MULTIPLE PREGNANCY twin triplet pregnancy.pptx

Obg notes

1. MULTIPLE PREGNANCY

2. DEFINITION The presence of more than one fetus in the gravid uterus is describe as multiple pregnancy

3. INCIDENCE Incidence of twins in india and bangladesh is generally 1 in 70-100 pregnancy, Incidence is highest in africa amongest negros , lowest in the japan (1 in 19) Currently incidence of dizygotic twins in on the rise because of ovulation induction therapy is assisted reproductive techniques,

4. TYPES OF TWIN PREGNANCY Biovular: Dichorionic diamniotic : they develop from two separate ova which may or may not be come from the same ovary Uniovular Monochorionic diamniotic, monochorionic , mono amniotic a single ovum after fertalization undergoas division to form two embryos. They are always the same sex. Fetus papyraceous One fetus perishes early in pregnancy and is retained until term. The small fetus is compressed flat on the membranes, it probably result from anastomotic circulation.

5. Conjoined twins or siamese twins Twins that are physically joined at birth, sometimes sharing organs, and in some cases separatable by surgery. Super fecundation: fertilization of two different ova at different intermenstrual periods, it is only a theoretical possibility. Vanishing twins: It is a condition in which one of a set of twins or multiple embryos dies in utero, disappear or gets resorbed partially or entirely.

6. monozygotic twins dizygotic twins Monozygotic twins are developed by the splitting of a fertilized embryo into two Dizygotic twins are developed by two separate simultaneous fertilization events Cause is not known Caused either by IVF, certain fertility drugs or hereditary predisposition Genetic codes are nearly identical Genetic codes are same as any other sibling Gender is the same Gender is different Blood types are the same Blood types are different Appearance is extremely similar but may be affected by environmental factors Appearance is similar as any other siblings Can be either Di-Di, Mono-Di or Mono-Mono twins Only Di-Di twins One-third of the twins in the world are monozygotic Two-thirds of the twins in the world are dizygotic Bear a high risk for TTTS Bear a low risk for TTTS

7. Signs and symptoms of twin pregnency Size of the uterus is larger than normal. The patient may complaints of breathlessness and palpitation because of the pressure on the diaphragm by the enlarging uterus. Anemia may be present Edema Weight gain is more than normal Hydramnios or excessive liquor amnii may be present Malpresentation or abnormal presentation of fetus.

8. DIAGNOSIS OF TWIN PREGNENCY HISTORY OBSTETRICAL EXAMINATION Inspection Palpation Auscultation Tape measurement Ultrasonography radiology

9. management During pregnancy Frequent antenatal visit Proper diet Adequate rest Prophylactic tocolytics or cerclage During labour Delivery should be in a hospital. A term of experienced obstetrician, assistant, anesthetist and neonatologist is necessary for safety

10. First Stage It is managed as usual unless there is an indication for caesarean section Second Stage: Delivery of the first twins: If it is cephalic : proceed as normal usually there is no problem. If it is breech: caesarean section is safe for fear of locked twins, although vaginal delivery may pass without the complication. Immediate clamping of the cord is essential after delivery of the first twins to avoid bleedding from a uniovular second twins.

11. Delivery of second twins It depend upon its presentation Third stage of labour Active management and observation is indicated to guard against postpartum haemorrhage .

12. NURSING MANAGEMENT OF TWIN PREGNENCY ANTENATAL CLINICAL CARE: Early booking of pregnancy obstetrical examination of the large gestational fundus. By 30 weeks twin pregnancy is diagnosed and confirmed by ultrasonography. AT SECOND STAGE OF LABOUR: Delivery of first baby is usually done. Spontaneously and timely episiotomy required, In the case of slow labour. dilute oxytocin low forceps delivery is needed. Nutrition counselling Evaluate the women for signs and symptoms of obstetric complications.

13. complications Preterm labor/ Delivery Low birth weight Intra uterine growth retardation pre-eclampsia Gestational diabetes mellitus Placental abruption Fetal loss Conjoined twins

14. Abortion Polyhydramnios Prolonged labour

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