د. نجمه محمود كلية الطب جامعة بغداد فرع النسائية والتوليد Multiple pregnancy د. نجمه محمود كلية الطب جامعة بغداد فرع النسائية والتوليد

Incidence &epidemiology : Account for 1% of all pregnancy. Types of multiple gsetation: Dizygotic Monozygotic Diamniotic Dichorionic monoamniotic monochorionic Incidence &epidemiology : Account for 1% of all pregnancy. Incidence varies with : 1) Ethnic group.

2)Maternal age. 3)parity. 4)method of conception. 5)family history 2)Maternal age. 3)parity. 4)method of conception. 5)family history. Determination of zygosity &chorionicity: 1) zygosity : by DNA fingerprinting 2)Chorionicity : a)Fetal gender By uss & relies on: b) No. of placenta. c)Characteristic of membrane between the two amniotic sacs.

Pregnancy complications according to chorionicity 1) miscarriage & severe preterm delivery. 2) perinatal mortality in twin pregnancy. 3) IUGR 4) Fetal abnormalities. 5) chromosomal defect. 6) Death of one fetus in twin pregnancy 7) TTTS

Clinical features &diagnosis of twin :pregnancy (1) History (2) clinical examination. (3) Investigations-uss. USS can determine No. of fetuses / chorionicity/ accurate dating of pregnancy/detect fetal abnormalities /detect fetal growth &wellbeing in3rd trimester /determine presentation /detect TTTS in monochorionic twins

Pregnancy complications & their management : 1) Hyperemesis gravidarum. 2) Hypertensive disease. 3) Gestational DM. 4) Anemia. 5) Minor symptoms of pregnancy. 6) APH. 7) PPH. 8) Thromboembolism.

Labour & delivery: Malpresentation Oxytocin Locked twin ECV & IPV IV line FHR monitoring. Epidural analgesia Blood preparation Indication of C/S in twin pregnancy: 1- Malpresentation of 1st twin. 2- monochorionic twin. 3- Evidence of IUGR in one or both twin. 4- Second twin is larger than the first. 5- Hx of fertility treatment.

Embryo reduction for higher order pregnancy: The objective of this iatrogenic reduction of embryo is to improve pregnancy outcome, it is done in qaudripm,,nmmmmlet & higher order by injection of KCL into the fetal heart by USS guidance; this is done at 11 week in order to give chance for spontaneous reduction &also to determine presence of any congenital abnormalities so determine which embryo is reduced, the risk of miscarriage from the procedure is 10%.