More than one fetus is developing in the mother’s womb; it is called numerous pregnancies. It may be twins(two fetuses), triples(three fetuses), quadruplets(four fetuses), quintuplets(four fetuses), sextuplets(six fetuses).
Dizygotic twins (non-identical):
- Dizygotic twins from two separate ova that are fertilized by two separate spermatozoa.
- It may not be from the same ovary.
- Twins may be the same sex or maybe different sex.
- They are having two placentae, two amnions, two chorions, and two umbilical cords.
- The Dizygotic twins’ ratio is more common than monozygotic twins.
Monozygotic (identical) twins:
- Monozygotic twins developed from a single ovum by fertilization of single sperm.
- They are from the same sex.
- They have similar physical, mental characteristics or blood group but not the fingerprints.
- It is the fertilization of two ova produced in the same menstrual cycle and by two spermatozoa and deposited in two separate acts of coitus.
- It is the fertilization of two ova produced in two different menstrual cycles by two separate spermatozoa.
Examination of placenta and membranes
- Dizygotic twins have two placentae; maybe they are entirely separated or fused.
- Amnion and chorion are there to surrounding the fetuses.
- Intervening membranes consist of 4 layers-amnion and chorion.
- The placenta is single.
- The intervening membrane consists of two layers of amnion only.
Factors affecting the twinning
- Unknown causes Family history of the mother
- Increased maternal age
- Nutritional factors: heavy body women.
- Infertility treatment
- High gonadotropin hormone.
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Clinical presentation of multiple pregnancies
- Increased nausea, vomiting
- Increased pressure symptoms: constipation, pedal edema, varicosity of veins, palpitations, precordial pain
- Fatigue, indigestion, backache, sleeplessness
- History off over distension
- History off premature labor
- Excessive fetal movements
- Ovulation-inducing drugs
- Size of the uterus: large than normal
- Pressure symptoms: due to pressure on the diaphragm by enlarging uterus ex: breathlessness, palpitation
- Weight gain: more than normal
- Pre eclamptic toxemia
- High BP
- Protein in the urine
Also read: Headache And Vomiting: How To Deal With It?
Diagnosis of multiple pregnancies
- History of ovulation including therapy
- Family history of twins – maternal side
- Enlargement of the abdomen in the second trimester. of pregnancy Palpation
- Fundal height is significant for the date by 4cm/more after 22 weeks
- Two relatively small heads or three fetal pole or two fetal parts are usual signs.
- Two fetal heart sounds at a difference of 10 beats/min are heard by two auscultation at two sites.
- Abdominal girth at umbilicus shows measures in inches more than the corresponding action at gestation weeks at 30 weeks 30 inches.
- One head will feel in pelvis & another one at brim or fundus.
- Congenital malformation
- Conjoined twins diagnosed
- 28-30 weeks to diagnose twins, presentation, fetal death, gross congenital anomalies.
Complications of multiple pregnancies
- Antepartum hemorrhage Malpresentation Preterm labor
- Mechanical distress nausea
- Early rupture of membranes and
- Cord prolapse
- Prolonged labor
- Increased operative interference Bleeding
- Postpartum hemorrhage
- Congenital problems
- Fetal anomalies
- Frequent antenatal visit
- Ante partum surveillance: USG examinations
- Corticosteroids for the lung maturity of the fetus.
- Proper diet
- Tests of fetal well being
- Adequate rest
- Prophylactic tocolytics
For further reading
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