MULTIPLE PREGNANCY

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MULTIPLE PREGNANCY

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

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• 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

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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

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• 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

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HOW DOES MULTIPLE PREGNANCY OCCUR

• Fraternal multiples(non-identical,dizygotic)
• Maternal multiples(identical,mono-
• zygotic)

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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

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• 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

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

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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

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MANAGEMENT

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

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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