??? Multiple gestation

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??? Multiple gestation

• ?????
• ??????????????,Twins???????1,????????????????????
  ??????????,??????????2,?????????1015,??????10??
  
• ?????
• Twin 1/80 1/100
• Triplet 1/802
• Quadruplet1/803

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• ??????
• Superfetation(????)
• ovulation and fertilization during the course of
  an established pregnancy, whish would
  theoretically be possible until the uterine
  cavity is obliterated by the decidua capsularis
  to the decidua vera ?
• an interval as long as or longer than a menstrual
  cycle
• Superfecundation(????)
• ?????? (within same menstrual cycle) ?two
  ova??,??????????????????sperm?
• Discordancy twins
• ?????????,????????25??discordancy???????uteroplac
  ental insufficiency?

3

• ??Monozygotic ??
• Dianmiotic - Dichorionic twin???30,???inner
  cell mass (morula) ???,??blastocyst????chorion,???
  72 hr?,Sonography??separate placentas,???????twin
  peak sign or lambda sign (????placentas???)?
• Dianmiotic - Monochorionic twin????????68,????4
  8??,inner cell mass (Morula) ???,??blastocyst???
  chorion,?amnion?????????????,????twin -to twin
  transfusion syndrome (TTTS),????????????,?25?
• Monoamniotic - Monochorionic twinamnion???,???81
  3?,embryonic disk???,???????????????????(entanglem
  ent of umbilical cords),?????,??????C/S????,?Monoa
  mnionic status???????cord entanglement??????cord
  accident ????????
• Conjugated twin??????13??,embryonic
  disk???,?????????conjoined twins???????????(1)Ante
  rior (thoracopagus, ???), (2)Posterior(pyopagus),
  (3)Cephalic(craniopagus), (4)Caudal(iscbiopagus)?

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• ?????????
• ?????????????dizygotic twin?2/3,?race, heredity,
  maternal age, parity??????????????? monozygotic
  twin (1/250) ?1/3,?race, heredity, maternal age,
  parity???
• ???????????????,????????,????infertility
  drug??????,?????????????????????90 Dizygotic
  twin, 10 monozygotic twin??????????????????clomop
  hene?????gonadotropin?FSH?HMG?,???????????????,???
  ??????????,????????,????clomiphene??????5-10????

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• ????
• ???U/S???????????????????????
• ??16-18???????????,?????????????indication???????,
  ???????????,?????????
• ?????????????????????300kcal????????
• ???????malformation????????,?????TTTS???
• ?????????,????,??????????????????????????????????
  ?????????,???????????????????consumptive
  coagulopathy,???????,????hypofibrinogenemia,?????h
  eparin infusion???

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• ????????????
• Spontaneous preterm labor????37wks??????,?preterm
  premature ruptured of membrane???????????????,????
  ?????????????????????????????????????,???2nd
  trimester??,??curve????????????????,???????????,??
  ??????,???30???,??????????????????,???????????????
  ??,??????????????????,?3840wks?????????,?????36wk
  s??????,?????33wks??????,?????29wks?
• ??Presentation
• Cephalic Cephalic 42
• Cephalic Breech 27
• Cephalic Transverse 18
• Breech Breech 5
• Others 8

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• ??Complication
• Maternal
• Preterm labor???????ICH?NEC?RDS
• Pre-eclampsia and eclampsia rate???????preeclamps
  ia???epigastric pain, hemolysis, thrombocytopenia
• Thrombophlebitis and embolic phenomenon
• ????????????????adverse effect????
• PPH due to???????????
• Polyhydramnios, oligohydramnios, abruptio
  placenta, placenta previa??????
• Fetal/neonatal
• Spontaneous abortion
• Prematurity or LBBW or stillbirth
• Birth injury
• Malpresentation
• Congenital anomalies
• Cord accident or prolapse
• Twin to twin transfusion syndrome

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• ??????????multifetal???????
• ??10???????????selective termination?????????????f
  etal survival rate,????complication????????,??????
  ??????????????????,??????????????
• ???????????transabdominal or transvaginal
  reduction,transabdomen???????12-14wks?,?transvagin
  al ??????10-12wks?,??????spontaneous
  abortion??????????????? ???????????,????????,?????
  ?????,???????,???KCL,?????0.52 cc?
• Complication
• Infection,??,DIC ,????abortion ,???????????,??????
  ???????,Preterm labor
• ???outcome???????,??????????fetal
  loss???,???fetal loss?????infection????

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• ???Twin to twin transfusion syndrome (TTTS)
• General conception?????monochorionic
  twins,?monochorionic ????complication,????,mortali
  ty rate?50100,??????prognosis???
• Pathophysiology
• ?????donor twin??recipient twin,??donar anemia
  and growth restriction,???oligohydramnios???,?reci
  pient??polycythemic?circulation overload??hydrops
  fetalis,???polyhydramnios????Recipent????????hyper
  volemia?hyperviscosity???circulation
  overload??heart failure or occlusive
  thrombosis?polycythemia???????????kernicterus,????
  second trimester?

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• ???Twin to twin transfusion syndrome (TTTS)
• Diagnosis
• ??????communicating vessels in the placenta?
• Hb????5 g/dl?
• ?????????20?
• ???polyhydramnios,???growth restriction and
  oligohydramnios?
• monochorionicity?
• Management
• ???????????????????(serial amniocentesis from the
  twin with polyhydramnios)?????,???????laser
  coagulation of the communicating vessels in the
  placenta?

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Thank you for your attention!!