- Главная
- Разное
- Дизайн
- Бизнес и предпринимательство
- Аналитика
- Образование
- Развлечения
- Красота и здоровье
- Финансы
- Государство
- Путешествия
- Спорт
- Недвижимость
- Армия
- Графика
- Культурология
- Еда и кулинария
- Лингвистика
- Английский язык
- Астрономия
- Алгебра
- Биология
- География
- Детские презентации
- Информатика
- История
- Литература
- Маркетинг
- Математика
- Медицина
- Менеджмент
- Музыка
- МХК
- Немецкий язык
- ОБЖ
- Обществознание
- Окружающий мир
- Педагогика
- Русский язык
- Технология
- Физика
- Философия
- Химия
- Шаблоны, картинки для презентаций
- Экология
- Экономика
- Юриспруденция
Multiple pregnancy презентация
Содержание
- 1. Multiple pregnancy
- 2. Multiple Pregnancy/ Multifetalpregnancy The presence of more
- 3. INCIDENCE Hellin’s Law: Twins: 1:89 Triplets: 1:892
- 4. Demography Race: most common in Negroes Age:
- 5. Twins Varieties: 1. Dizygotic twins: commonest (Two-third)
- 6. Monozygotic twins (syn: Identical, uniovular): Upto
- 8. Conjoined twins Ventral:
- 9. Superfecundation Fertilization of two different ova
- 10. Differences in zygocity Monozygotic 1 ova +
- 11. Differences in chorionicity with single placenta D
- 12. Diagnosis HISTORY: History of ovulation inducing
- 13. GENERAL EXAMINATION: Prevalence of anaemia is
- 14. Palpation: Fundal height more than the
- 15. D/D of increased fundal height Full bladder
- 16. INVESTIGATIONS Sonography: In multi fetal pregnancy it
- 17. Fetal anomalies Fetal growth monitoring
- 18. Radiography Biochemical tests: raised but
- 19. Lie and Presentation Longitudinal lie
- 20. Complications Maternal Pregnancy Labour
- 21. GDM ( 2 – 3 times) Antepartum
- 22. During Labour: Prelabour rupture of the
- 23. FETAL – more with monochorionic Spontaneous abortion
- 24. FETAL – more with monochorionic Low birth
- 25. FETAL COMPLICATIONS (ctd) Congenital anomalies –
- 26. FETAL COMPLICATIONS (ctd) TRAP -Twin reversed
- 27. Monoamniotic twins
- 28. Antenatal Management Diet: additional 300
- 29. Management During Labour Place of delivery: tertiary
- 30. Management During Labour SECOND STAGE –delivery of
- 31. Management During Labour Delivery of second twin
- 32. Indications of caesarean Non cephalic presentation
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
Слайд 2Multiple 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)
Two fetuses (twins)
Three fetuses (triplets)
Four fetuses (quadruplets)
Five fetuses (quintuplets)
Six fetuses (sextuplets)
Слайд 3INCIDENCE
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
Incidence of dizygotic varies & increasing
Слайд 4Demography
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
Heredity - family history of multifetal gestation
Nutritional status – well nourished women
ART - ovulation induction with clomiphene citrate, gonadotrophins and IVF
Conception after stopping OCP
Слайд 5Twins
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.
Dizygotic twins (syn: Fraternal, binovular) -
- fertilization of two ova by two sperms.
Слайд 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.
Between 8th & 12th day- monoamniotic-monochorionic
After 13th day - conjoined / Siamese twins.
Слайд 8Conjoined twins
Ventral:
1) Omphalopagus
2) Thoracopagus
3) Cephalopagus
4) Caudal/ ischiopagus
Lateral:
1) Parapagus
Dorsal:
1)Craniopagus,
2)Pyopagus
3) Cephalopagus
4) Caudal/ ischiopagus
Lateral:
1) Parapagus
Dorsal:
1)Craniopagus,
2)Pyopagus
Слайд 9Superfecundation
Fertilization of two different ova released in the same cycle
Superfetation
Fertilization of two ova released in different cycles
Слайд 10Differences in zygocity
Monozygotic
1 ova + 1 sperm
Same sex
Identical features
Single or double
placenta
Same genetic features
DNA microprobe -same
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
Слайд 11Differences 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
Слайд 12Diagnosis
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.
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.
Слайд 13GENERAL 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.
Слайд 14Palpation:
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
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
Слайд 15D/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
Adenexal mass with preg
Ascitis with preg
Molar pregnancy
Слайд 16INVESTIGATIONS
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,
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,
Слайд 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
Presentation and lie of the fetuses
Twin transfusion (Doppler studies)
Placental localization
Amniotic fluid volume
Sonography ( ctd )
Слайд 18Radiography
Biochemical tests: raised but not diagnostic
Maternal serum chorionic gonadotrophin,
Alpha fetoprotein
Unconjugated oestriol
Alpha fetoprotein
Unconjugated oestriol
Слайд 19Lie and Presentation
Longitudinal lie (90%)
both vertex
(40%)
Vertex + breech (28%)
breech + vertex ( 9%)
both breech ( 6%)
Others
vertex + transverse
breech + transeverse
both transeverse
Vertex + breech (28%)
breech + vertex ( 9%)
both breech ( 6%)
Others
vertex + transverse
breech + transeverse
both transeverse
Слайд 20Complications
Maternal
Pregnancy
Labour
Puerperium
Fetal
MATERNAL: During pregnancy:
- miscarriages
Hyperemesis gravidorum
Anaemia
Pre-eclampsia (25%)
Hydramnios ( 10 % )
Слайд 21GDM ( 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
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
Слайд 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
Placental abruption after delivery of 1st baby
Postpartum haemorrhage
During puerperium:
Subinvolution
Infection
Lactation failure
Слайд 23FETAL – 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
Fetus papyraceous/compressus – 2nd trim
Complications in 2nd twin (depend on chorionicity)
– neurological, renal lesions
- anaemia, DIC
- hypotension and death
Слайд 24FETAL – 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
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
Слайд 25FETAL 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
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
Слайд 26FETAL 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
Cord entanglement and compression – more in monoamniotic twins
Locked twins
Asphyxia – cord complication, abruption
Still birth – antepartum or intrapartum cause
Слайд 27 Monoamniotic twins
high perinatal morbidity, mortality.
Causes : cord entanglement
congenital anomaly
preterm birth
twin to twin transfusion syndrome
Causes : cord entanglement
congenital anomaly
preterm birth
twin to twin transfusion syndrome
Слайд 28Antenatal 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
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
Слайд 29Management 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
confined to bed, oral fluids or npo
intrapartum fetal monitoring
ensure preparedness
SECOND STAGE – first baby
- second baby
Слайд 30Management 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
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
Слайд 31Management 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
-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
Слайд 32Indications of caesarean
Non cephalic presentation of first twin
Monoamniotic twins
Conjoined twins
Locked
twins
Other obstetric conditions
Second twin – incorrectible lie, closure of cervix
Other obstetric conditions
Second twin – incorrectible lie, closure of cervix
