Multiple pregnancy is used to describe the development of more than one fetus in the uterus at the same time. It is a high risk pregnancy. Careful supervision and proper monitoring is needed for prevention of further complications.

1. PRESENTATION ON
TWIN PREGNANCY
MS LIPI MONDAL
SENIOR TUTOR,JCN

2. DISEASE CONDITION
• Introduction: The term, ‘Multiple Pregnancy’ is used to describe the development of more
than 1 fetus in uterus at the same time. Families are expecting a multiple birth have
different health needs, requiring extra practical support and understanding throughout the
pregnancy, the postnatal period and the early years.
• Definition: Simultaneous development of two fetuses in the uterus is called Twin
Pregnancy.
• Incidence: The incidence varies widely. It is the highest in Nigeria being 1 in 20 and lowest
in far eastern countries being 1 in 200 pregnancies. In India, the incidence is about 1 in 80.

3. TYPES
The common types are-
I. Binovular Twins: It is the commonest
(2/3rd ) and results from the fertilization
of two ova, most likely ruptured from
two Distinct Graffian Follicles usually of
the same or one from each ovary, by
two sperms during a single ovarian
cycle. The babies bear only fraternal
resemblance to each other (that of
brothers and sisters from different
births) and hence called fraternal twins.

4. TYPES
• Uniovular Twins: (1/3rd) results from the
fertilization of a single ovum. The
twinning may occur at different periods
after fertilization and this markedly
influences the process of implantation
and the formation of the fetal
membranes. The exact stage at which the
separation occurs, is probably after the
formation of inner cell mass (between 4th
to 8th day).

5. USG ALGORITHM

6. GENESIS OF TWINS
• Dizygotic Twins:
Diamniotic-Dichorionic
 Most common represents 2/3rd of cases. Fertilization of more than one egg by more than one sperm.
 Non identical, may be of different sex. 2 chorion and 2 amnion.
 Placenta may be separated or fused. Each fetus is contained within a complete amniotic-chorionic
membrane.
 2 completely different pregnancies.
 Risk:
 Pre-term Labour (For every extra gestation the due date is substracted by 4 weeks)
 Malpresentation (Due to lac of adequate space)
So, most cases goes under C-Section.
 PPH ( Multiple fetal centers present. So, uterus is penetrated multiple times and leads to increased chance of
PPH)

8. GENESIS OF TWINS
• Monozygotic Twins:
Dichorionic-Diamnionic
 1 egg takes part.
Split present (More separate twins, the earlier split)
Split occurs for this type in 0-3 days after fertilization in tubal phase.
2 placenta present.
 2 Sacs present.

9. GENESIS OF TWINS
Monochorionic-Diamniotic
 1 Egg Takes part.
 Split in 4-3 days in Blastocyst Phase.
 1 Placenta present.
 2 Sacs present.
 Possibility of Twin-Twin Transfusion

10. TWIN-TWIN TRANSFUSION

11. GENESIS OF TWINS
Monochorionic-Monoamnionic
 1 Egg takes part.
 1 Placenta is present.
 1 Sac is Present.
 Split present. (If in 9-12 days , UNCONJOINED. If in grater or equal to 12 days, CONJOINED)
 Risk:
 Cord Entangalment
 Conjoining of Twins.
According to my patient, Monozygotic Twins Present

12. DIFFERENT STAGES OF SEPARATION

13. TYPES OF CONJOINED TWINS

14. ETIOLOGY
The cause of twin pregnancy is not known. The frequency of monozygotic twins remains
constant,throughout the globe and is probably related to maternal environmental factors.
Prevalance of dizygotic twins related to:
 Race
 Heredity
 Adversing age of mother
 Influence of parity
 Iatrogenic In case of my patient, no significant data
found related to this.

15. CLINICAL FEATURES
Maternal Physiological Changes:
 Increased weight gain and cardiac output.
 Plasma volume is increased by an additional 500 ml. There is no corresponding
increase in red blood cell volume resulting exaggerated hemodialution and anemia.
 There is increased feto-protein level, tidal volume and GFR.
According to my patient, Acute abdominal pain, pale and fatigue, severe
blood loss is present.

16. DIAGNOSTIC PROCEDURE
 History Taking
 Physical Examination
 Abdominal Palpation
 Investigations
• Sonography (confirmation of diagnosis as early as 10th week of pregnancy, viability of fetus,
fetal anomalies, fetal growth monitoring, twin transfusion, placental localization,amniotic
fluid volume)
• Chorionicity of placenta (presence of lambda or twin peak sign indicates dischorionic
placenta)
• Radiography
• Biochemical Test (Maternal serum chorionic gonadotrophin, alpha- feto proteion and
unconjugated oestriol are approximately double those single tone pregnancy)
According to my patient, excessive weight gain,
fatigue found in history taking and physical
examination.
A monoamniotic-dichorionic twin pregnancy
with adequate liquor amnii with 37 week
gestational age found in USG.
In blood studies, Hb-15.2 gm/dl,FBS-90 mg/dl,
platelet-2.0 lac/cumm found.

32. Thank you