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MULTIPLE PREGNANCY

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.

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MULTIPLE PREGNANCY

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  1. MULTIPLE PREGNANCY DR. RAZAQ MASHA, FRCOG Consultant, Ob/Gyn Dept.

  2. 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

  3. 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

  4. 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 technologies e.g. IVF

  5. HOW DOES MULTIPLE PREGNANCY OCCUR • Fraternal multiples • Maternal multiples

  6. 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

  7. 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 abour 15 percent of identical twins

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

  9. 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

  10. MANAGEMENT • Prevent anaemia • Tocolytic medication • Corticosteroids • Cervical cerclage ? – for higher order multiples

  11. 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

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