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Multiple Pregnancy

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When more than one foetus simultaneously develops in the uterus, it is called multiple pregnancy. Two foetus are twins and the commonest.

They are of 2 types:
Binovular twins (fraternal, dizygotic)- This results from fertilization of 2 ova (eggs), by two different sperms during same ovarian cycle. The babies bear only fraternal resemblance to each other (That of brother & sister of different birth). They have two separate placenta & membranes.

Uniovular twins (identical, monozygotic)- Twinning occurs at different periods after fertilization. The placenta & membranes are one. Uniovular twins are always of same se

Incidence
Of twins depends upon- race, hereditary, advancing age of mother, as the number of children increase the chances of twins increase, ovulation inducing drugs (as in infertility treatment). The commonest presentation & lie of the foetus is longitudinal (like in normal pregnancy). But malpresentations are quite common


Diagnosis:
Persons having history of taking ovulation inducing drugs (treatment for infertility) and family history of twins. Mild ailments of pregnancy are exaggerated like increased vomiting, breathing difficulty, swelling of legs, unusual rate of abdominal enlargement, excessive foetal movements. On examination abdomen is enlarged more than what it should be at that month, multiple foetal parts are felt. Two distinct foetal heart is heard.

Sonography confirms the diagnosis.

Complications:
Anaemia, pre-eclampsia, hydramnios, antepartum haemorrhage, malpresentation, preterm labour, mechanical distress, early rupture of membrane, prolonged labour, postpartum haemorrhage. As far as foetus is concerned chances of abortion, prematurity, intrauterine death and still birth are seen.

Management:
During antenatal period a good diet, supplement therapy of iron, calcuim, vitamin & folic acid, avoid physical & mental stress, regular & frequent antenatal check ups are a must. If position of the babies are longitudinal (normal) normal delivery is of choice. Both babies are delivered one by one. As the babies are relatively small there is no difficulty in delivering them.

Indication of Caesarean Section:
Problems associated with pregnancy like small pelvis, low lying placenta (placenta previa), severe toxaemia, previous caesarean section etc.
Malpresentation, abnormal position of the twins or twins which are attached to each other will require caesarean section.