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

3. 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.

4. 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.

7. 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

9. 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

12. 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.

13. Labour & delivery: Malpresentation Oxytocin Locked twin ECV & IPV IV line FHR monitoring. Epidural analgesia Blood preparation Indication of C/S in twin pregnancy: 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.

14. 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%.