Download Free Medical Multiple Pregnancy PowerPoint Presentation

Multiple Pregnancy PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Obstetrics & Gynecology, which is titled "Multiple Pregnancy", to know about Multiple Pregnancy/ Multifetalpregnancy, the presence of more than one fetus in the gravid uterus.

Tags : Obstetrics, Gynecology, Multiple Pregnancy, Multifetalpregnancy, fetus, uterus

Published on : Jul 18, 2021 | Views : 6139 | Downloads : 36

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Multiple Pregnancy Prof Uma Singh
Slide 2-

Multiple Pregnancy/ Multifetalpregnancy The presence of more than one fetus in the gravid uterus is called multiple pregnancy Two fetuses (twins) Three fetuses (triplets) Four fetuses (quadruplets) Five fetuses (quintuplets) Six fetuses (sextuplets)
Slide 3-

INCIDENCE Hellin’s Law: Twins: 1:89 Triplets: 1:892 Quadruplets: 1:893 Quintuplets: 1:894 Conjoined twins: 1 : 60,000 Worldwide incidence of monozygotic - 1 in 250 Incidence of dizygotic varies & increasing
Slide 4-

Demography Race: most common in Negroes Age: Increased maternal age Parity: more common in multipara Heredity - family history of multifetal gestation Nutritional status – well nourished women ART - ovulation induction with clomiphene citrate, gonadotrophins and IVF Conception after stopping OCP
Slide 5-

Twins Varieties: 1. Dizygotic twins: commonest (Two-third) 2. Monozygotic twins (one-third) Genesis of Twins: Dizygotic twins (syn: Fraternal, binovular) - - fertilization of two ova by two sperms.
Slide 6-

Monozygotic twins (syn: Identical, uniovular): Upto 3 days - diamniotic-dichorionic Between 4th & 7th day - diamniotic monochorionic - most common type Between 8th & 12th day- monoamniotic-monochorionic After 13th day - conjoined / Siamese twins.
Slide 7-

ppt slide no 7 content not found
Slide 8-

Conjoined twins Ventral: 1) Omphalopagus 2) Thoracopagus 3) Cephalopagus 4) Caudal/ ischiopagus Lateral: 1) Parapagus Dorsal: 1)Craniopagus, 2)Pyopagus
Slide 9-

Superfecundation Fertilization of two different ova released in the same cycle Superfetation Fertilization of two ova released in different cycles
Slide 10-

Differences in zygocity Monozygotic 1 ova + 1 sperm Same sex Identical features Single or double placenta Same genetic features DNA microprobe -same Dizygotic 2 ova + 2 sperm Same or opposite sex Fraternal resemblance Double or s/t fused Different genetic features DNA microprobe - different
Slide 11-

Differences in chorionicity with single placenta D / D ( fused placenta ) Monozygotic or dizygotic Thick dividing membrane > 2mm Twin peak / lambda sign M / D Monozygotic Thin dividing membrane 2mm or less T sign
Slide 12-

Diagnosis HISTORY: History of ovulation inducing drugs specially gonadotrophins Family history of twinning (maternal side). SYMPTOMS: Hyperemesis gravidorum Cardio-respiratory embarrassment - palpitation or shortness of breath Tendency of swelling of the legs, Varicose veins Hemorrhoids Excessive abdominal enlargement Excessive fetal movements.
Slide 13-

GENERAL EXAMINATION: Prevalence of anaemia is more than in singleton pregnancy Unusual weight gain, not explained by pre-eclampsia or obesity Evidence of preeclampsia(25%)is a common association. ABDOMINALEXAMINATION: Inspection: The elongated shape of a normal pregnant uterus is changed to a more "barrel shape” and the abdomen is unduly enlarged.
Slide 14-

Palpation: Fundal height more than the period of amenorrhoea girth more than normal Palpation of too many fetal parts Palpation of two fetal heads Palpation of three fetal poles Auscultation: Two distinct fetal heart sounds with Zone of silence 10 beat difference
Slide 15-

D/D of increased fundal height Full bladder Wrong dates Hydramnios Macrosomia Fibroid with preg Ovarian tumor with preg Adenexal mass with preg Ascitis with preg Molar pregnancy
Slide 16-

INVESTIGATIONS Sonography: In multi fetal pregnancy it is done to obtain the following information: Suspecting twins – 2 sacs with fetal poles and cardiac activity Confirmation of diagnosis Viability of fetuses, vanishing twin Chorionicity – 6 to 9 wks ( single or double placenta, twin peak sign in d /d gestation or Tsign in m/d ) Pregnancy dating,
Slide 17-

Fetal anomalies Fetal growth monitoring (at every 3-4 weeks interval) for IUGR Presentation and lie of the fetuses Twin transfusion (Doppler studies) Placental localization Amniotic fluid volume Sonography ( ctd )
Slide 18-

Radiography Biochemical tests: raised but not diagnostic Maternal serum chorionic gonadotrophin, Alpha fetoprotein Unconjugated oestriol
Slide 19-

Lie and Presentation Longitudinal lie (90%) both vertex (40%) Vertex + breech (28%) breech + vertex ( 9%) both breech ( 6%) Others vertex + transverse breech + transeverse both transeverse
Slide 20-

Complications Maternal Pregnancy Labour Puerperium Fetal MATERNAL: During pregnancy: - miscarriages Hyperemesis gravidorum Anaemia Pre-eclampsia (25%) Hydramnios ( 10 % )
Slide 21-

GDM ( 2 – 3 times) Antepartum hemorrhage – placenta previa and placental abruption Cholestasis of pregnancy Malpresentations Preterm labour (50%) twins – 37 weeks, triplets – 34 weeks, quadruplets – 30 weeks Mechanical distress such as palpitation, dyspnoea, varicosities and haemorrhoids Obstructive uropathy
Slide 22-

During Labour: Prelabour rupture of the membranes Cord prolapse Incoordinate uterine contractions Increased operative interference Placental abruption after delivery of 1st baby Postpartum haemorrhage During puerperium: Subinvolution Infection Lactation failure
Slide 23-

FETAL – more with monochorionic Spontaneous abortion Single fetal demise Vanishing twin – before 10 weeks Fetus papyraceous/compressus – 2nd trim Complications in 2nd twin (depend on chorionicity) – neurological, renal lesions - anaemia, DIC - hypotension and death
Slide 24-

FETAL – more with monochorionic Low birth weight ( 90%) Prematurity – spontaneous or iatrogenic Fetal growth restriction - in 3rd trimester, asymmetrical, in both fetus Discordant growth - Difference of >25% in weight , >5% in HC, >20mm in AC, abnormal doppler waveforms - Causes – unequal placental mass, lower segment implantation, genetic difference, TTTS, congenital anomaly in one
Slide 25-

FETAL COMPLICATIONS (ctd) Congenital anomalies – conjoined twins, neural tube defects – anencephaly, hydrocephaly, microcephaly, cardiac anomalies, Downs syndrome, talipes, dislocation of hip TTTS -Twin to twin transfusion syndrome - cause – AV communication in placenta – blood from one twin goes to other – donor to recipient - donor – IUGR, oligohydramnios - recipient – overload, hydramnios, CHF, IUD
Slide 26-

FETAL COMPLICATIONS (ctd) TRAP -Twin reversed arterial perfusion syndrome or Acardiac twin - absent heart in one fetus with arterio-arterial communication in placenta, donor twin also dies Cord entanglement and compression – more in monoamniotic twins Locked twins Asphyxia – cord complication, abruption Still birth – antepartum or intrapartum cause
Slide 27-

Monoamniotic twins high perinatal morbidity, mortality. Causes : cord entanglement congenital anomaly preterm birth twin to twin transfusion syndrome
Slide 28-

Antenatal Management Diet: additional 300 K cal per day, increased proteins, 60 to 100 mg of iron and 1 mg of folic acid extra Increased rest Frequent and regular antenatal visit Fetal surveillance by USG – every 4 weeks Hospitalisation not as routine Corticosteroids -only in threatened preterm labour , same dose Birth preparedness
Slide 29-

Management During Labour Place of delivery: tertiary level hospital FIRST STAGE: blood to be cross matched and ready confined to bed, oral fluids or npo intrapartum fetal monitoring ensure preparedness SECOND STAGE – first baby - second baby
Slide 30-

Management During Labour SECOND STAGE –delivery of first baby as in singleton pregnancy start an IV line no oxytocic after delivery of first baby secure cord clamping at 2 places before cutting ensure labeling of 1st baby Delivery of second twin FHS of second baby lie and presentation of second twin wait for uterine contractions conduct delivery
Slide 31-

Management During Labour Delivery of second twin – problems & interventions -inadequate contraction- augmentation – ARM, oxytocin -transverse lie – ECV, IPV -fetal distress, abruption, cord prolapse- expedite delivery – forceps, ventouse, breech extraction THIRD STAGE – AMTSL - continue oxytocin drip - carboprost 250µgm IM - monitor for 2 hours
Slide 32-

Indications of caesarean Non cephalic presentation of first twin Monoamniotic twins Conjoined twins Locked twins Other obstetric conditions Second twin – incorrectible lie, closure of cervix
Slide 33-

MCQs Text book of Obstetrics, Dr J B Sharma, 1st edition ( 2012) page-473 to 483 Chapter - multiple pregnancy
Slide 34-

1. Splitting of single fertilized ovum between 8 to 12 days results in a) conjoined twins b) monochorionic monoamniotic twin c) dichorionic diamniotic twin d) monochorionic diamniotic twin
Slide 35-

Splitting of single fertilized ovum between 8 to 12 days results in a) conjoined twins b) monochorionic monoamniotic twin c) dichorionic diamniotic twin d) monochorionic diamniotic twin
Slide 36-

2. Twin peak sign is a feature of a) conjoined twins b) monochorionic monoamniotic twins c) dichorionic diamniotic twins d) monochorionic diamniotic twins
Slide 37-

Twin peak sign is a feature of a) conjoined twins b) monochorionic monoamniotic twins c) dichorionic diamniotic twins d) monochorionic diamniotic twins
Slide 38-

3. Additional caloric requirement ( K cal per day) of a mother in a case of twin pregnancy is a) 300 b) 500 c) 800 d) 1000
Slide 39-

Additional caloric requirement ( K cal per day) of a mother in a case of twin pregnancy is a) 300 b) 500 c) 800 d) 1000
Slide 40-

4. Additional iron supplementation requirement ( mg per day) of a mother in a case of twin pregnancy is a) 30 b) 50 c) 100 d) 200
Slide 41-

Additional iron supplementation requirement ( mg per day) of a mother in a case of twin pregnancy as compared to singleton pregnancy is a) 30 b) 50 c) 100 d) 200
Slide 42-

5. Iron supplementation required by a mother having twin pregnancy is a) 30 b) 50 c) 100 d) 200
Slide 43-

Iron supplementation required by a mother having twin pregnancy is a) 30 b) 50 c) 100 d) 200
Slide 44-

6. Twin pregnancy is complicated by all of the following except a) placenta previa b) malpresentation c) hydramnios d) post term labour
Slide 45-

Twin pregnancy is complicated by all of the following except a) placenta previa b) malpresentation c) hydramnios d) post term labour
Slide 46-

7. Caesarean section is indicated in a) monoamniotic twin b) monochorionic twin c) dichorionic twin d) diamniotic twin
Slide 47-

Caesarean section is indicated in a) monoamniotic twin b) monochorionic twin c) dichorionic twin d) diamniotic twin
Slide 48-

8) 32year old G2P1 at 20 weeks pregnancy in USG shows twin pregnancy, single placental mass with dividing membrane having inverted T sign. The type of twinning is a) monochorionic monoamnionic b) monochorionic diamnionic c) dichorionic monoamnionic d) dichorionic diamnionic
Slide 49-

8) 32year old G2P1 at 20 weeks pregnancy in USG shows twin pregnancy, single placental mass with dividing membrane having lambda sign. The type of twinning is a) monochorionic monoamnionic b) monochorionic diamnionic c) dichorionic monoamnionic d) dichorionic diamnionic
Slide 50-

9) Monochorionic twin placenta has unidirectional deep arteriovenous communication with lack of superficial vascular anastomoses. The likely complication is a) twin to twin transfusion syndrome b) twin reversed arterial perfusion c) acute intertwin transfusion d) twin cord entanglement
Slide 51-

9) Monochorionic twin placenta has unidirectional deep arteriovenous communication with lack of superficial vascular anastomoses. The likely complication is a) twin to twin transfusion syndrome b) twin reversed arterial perfusion c) acute intertwin transfusion d) twin cord entanglement
Slide 52-

10) Most common variety of conjoined twins is a) craniopagus b) thoracopagus c) omphalopagus d) pyopagus
Slide 53-

10) Most common variety of conjoined twins is a) craniopagus b) thoracopagus c) omphalopagus d) pyopagus