of the MZ twin incidence ?
not related to inhertanc eor the induction of ovulation
what happen if the zygot split early after 2days of fertilization ?
twin may have teo option either :
- they seperaltly have own sac and placenta so ( dichorionic diamniotic twin )
- but must commnly they share one pal enta with two sac so (monochorionic diamniotic )
if the zygot split late after 13 days of the fertilization ?
this will inccrease the mortalitlty rate as the twins will share the same organs they called conjoined twin (التوائم السياميه )
in general when the incidance rate increase of having twins ?
1- taking drugs that induct the ovulation
2- twin increase with age and parity
3-its more in the black race
How to dignosis pt with twin ?
1-pt feel large abdomen more than normal and excess of the fetal movment
2- family history of twin and usage of drugs
on Examination
- gain large wieght
- uterus is much larger than normal and feeling of 2 fetal heart
confirm by the u/s
what’re the complication of having twins on the mother ?
1- hyperemsis
2-anemia
------------ 3-hypertion and precalmpsia 4-polyhyramnios 5-perterm rupture membrane 6-perterm labour
7-peranteral heamorrge
8-postanter heamorrage
9- increase the risk of abortion
whatre the complication of two babys on the fetus them self ?
1-prematurty
2-intrautrine resistrctive growth
3-congintal abnormality
4-increase the morbidty and mortality
5-umblical cord prolapse
other complication in MZ twin ?
singlton twin (malformation )
umblival cord abnoramlity
twin to twin transfusion
means there is anastmosis happen in monzygotic who have monochorionic
so one fetus is large and the other is small one os the donor and the other is receipant
receipant ( كبير )
donor (صغير)
method of delivery of the twin ?
if vertex -vertex in 50% its vaginal
1st wint is the indicator if it ecphaic 70 or breech 30
time between th edelivery of 1st and the 2nd twin ?
30mintues
if the zygot split late after 8-13 days of the fertilization ?
same placenta and one sac
if the zygot split late after4-8 days of the fertilization ?
one placenta and two sac
INCIDANCE of twins
1-race .in blacl
2- DZ twins increase incidence with age and
parity .
3- the incidence increase with use of ovulation
induction drugs .
DIAGNOSIS of twins
–HISTORY :
*-maternal feeling of larger than normal
abdomen and sensation of excessive fetal
movement .
- family history of twining .
- the use of ovulation drugs .
2- EXAMINATION :
*excessive weigh gain.
*on palpation the uterus is larger than date and
multiple fetal parts are felt and 2 fetal hearts
are detected .
Diagnosis is confirmed by ultrasound
Diagnosis is confirmed by
confirmed by ultrasound
COMPLICATIONS of twins
MATERNAL
MATERNAL:
1- hyperemsis gravidarum.
2- increase risk of aneamia.
3-increase risk of abortion .
4-increase risk of hypertension and preclampsia.
5-Preterm labour and preterm rupture of membranes
.
6- APH.Antepartum haemorrhage
7- polyhydramnios .
8-increase risk of operative delivery and c/s.
9-increase risk pf PPH post partum heamorrge
COMPLICATIONS of twins
fetal
1-prematurity. 2- IUGR . 3-increase risk of cong . Anomalies. 4-increase risk of perinatal morbidity and mortality. 5-Umbilical cord prolapse
Specific Complications in
Monochorionic Twins
twin to twin transfusion in 10%
Congenital malformation. Twice that of
singleton. X2
Umbilical cord anomalies. In 3 – 4 %.
Conjoined twins. Rare 1:70000 deli
varies.
twin to twin transfusion result from
vascular anastemosis
between twins vessels at the placenta.
Usually arterio (donor) venous (recipient).
Occurs in 10% of monochorionic twins.
,the donor bleeds
into the recipient so one is pale with
oligohydraminose while the other is
polycythemic with hydraminose.
he donor twin is usually smaller and has oligohydramnios due to decreased urine production, whereas the recipient is larger with polyhydramnios due to polyuria.6 days ago
mother with twin should be seen
seen more frequently than
mothers of singleton usually
every 2 weeks at 20-30 weeks من الشهر الخامس
الىقريب السابع
then weakly after .
Each visit she should be examined for signs of
preterm labour and
1-edema and Bp checked
2-urine for albumin is done
3-Hb%
4- The mother should have serial u/s to detect any fetal
abnormalities
mother should supply
iron and folic acid
Method Of Delivary
50% if vertex vertex
Mode of dlivery has tradetionaly
been decided on
-the presentation of the first twine(cephalic in70%
breech in 30%)
- growth
- fetalwellbeing.
indicate ceasarean section.
indicate ceasarean section.
The presentation of the second twin is of little relevance until after the
birth of the first.Mothers with previous ceasarean section best
delivered by repeat cesarean because of greater risk of scar
dehiscence or rupture.
The time between delivery of the 1st and second twin
should
not exceed 30 min
INTRAPARTUM MANGEMENT
1- labor should be conducted in a well equipped hospital
under supervision of expert tem (obst,anasth,and pead)
2-,early in labour iv line should be inserted and blood
prepared .
3-Oxytocin is used as indicated in singlton pregnancy ,fetal
4-heart monitoring of both fetuses should be done
5-after delivery of the first twin
6-examine the lie and presentation of the second twin if transverse or
oblique correction should be don by external version if
failed internal version and delivery of the baby by breech
extraction .
7-The time between delivery of the 1st and second twin
should not exceed 30
delivery of the 2nd twin malpresentation ..
if transverse or oblique correction should be don by external version if
failed internal version and delivery of the baby by breech
extraction .
