multiplepregnancy-140101123400-phpapp02
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Multiple Pregnancy
Presented by
Varsha Sharma
MSc. Nursing 2nd year
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IncidenceHellin’s Law – Twin = 1:!
Tri"le#s = 1:!$
%uadru"le#s =1:!&
M'n'(yg'#ic = )*+,1!!! -ir#hs
i(yg'#ic = /aries de"ending'n ma#ernal age0 race and
ge'gra"hical dis#ri-u#i'n
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e#i'l'gy
ssis#ed re"r'duc#i'n #echniues
Increase "ari#y
Increase ma#ernal age
3amily his#'ry4re/i'us mul#i"le "regnancy
5rican race
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"regnancy
1. i(yg'#ic , -in'/ular , 5ra#ernal
2. M'n'(yg'#ic , 6ni'/ular , iden#ical
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Monozygotic / Uniovular /Identical
Dizygotic / binovular /fraternal
1.1,) #wins
2. 1 s"erm and 1 '/um
).Iden#ical
7. Ty"e '5 "lacen#ade"ends 'n #he #ime '5s"li##ing '5 em-ry'+.Incidence isinde"enden# '5 race0age0 "ari#y
1.2,) #wins
2. 2 s"erms and 2 '/a
). ich'ri'nic
iamni'#ic #wins
7. 2 se"ara#e "lacen#a"resen#
+. Incidence isde"enden# '5 race0 age0"ari#y0 and '/ula#i'n
inducing drugs
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twins
1.ich'ri'nic iamni'#ic :
i. i/isi'n 'ccurs wi#h in 82 hrs '5 5er#ili(a#i'n
ii.May ha/e 2 di9 "lacen#as, single 5used
"lacen#aiii.icul# #' di9eren#ia#e 5'rm di(yg'#ic #wins
i/.;'#h -a-ies ha/e same se<
2.M'n'ch'ri'nic iamni'#ic:I. i/isi'n 'ccurs wi#h in 7 – days '5
5er#ili(a#i'n
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). M'n'ch'ri'nic M'n'amni'#ic:
I. i/isi'n 'ccurs *12 days '5 5er#ili(a#i'n
7. >'n?'ined #wins:I. i/isi'n 'ccurs a5#er 1)#h day
II. Inc'm"le#e di/isi'n '5 em-ry'nic disc
III. Ty"es: *#h'rac'"agus
* 'm"hal'"hagus
*crani'"agus
*"y'"agus
*ischi'"agus
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Clinical presentation
Symptoms • @ nausea0 /'mi#ing
• @ "ressure sym"#'ms:
c'ns#i"a#i'n0 "edal edema0 /aric'si#y '5 /eins0"al"i#a#i'ns0 "rec'rdial "ain
• 3a#igue0 indiges#i'n0 -acAache0 slee"lessness
• H,B '/erdis#ensi'n
• H,B "rema#ure la-'r• C<cessi/e 5e#al m'/emen#s
• 3undal heigh# 0 H,B '/ula#i'n inducing drugs
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SI!"S • nemia
• Cdema
• -n'rmal Deigh# Eain
• 6#erine Heigh# F 4BE
I# may -e n'rmal si(e in case '5 -in'/ular #wins, when1 '5 #he -a-ies die in u#er'
Palpation
3eel 2 se"ara#e heads, F 2 "'les#uscultation
2 3HS wi#h di9erence '5 a# leas# 1! -ea#s heard 'n 2sides '5 u#erus -y 2 "e'"le0 a# leas# G inches away
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'le '5 ul#ras'und
>'nrma#i'n '5 ch'ri'nici#y Twin "eaA sign , Lam-da sign = dich'ri'nic
"lacen#a
Iden#i5y #he num-er and si#e '5 "lacen#a0 5use'r se"ara#e
Lie and "resen#a#i'n '5 #win
mni'#ic Juid assessmen#
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In#ra"ar#um c'm"lica#i'ns
4BM K c'rd"r'la"se
-ru"#i'n in #he2nd #win
In#erl'cAing '5#wins
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Twin #' Twin Tras5usi'n Syndr'me
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T$I"% T$I" T&#"S'USI("
S)"D&(M*
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r#eri' /en'us anas#'m'seswi#h ne# J'w in 'ne direc#i'n..
Donor+arterial side,
recipient
•Se/ere I6E•"''r renal
"er5usi'n•nuria•se/ere'lig'hydramni's
•Hy"er/'lemia•4'lyuria wi#h"'lyhydramni's•>>3dea#h
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Vanishing #win
>essa#i'n '5 cardiacac#i/i#y in a "re/i'usly/ia-le 5'e#us
Fetus
papyraceous…
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>'rd en#anglemen#
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Single 5e#al demise
m'n'ch'ri'nic
ea#h '5 'ne
#win
S-ift of bloodN'rmal#win
.0 ris1 of co%twin deat- /.0 ris1 ofneurological damage in surviving twin
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>'ngeni#al an'malies
Structuralmalformations
C-romosomalanomalies
>'n?'in# #winscardiac 5e#us
nence"haly Tali"esisl'ca#i'n '5 hi"e#c..
'wn’s syndr'me
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Conjoint twins
Always monozygotic
classifcation
Th'rac'"agus
>rani'"agus
'm"hal'"agus
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4yg'"agus
ischi'"agus
4rena#al diagn'sis*#' c'unsel #he "aren#s 5'rm#" , #' "lan si#e K m'de '5 deli/ery
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Acardiac oetus
N'rmal 5e#us,"um"#win
Minimal '<y. e<#rac#ed -y
l'wer "ar# '5 cardiac5e#us
#%#anastamosesin placenta
e
'<ygena#ed-l''d
6m-.
6m-.
3ully de '<ygena#e
6""er "ar# '5 5e#us 0n' gr'6m-.V2%2anastomosesin placenta
6m-.V
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cardiac #wins
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nence"haly
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Managemen# '5 mul#i"le "regnancy
n#ena#al care :
C<#ra a##en#i'n K die#: a# leas# )!! Acal m're#han in n'rmal "regnancy
'u#ine ir'n and 5'lic acid
e#ailed an'maly scan 5'll'wed -y serialgr'w#h scan a# 20 )2 and )G weeA
H's"i#ali(a#i'n i5 sus"ec#ed "re#em
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M'de '5 deli/ery
e"end 'n "resen#a#i'n '5 1s# #win
;'#h /er#e< , 1s# #win /er#e< –
/aginal deli/ery
Indica#i'n 5'r Clec#i/e LS>S*M're #han 2 5e#uses
*1s# #win mal"resen#a#i'n0 >4
*Scarred u#erus
*>'n?'in# #win
*I6E in dich'ri'nic #win
*TTTS
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Cmergency LS>S :
*3e#al dis#ress
*c'rd "r'la"se in 1s# -a-y
*N'n "r'gress '5 la-'r*2nd #win is #rans/erse0 /ersi'n 5ailed a5#erdeli/ery '5 1s# #win
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Managemen# during la-'ur 1s# s#age
1. e#ermine #he "resen#a#i'n '5 1s# #win
2. Main#ain "ar#'gram
). Cs#a-lish IV line
7. ;l''d gr'u"ing and cr'ss ma#ched+. >'n#in'us in#ra"ar#um #win >TE m'ni#'ring
G. nalgesic
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Managemen# during la-'ur 2nd s#age
1.eli/ery '5 1s# #win
2.>lam" and cu# #he c'rd
).N'#e lie '5 #he 2nd #win deli/ered wi#hin 2! min
7.L'ngi#udinal lie a-d'minally K /aginally : S#ar# 2 uni#s '5 "i#'cin IV dri"
>e"halic 3i< #he head in#' "el/isM Kdeli/er #he 5e#us
;reech ssis#ed -reech deli/ery0 ;reech e<#rac#i'n
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I5 2nd #win has #rans/erse lie :
• ssis#an# "er5'rms C>V.
• 3i< #he head in l'wer "'le '5 #he u#erus andacc'ucher "er5'rms c'n#r'lled BM ru"#ure'5 mem-rane
• I5 #his 5ails: d' I4V in#ernal "'dalic /ersi'n5'll'wed -y -reech e<#rac#i'n
• Br "r'ceed wi#h emergency LS>S
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