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Multiple Gestations

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Clinton Pong
Clinton Pong
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Multiple Gestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Incidence is increasing! Inc 65% for twins Inc 500% for triplets+ Multifetal gestation = only 3% of total births, but >20% of complications like PTD, LBW, VLBW babies
On average… Twins deliver @ 35+2wk Triplets deliver @ 32+1wk BUT The lowest mortality for: Twins = 38 wk Triplets = 35 wk
Morbidity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
AMA, ART and ovum induction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Etiology: Monozygotic ,[object Object],[object Object],[object Object],[object Object],[object Object],Morula Day 0-3 Blastocyst Day 4-8 Implanted blastocyst Day 8-13 Embryonic disc Day 13-15
Etiology: Dizygotic Ultrasound image of "twin-peak" sign showing an extension of placental tissue into the intertwin membrane, confirming dichorionic twinning. 2/3 of all twins Diamniotic/dichorionic
Differential diagnosis for LGA uterus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Maternal Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Preterm Delivery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fetal complications: TTTS ,[object Object],[object Object],[object Object],[object Object]
Fetal Complications: IUGR ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Routine Antepartum Fetal Surveillance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Reduction/Selective Termination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
When do you deliver twins?
References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ACOG Bulletin Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Multiple Gestations

  • 1.
  • 2. Incidence is increasing! Inc 65% for twins Inc 500% for triplets+ Multifetal gestation = only 3% of total births, but >20% of complications like PTD, LBW, VLBW babies
  • 3. On average… Twins deliver @ 35+2wk Triplets deliver @ 32+1wk BUT The lowest mortality for: Twins = 38 wk Triplets = 35 wk
  • 4.
  • 5.
  • 6.
  • 7. Etiology: Dizygotic Ultrasound image of "twin-peak" sign showing an extension of placental tissue into the intertwin membrane, confirming dichorionic twinning. 2/3 of all twins Diamniotic/dichorionic
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15. When do you deliver twins?
  • 16.
  • 17.