Multiple Pregnancy for TPC

Category: Others/ Misc

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Multiple Pregnancy for TPC


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Multiple Pregnancy:

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


Incidence Increased with Assisted Reproduction Clomiphene citrate / Letrozol/ HMG, hCG Advanced Age Race – Afro-carribeans 1:80-100

Risks in Multiple Pregnancy:

Risks in Multiple Pregnancy

DC twins - lambda sign:

DC twins - lambda sign

MC twins - T sign:

MC twins - T sign

Chorionicity v/s Zygosity:

Chorionicity v/s Zygosity

Techniques for invasive testing :

Techniques for invasive testing

Loss rates: Amniocentesis in Twins:

Loss rates: Amniocentesis in Twins

Chorionic Villous Sampling in Twins:

Chorionic Villous Sampling in Twins

Selective Fetocide / ER:

Selective Fetocide / ER

Management: Antenatal:

Management: Antenatal Maternal and Fetal Surveillance

Ultrasound in Multiples:

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

Complications in Twins: Based on Chorionicity:

Complications in Twins: Based on Chorionicity EVENT DICHORIONIC MONOCHORIONIC Miscarriage (11-23 weeks) 2% 10% Perinatal Death (>23 weeks) 2% 4% Fetal Growth Restriction (one /both) 20% 30% Preterm delivery (<32 weeks) 5% 10% Major birth defects 1% 4%

PowerPoint Presentation:

Delivery <34 wks 1.8% Spontaneous 2/3 rd Iatrogenic 1/3 rd Previous affected pregnancy (15%) Nulliparous / No previous PTD (85%) Prevalence of spontaneous early preterm birth 25% reduction (4% of total) Cervical cerclage or Progesterone Early screening for Preterm delivery

Twin Twin Transfusion Syndrome:

Twin Twin Transfusion Syndrome Monochorionic twins Donor twin is small, growth restriction Recepient twin is big Oligo / polyhydramnios Big bladder, heart enlarged in recepient Oliguria, donor Abnormal Dopplers Anastomoses in TTTS

Prognosis - TTTS:

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.

Treatment of TTTS by selective laser ablation of A-V Anastamoses:

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

Electronic Fetal Heart Rate monitoring in labour:

Electronic Fetal Heart Rate monitoring in labour

Epidural Analgesia (painless labour):

Epidural Analgesia (painless labour)

Timing and Mode of Delivery:

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


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


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,, is her first step towards this future.

Services Offered:

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

Topics covered:

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

Interactive Corner:

Interactive Corner Month by Month happenings Articles FAQs Gestation Calendar

Society Memberships:

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

Contact Us:

Contact Us Email: Mobile: +91 9324304212 KDAH Board line: +91 22 30999999

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