multiple pregnancy

Definition:

A multiple pregnancy is a pregnancy involving more than one fetus , twins ,triplets ,and quadruplets .are multiple pregnancies


PATHOPHYSIOLOGY:

The 2 types of twins are monozygotic and dizygotic.

Two sperm fertilizing ovum produce dizygotic twins , sometimes are called fraternal twins . separate amnions ,chorions ,and placentas are formed indizgotic twins
Monozygotic twins develop when a single fertilized ovum splits during the first 2 weeks after coception .Monozygotic twins also called identical twins .

CAUSES OF MULTIPLE PREGNANCIES:

• Heredity: .
A family history of multiple pregnancy increases the chances of having twins

• Older age:
Women over 30 have a greater chance of
multiple conception.

• high parity.

• Race.


Other factors:

• Ovulation stimulating medications such as clomiphene citrate and follicle stimulating hormone (FSH) help produce many eggs, which, if fertilized, can result in multiple babies.

• Assisted reproductive technologies such as in vitro fertilization (IVF).


SYMPTOMS OF MULTIPLE PREGNANCY:

• uterus is larger than expected for the dates in pregnancy

• increased morning sickness

• increased appetite

• excessive weight gain, especially in early pregnancy

• fetal movements felt in different parts of abdomen at same time


DIAGNOSIS OF MULTIPLE PREGNANCY

• Pregnancy blood testing

• Levels of human chorionic gonadotrophin (HCG) may be quite high with multiple pregnancy.

• Alpha-fetoprotein

• Levels of a protein released by the fetal liver and found in the mother’s blood may be high when more than one fetus is making the protein.
• Ultrasound

COMPARISON BEWEEN IDENTICAL & FRATERNAL TWINS :

Identical twins :
Identical (monozygotic) twins and triplets come from a single egg that has been fertilized by one sperm.

Identical twins :

• Are always the same sex and blood type.
• Do not always look alike.
• May look like mirror images of each other.
One child may be right-handed while the other is left-handed.


Fraternal twins

Fraternal (dizygotic) twins develop when separate eggs are fertilized by different sperm.
• Tend to run in families .
• Are born most frequently to women who are white or of African descent.
• Can be of different sexes and have different blood types.
• May look very different from one another, with different-colored hair and eyes; they may also look alike, as siblings tend to do.

Possible complication of multiple pregnancy:

• Preterm labor and birth.
• Pregnancy-induced hypertension .
• Anemia.
• Birth defects.
• Twin-to-twin transfusion syndrome.
• Abnormal amounts of amniotic fluid.
• Cesarean delivery.
• Postpartum hemorrhage.

Labor and delivery of multiple pregnancy

• Delivery often occurs earlier – before the usual 38-42weeks.
• Consideration will be given to the position and number of fetuses present , their condition during labor and whether they are preterm .
• One or both of the twins may need to be delivered by cesarean birth.

• If both are head first , they are more likely to be delivered.
• vaginally.
• A pediatrician or neonatalogist will examine the babies .
• During labor each of the fetuses heart rates should be monitered.

Multifetal pregnancy reduction :

Management of multiple pregnancy

Management of multiple pregnancy may include the following:
• Increased nutrition
• Mothers carrying two or more fetuses need more calories, protein, and other nutrients, including iron. Higher weight gain is also recommended for multiple pregnancies.

• More frequent prenatal visits (to check for complications and to monitor nutrition and weight gain).
• Increased rest
• Some women may also need bedrest - either at home or in the hospital depending on pregnancy complications or the number of fetuses. Higher-order multiple pregnancies often require bedrest beginning in the middle of the second trimester.

• Cervical cerclage

• Cerclage (a procedure used to suture the cervical opening) is used for women with an incompetent cervix. This is a condition in which the cervix is physically weak and unable to stay closed during pregnancy. Some women with higher-order multiples may require cerclage in early pregnancy.