This document discusses multiple pregnancy, specifically twins. It begins by outlining Hellin's Rule which describes the statistical likelihood of having multiples based on maternal factors. It then differentiates between dizygotic and monozygotic twins and describes the key differences. Factors that can increase the chances of dizygotic twins are also outlined. The rest of the document details various maternal and fetal complications that can arise in twin pregnancies such as preeclampsia and preterm birth. Specific complications of monozygotic twins like twin-twin transfusion syndrome are also explained.
10. Chorionicity
Type of placentation
Prenatal detection by USS
Clinical implications in antepartum & intrapartum
management…
Monochorionic MZ
Dichorionic+discordant
sex DZ
Dichorionic+concordant
sex MZ or DZ
11. USS DETERMINATION OF CHORIONICITY
Number of sacs
Placenta
Sex
Intertwin membrane
Lambda sign & T sign
Ideal time for assessing of chorionicity is before 14
weeks
22. 3. Single fetal demise
monochorionic
Shift of blood
Normal
Death of one twin
twin
25% risk of co-twin death /25% risk of neurological
damage in surviving twin
25. Arterio venous anastomoses with net
flow in one direction..
A/c or C/c…
•Severe IUGR
•poor renal perfusion
Donor(arterial side) •Anuria
•severe oligohydramnios
•Hypervolemia
recipient •Polyuria with polyhydramnios
•CCF…..hydrops…death
31. Acardiac foetus
A-A anastamoses Umb. A
in placenta
Umb
De oxygenated
.A
blood
Minimal oxy. extracted by lower
Normal fetus/pump twin part of Acardiac fetus
Fully de oxygenated
Umb.V V-V anastomoses Umb.V Upper part of fetus ,no growth
in placenta