In the name of God Multi fetal pregnancy Etiology : More commonly fertilization of two ova with tow sperm double ovum or fratermal or dizygotic twins About tow third. A bout one third as often One fertilized ovum divided into two
similar structures, into a separate individual that we call it a single ovum monozygotic or Identical twins Either or both process may be involved in the formation of high number of fetuses . Genesis of monozygotic twins If division occurs within first 72 hours before the inner cell mass is formed and the outer layer of blastocyst is not commited to chorion , They will evolve two
embryoes ,with diamniotic ,dichorionic monozygotic. The frecuency 18-36% There may be two distinct placenta or may be a single fused placenta . If division occurs between the fourth and eighth day ,Two amniotic sac will be covered with a common chorion diamniotic , monochorionic ,monozygotic . If the amnion is established ,witch occurs about 8 days fertilization mono amniotic
,mono chorionic, monozygotic twin pregnancy will result . If devision is after this , that is after formation of embryonic disk cleavage is incomplete and conjoined twins are formed . 1 250 . . . . . .
. . . . Combined pregnancy:
2 . :Race 1 100 1 79. . : . : 40 7 . : . : FSH
. . : Hydatidiform mole . . 24 . :
. . %40-20 . . . HMG . IVF . : : . : : . . : Zygosity
. . . Sex and Zygosity : . : . 45XO 46XY.
Rudimentary . . . . Thoracopagus . Pyopagus Cephalic
Caudal. . thoracopagus. . . : . . . . . . . . . . .
. AF . . . Over load . . Diagnosis of multiple fetuses
History and physical examination . : 1 . LMP .
. .
Fetal part )1 18 )2 )3
)4 )5 . )6 HCG HPL , AFP, . : : : . . . : . . . . Fetus compressus Fetus papyraceous
: Perinatal mortality . . : . . . . : . 2 . 1 . . Superfetation :an interval as long as or longer than an ovulatory cycle intervens
between fertilizations (NOT DETERMINED IN HUMAN ) Superfecundation: refers to the fertilization of two ovum within a short period of time but not at the same coitus ,not necessary by the sperm from the same man %50-40 . %60-50
: Obstructive . : . Management of pregnancy with multiple fetuses
. : . . . .
. . . . . . 300 60-100 . 1
Bed rest B mimetics
. . 1 . . . 1 . . .h cc 60-120/ . 2 . : . Analgesia &Anesthesia
thiopantal+N2O +Oxygen+Succinylcholin . . Pudendal block+ N2O+Oxygen . . . . . .
. . : %6/38 Cephalic Cephalic Cephalic- Breech 5/25% Breech Cephalic 1/13% Breech Breech 2/9% Cephalic Transverse 8%
%9/3 Cephalic Cephalic . . . : :
. : . . . . . . . : . : . . . . . Breech Cephalic Lock .
: . . . Vertex Breech Fix . : . . . . : . . . ominus deceleration . . . . .
. . 10 . . . . Breech Pelvic inlet Fix Fundal . . . Cephalic Internal Pelvic Version . .
