MULTIPLE PREGNANCY

DR. RAZAQ MASHA, FRCOG Consultant, Ob/Gyn Dept.

This is a pregnancy with two or more fetuses: Twins = 2 fetuses Triplets = 3 fetuses Quadruplets= 4 fetuses Quintuplets = 5 fetuses Sextuplets = 6 fetuses Septuplets = 7 fetuses

WHAT CAUSES MULTIPLE PREGNANCY

There are many factors related to having a multiple pregnancy. Naturally occurring factors include the following: Heredity Older age High parity Race

Other factors that have greatly increased the multiple birth rate in recent years include reproductive technologies Ovulation stimulating medications such as clomiphene citrate and follicle stimulating hormone Assisted reproductive technoligies e.g. IVF

HOW DOES MULTIPLE PREGNANCY OCCUR

Fraternal multiples(nonidentical,dizygotic)

Maternal multiples(identical,monozygotic)

COMPLICATIONS
Preterm Labour and birth About half of twins and all higher order multiples are premature Respiratory distress syndrome Temp. Infection Pregnancy induced hypertension three times more likely with multiple pregnancy Occurs earlier Increased risk of abruptio placentae

Cont.
Anaemia Birth defects twice the risk of birth defects like neural tube defects, gestro intestinal and heart abnormalities Miscarriage Twin to twin transfusion - occurs in about 15 percent of identical twins

Cont.
Polyhydramnios Caesarean delivery increased incidence from abnormal fetal positions Post partum haemorrhage large placental area uterine atony

DIAGNOSIS
Symptoms & Signs hyperemesis gravidarum excessive weight gain fetal movts felt in different parts of the abdomen uterus larger than dates

Beta HCG much higher for gestation. Ultrasound

MANAGEMENT

Prevent anaemia Tocolytic medication Corticosteroids Cervical cerclage ? for higher order multiples

DELIVERY

Presentation of first fetus in twins: if cephalic, vaginal delivery should be anticipated if breech, mode of delivery will depend on other factors higher order multiples are usually delivered by caesarean section Anticipate and prepare for post-partum haemorrhage