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Multiple Pregnancy for TPC

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Title: Multiple Pregnancy for TPC


1
www.totalpregnancycare.com
2
Multiple Pregnancy
  • Dr Shantala Vadeyar
  • MD, FRCOG, DM (UK)
  • Advanced Obstetric Ultrasound (RCO/RCR)
  • Subspecialist in Maternal-Fetal Medicine (RCOG)
  • Consultant Obstetrics, Fetal Maternal Medicine
  • Kokilaben Dhirubhai Ambani Hospital, Mumbai

3
Incidence
  • Increased with Assisted Reproduction
  • Clomiphene citrate / Letrozol/ HMG, hCG
  • Advanced Age
  • Race Afro-carribeans
  • 180-100

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Risks in Multiple Pregnancy
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DC twins - lambda sign
10
MC twins - T sign
11
Chorionicity v/s Zygosity
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Techniques for invasive testing
17
Loss rates Amniocentesis in Twins
18
Chorionic Villous Sampling in Twins
19
Selective Fetocide / ER
20
Management Antenatal
Maternal and Fetal Surveillance
21
Ultrasound in Multiples
  • Diagnosis and Chorionicity determinaiton
  • Dating, Chromosomal Structural Normality
  • Growth, Dopplers
  • Amniotic fluid assessment
  • Twin twin transfusion syndrome
  • Invasive procedures amniocentesis, CVS
  • Cervical length and funnelling
  • Prediction of preterm labour
  • Timing of delivery Dopplers, BPS in IUGR, etc

22
Complications in TwinsBased on Chorionicity
EVENT DICHORIONIC MONOCHORIONIC
Miscarriage (11-23 weeks) 2 10
Perinatal Death (gt23 weeks) 2 4
Fetal Growth Restriction (one /both) 20 30
Preterm delivery (lt32 weeks) 5 10
Major birth defects 1 4
23
Early screening for Preterm delivery
Prevalence of spontaneous early preterm birth
24
Twin Twin Transfusion Syndrome
  • Anastomoses in TTTS
  • Monochorionic twins
  • Donor twin is small, growth restriction
  • Recepient twin is big
  • Oligo / polyhydramnios
  • Big bladder, heart enlarged in recepient
  • Oliguria, donor
  • Abnormal Dopplers

25
Prognosis - TTTS
  • Staging (Quintero)
  • Stage I
  • Recipient hydramnios
  • Donor bladder visible/present
  • Stage II
  • Recipient hydramnios
  • Donor bladder remains empty (stuck twin)
  • Stage III
  • Abnormal Doppler studies
  • absent or reversed end-diastolic flow in Donor UA
    OR
  • abnormal venous Doppler pattern in Recipient UA
    (reverse flow in the ductus venosus or pulsatile
    umbilical venous flow)
  • Stage IV
  • Fetal hydrops means stage IV and the end
  • Stage V
  • Fetal death of one or both twins.

26
Treatment of TTTS by selective laser ablation of
A-V Anastamoses
Laser ablation
Stuck donor twin wrapped in membrane
Feely floating recipient twin In hydramnios
27
Electronic Fetal Heart Rate monitoring in labour
28
Epidural Analgesia(painless labour)
29
Timing and Mode of Delivery
  • Dichorionic twins 38 weeks
  • Monochorionic twins 36 wks
  • Vaginal delivery in uncomplicated DC or MC twins
    if cephalic, cephalic presentations
  • Precious pregnancy, abnormal presentations,
    complications like IUGR, preterm, maternal DM/HT
    usually delivered by LSCS
  • Increased risk of placenta praevia and APH, PPH

30
Complications
  • Post-partum haemorrhage
  • Bimanual massage
  • Uterotonics
  • Prophylactic Misoprostol PR
  • Syntocinon infusion
  • B Lynch Suture
  • Uterine Artery Ligation
  • Uterine Artery Embolisation
  • Hysterectomy

31
Profile
  • Total Pregnancy Care is an online guide for
    pregnancy, childbirth and motherhood related
    information. Women wanting to conceive, pregnant
    women, expecting parents, and new mothers can use
    this pregnancy portal for a healthy pregnancy,
    fulfilling childbirth and joyful motherhood. With
    pregnancy at its core, this portal covers various
    important aspects and especially addresses those
    matters that the Indian Woman always wanted to
    know but did not know whom to ask.
  • This website is compiled by Dr. Shantala, an
    Indian Obstetrician and Gynaecologist. She has
    over 20 years of extensive medical and
    diagnostics experience in areas commonly related
    to the Maternity and Pregnancy fields. She has
    studied and practiced in India as well as in the
    United Kingdom and thus brings about the fusion
    of best practices of the Oriental East and the
    Progressive West.
  • A mother of three children, she has complete
    understanding of the emotional, mental and
    physical needs of the New Age Pregnant Woman. Her
    patients appreciate her empathic approach and
    wholeheartedly express their gratitude for her
    generosity and care. Dr.Shantala is presently a
    full time Obstetrics and Gynaecology Consultant
    at the Kokilaben Dhirubhai Ambani Hospital and
    Medical Research Institute, a premier health care
    initiative of the Reliance ADA Group. Dr.Shantala
    has a clear vision to promote a holistic
    pregnancy approach and her mission is to provide
    comprehensive maternity care. This website,
    www.TotalPregnancyCare.com, is her first step
    towards this future.

32
Services Offered
  • Pre-pregnancy counseling
  • Genetic counseling
  • Antenatal care, Labour Delivery
  • Specialist Ultrasound scans
  • Viability scan
  • The First trimester scan / Nuchal translucency
    scans
  • Detailed anatomy / anomaly scans
  • Fetal Echocardiograph
  • 3D / 4D scans
  • Assessment of the High risk Fetus and Mother
  • Amniocentesis
  • Chorionic Villous sampling
  • Cordocentesis
  • Intra-uterine transfusions
  • Embryo Reduction / Selective fetocide
  • Second opinion scans

33
Topics covered
  • Pre-Conception
  • Working on getting pregnant or just starting to
    think about a family, this is the place for you
  • Pregnancy
  • From trying to conceive to the first trimester to
    labor, learn what to expect during your pregnancy
    and more
  • Labor Delivery
  • From that first contraction to the final push,
    here's what to expect during labor and delivery
  • Post-Pregnancy
  • Learn more about your diet and workouts,
    shopping, feeding and your child's health

34
Interactive Corner
  • Month by Month happenings
  • Articles
  • FAQs
  • Gestation Calendar

35
Society Memberships
  • British Maternal Fetal Medicine Society
  • Fetal Medicine Centre
  • Kokilaben Dhirubhai Ambani Hospital Medical
    Research Institute
  • Royal College of Obstetricians and
    Gynaecologists
  • International Society of Ultrasound in
    Obstetrics and Gynecology

36
Contact Us
  • Email shantala_at_totalpregnancycare.com
  • Mobile 91 9324304212
  • KDAH Board line 91 22 30999999

37
THANK YOU
www.totalpregnancycare.com
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