Gemelli

Dr. Hydrawati Sari, SpOG

Ethiology of multiple fetuses

Dizygotic:

fertilisasi pd 2 ovum yg berbeda

Monozygotic

= Identical twins: berasal dr 1

telur yg difertilisasi dan mengalami
pembelahan

Pembelahan

72 jam pertama 2 embryos,

diamniotic, dichorionic dan
2 placenta atau 1 plasenta yg
mengalami fusi
4-8 hari 2 embryos,
diamniotic, monochorionic.
8 hari stl fertilisasi 2
embryos, monoamniotic dan
monochorionic.
Divisions conjoined twins

Pemeriksaan klinis
Doppler

tdp 2 DJJ.

Palpasi

uterus: teraba 2 kepala janin atau

multiple fetal parts

Uterus

lbh besar dari umur kehamilan

Diferential diagnosis
1.
2.
3.
4.
5.
6.
7.

Janin multipel
Salah menentukan HPM
Hydramnion
Mola Hidatidosa
Myoma uteri
Massa di adneksa
Janin makrosomia (akhir kehamilan)

Pemeriksaan
USG: jml GS
2. Biochemical tests:
1.

Risiko
1.

Abortus

2.

Malformas janin:
Congenital malformation > single
BBLR
a- IUGR
b- preterm
c- discordance
Partus prematurus
a- 57% of twins at 35 weeks.
b- 92% of triplets at 32 weeks.
c- all quadruplets at 2930 weeks

3.
4.
5.

Problems Specific to
Monochorionic twins
Twin-Twin transfusion syndrome:* 15% of monochorionic develops.
* Early onset often is associated with poor prognosis.
* Twin-Twin transfusion can be acute or chronic.
* The net effect of blood flow imbalance result:
a- donor small, hypoperfused, anemic.
b- recipient large, hyperperfused.

Presentasi janin

Kepala Kepala 42%

Kepala - Bokong 27%
Kepala Lintang 18%
Bokong - Bokong 5%
Yg lain 8%

Cara persalinan: tergantung presentasi janin

Thank You