Prepared by:
1
Occurrence:
• Incidence= 1%
– 1/3rd=monozygotic, Twins
– 2/3rd=dizygotic
• Monozygotics = 1
in 80n-1
– Hellin’s rule Monozygotic Dizygotic
– n= Number of
fetus
• Twins=1:80
• Triplet=1:802 M/M=5% M/D=3% D/D=3% D/D=60%
• Quadruplet=1:803
2
Embryonic division
3
Zygosity
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Types
Dizygotic=2 ova fertilized Monozygotic=1 ova
fertilized then split
• 2 Placentae (may be • 1 placenta
fused)
• Sex may not be same • Same sex
• Blood group may not be • Same blood group
same
• Variable incidence • Constant incidence
(1:250)
• May not match HLA • Similar HLA antigen
antigen
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Conjoined twin
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Types of conjoined twins
1. Thoracopagus
2. Pyopagus
3. Craniopagus
4. Ischiopagus
7
Clinical Features…
Increased
1. Wt.
2. CO
3. Plasma & blood vol
4. AFP
5. Tidal vol.
6. GFR
8
Presentation:
• Vx.Vx.=60%
• Vx.Br.=20%
• Br.Vx.=10%
• Br.Br.=10%
9
…Clinical Features…
1. H/O ovulation, Family history
2. Hyperemesis, larger abd. size, early
cardiorespiratory overload
3. Increased edema, varicocity, hemorrhoid
4. More anemia/edema
5. Early onset PET
6. Early delivery
10
…Clinical Features
• P/A: • Abd.girth (at umbilicus)
1. Large size uterus, =
No.of inch
2. Increased abd.girth, =
No.of week
3. >2fetal pole,
• Fundal ht.(from syphysis)
4. Multiple fetal parts, =
No.of cm
5. FHS at 2 places. =
No.of week
11
Test
2. USG
12
D/D
1. Big baby
2. Polyhydramnios
3. Pregnancy
+
Fibroid uterus/Ovarian tumor
4. Pregnancy + ascites
13
Maternal complication…
1.Hyperemesis
2.Anemia
3.PET
4.Polyhydramnios
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…Maternal complication…
5.Mechanical distress
6.Twin-twin transfusion
7.Cord entanglement
8.Conjoint twin
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…Maternal complication…
9. Placenta previa/APH
11. Malpresentation
16
…Maternal complication
14. Surgical intervention+
15. PPH
16. Subinvolution
17
Average gestational age at delivery:
18
Fetal Complication
1. Abortion
2. Premature birth
3. Discordant growth
4. IUGR/SB/IUFD
5. Birth asphyxia
19
Mortality factor…
Maternal
1. PPH
2. PET/ET
3. Anemia/Cardiac
failure
20
…Mortality factor
Perinatal
1. Prematurity
2. Entangled cord
3. Placental abruption
4. Surgical
intervention
21
Antenatal care…
1. + calori
2. +rest
3. Iron/Folic acid
4. + visit
5. + fetal scan
22
…Antenatal care
1. Uterine relaxant- Salbutamol,
Retodrine For Premature
contraction
2. Corticosteroid-
Dexamethasone 24mg/Day in
2-3 divided doses For fetal
maturity if <34wk
23
Labor management…
Prerequisites:
• Place-Hosp.
• Skilled obstetrician
• Keep obstetric
forceps ready
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…Labor management
1. Episiotomy under local anesthesia
25
26
…Labor management
27
…Labor management
2nd transverse
Or
28
Indication of CS…
Maternal
1. Placenta previa/APH
2. Cord prolapse
3. Severe PET/ET
4. Prev.CS
5. CPD
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…Indication of CS
Fetal
1. Conjoint twin
2. 1st transverse
3. Twin-twin shunt
4. IUGR
5. Monoamniotic twins
6. Locked twins
• At brim
• In vagina
30