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Multiplepregnancy…

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HELLIN’SRULE

 Twins 1 in80

 Triplets 1 in

80^2Quadruplets 1 in80^3gemellology

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Types oftwins………

DIZ!"TI

#

M"$"Z!"

 TI#

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DIZYGOTIC amni

on

amnio

n

2!o"io

ns

#$ways %i!o"ioni &

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'ato"s a(etin)

%i*y)oti twinnin)

Et!ni)"o+p

In"easin)mate"na$ a)e

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In"easin) pa"ity

'ami$y !,otwinnin)- espmate"na$

O.+$ationin%+tion

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/ONOZYGOTIC

01%ays

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34%ay

s

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C!o"ioniity Type o% placentation&renatal detection 'y ())

#linical implications in antepartum *intrapartum management…

Monoc+orionic /Z

Dic+orionic,discordant se- DZDic+orionic,concordant se- /Z o" DZ

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USS DETER/IN#TION O'CHORIONICITY 

Number of sacs

Placenta

Sex 

Intertwin membrane

Lambda sign & T sign

Ideal time %or assessing o% c+orionicity is

'e%ore 1. wee/s

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DIZ!"TI#

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L#/5D#SIGN

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/ONOCHORIONIC &DI#/NIONIC  T )I!$

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Importance ofchorionicity ?????

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/#TERN#L

CO/6LIC#TIONSntepartum

+yperemesis

+ydramnio

s

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Intrapartum

complicationsDys%unctional la'ourMalpresentations

Increased c+ance %or operatiedeliery&ost partum +emorr+ageetained placenta

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29 I(!

&oor placentation5une:ual placentals+aring5%etal anomalies……

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39 )ingle %etal demise

monoc+orio

nic

Deat+ o% one

twin

S!ift of8$oo% $orm

twin

29: "is; of o1twin %eat! ,29: "is; ofne+"o$o)ia$ %ama)e in s+".i.in) twin

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.9 #ord entanglement

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97 T

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rterio enous anastomoseswit+ net ;ow in one direction99

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)erial amnio reduction5%etoscopic lasera'lation o% anastomosis

69 @anis+ing twin

#essation o% cardiacactiity in a preiouslyia'le %oetus   Fetus

 papyraceous…

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A9 #ongenital anomalies

St"+t+"a$ma$fo"mations

C!"omosoma$anoma$ies

#onBoint twinscardiac %etus

nencep+aly TalipesDislocation o% +ipetc99

DownCs syndrome

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Conoint twins

 Always monozygotic

classifcation

 T+oracopagus

#raniopagus

omp+alopagus

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&ygopagus

isc+iopagus

&renatal diagnosis7to counsel t+e parents %ormtp < to plan site * mode o% deliery…

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cardiac twins

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nencep+aly

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Intrapartum complications

&"M * cordprolapse

'ruption in t+e2nd twin

Interloc/ing o%twins

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