Dr.

Imelda, SpOG

Maternal- Fetal Evidence Based Guidelines p 273-284

Current Obstetric & Gynecology Diagnosis & Treatment p 315-325

Gestasi > 1 fetus

Monozygotic (MZ)
1 fertilized
ovum membelah
menjadi dua
individu, sebagian
besar kembar
IDENTIK

ART
meningkatkan
insidensi

Insiden : 4/1000

Dizigotic (DZ) 2
ovum difertilisasi
oleh 2 sperma
yang berbeda
individu yang
secara genetik
berbeda
Insiden bervariasi
(ras, usia, paritas,
riwayat keluarga)
2

D
E
F
I
N
I
S
I

DZ : berasal dari 2 fertilized

ovum yang berbeda SELALU
dichorionic/ diamniotic (DC/DA)

MZ : berasal dari 1 fertilized ovum

yang membelah bisa berbagai tipe,
tergantung dari waktu pembelahan
ovum

Fetal
Spontaneous reduction

Maternal
Preeklampsia

Spontaneous loss
Anomali kongenital &
kromosom
IUGR & discordant growth

Single fetal demise

Preterm birth

Solusio Plasenta
Trombositopenia

Akut Fatty Liver

Diabetes Gestasional

Imaturitas

Komplikasi intrapartum

Kerusakan neurologis perinatal

Mortalitas perinatal

10

11

Twin- twin
tranfusion
syndrome
Insidens : 10- 15% MC/DA,
1/2500 kehamilan

Monoamniotic
twins
Insiden : 1 : 10.000 kehamilan

Diagnosis : USG
Etiologi :
1 plasenta, anostomosis AA, VV,
AV imbalance sirkulasi
donor twin anemia & efek
resultan (IUGR, oligohidramnion)

Acardiac twin (twin reversal

arterial perfusion TRAP)
MZ/MC 1/35.000 kehamilan
USG doppler (pump twin)
IUFD 35-50%

Resipien twin polihidramnion,

polisitemia, heart failure

Diagnosis : USG
Prognosis : buruk

Conjoined twin insiden 1/10000- 1/50.000 kelahiran

klasifikasi (anatomi + pagus)
menentukan manajemen &
prognosis
12

Staging fo TTTS
Stage 1

MC/ DA gestation with oligohidramnion

(MVP < 2 cm) dan Polyhidramnions
(MVP > 8 cm)

Stage 2

Absent (empty) bladder (in donor)

Stage 3

Abnormal Doppler

Stage 4

Hydrops

Stage 5

Death of one twin

13

Embryo & Fetal Pathology, Color Atlas with

Ultrasound Correlation, 2004

14

Embryo & Fetal

Pathology,
Color Atlas with
Ultrasound
Correlation, 2004

15

16

Embryo & Fetal Pathology, Color Atlas with

Ultrasound Correlation, 2004

Conjoined Twin

17

T
R
A
P
Embryo & Fetal Pathology, Color Atlas with Ultrasound Correlation,
2004
18

USG

Fetal
surveillance

Antepartum
Testing

Fetal
Growth

Amniotic
Fluid
19

Timing of
delivery

Elective delivery pd 37 mgg

UK

Route of
delivery

Triplet/ > SC
Presentasi vertex-vertex (40%)
TOL
Non cephalic second twin total
breech extraction BETTER than
podalic version
first twin NON- VERTEX SC

Delayed
interval
delivery

Preterm/ PPROM penurunan mortalitas &

morbiditas
KI : MC gestasi, soluio, PE, chorioamnionitis,
indikasi obs lainnya
berbanding terbalik dengan UK persalinan bayi
kembar yang pertama
20

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