Updated: 11/17/2015

Multiple Gestations

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Snap Shot
  •  23-year-old G3P1011 presents for her 10 week obstetric appointment. She reports increased nausea and vomitting, making PO intake difficult. US showed three gesational sacs.
Introduction
  • Occur in 1% of pregnancies
  • Multiple gestations are considered high risk pregnancies due to increased perinatal morbidity and mortality
    • Maternal complications include
      • anemia
      • hydraminos
      • eclampsia
      • preterm labor
      • postpartum atony and hemorrhage
      • increased risk of cesarian section
      • nausea/emesis
        • increased b-hCG from multiple placentas results in higher rates of hyperemsis gravidum than singleton pregnancies.
    • Fetal complications include
      • congenital anomalies
      • spontaneous abortion
      • IUGR
      • prematurity
      • PROM
      • umbilical cord prolapse
      • placental abruption
      • placenta previa
      • malpresentation
  • Average duration of gestations decreases with multiple gestations
Classification
  • Dizygotic
    • dizygotic twins occur when 2 separate ova are fertilized by two separate sperm
    • risk increases with age and parity
    • usually have two placentas (dichorionic)
  • Monozygotic
    • represent division of fertilized ovum at various times after conception
    • can have two placentas if a single ovum divided prior to implantation
Presentation
  • Usually suspected when uterine size exceeds calculated gestational age
Evaluation
  • Can be confirmed with ultrasound
Complications
  • Twin-Twin Transfusion Syndrome
 

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