{"id":210,"date":"2020-08-13T16:23:14","date_gmt":"2020-08-13T16:23:14","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=210"},"modified":"2023-09-30T10:38:00","modified_gmt":"2023-09-30T10:38:00","slug":"20-multifetal-gestation","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/basic_obgyn\/overview\/20-multifetal-gestation\/","title":{"rendered":"20. Multifetal Gestation"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/wUmUXknh_ls\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 7:42<\/p>\n<input type='hidden' bg_collapse_expand='69e9dc2217e123002433621' value='69e9dc2217e123002433621'><input type='hidden' id='bg-show-more-text-69e9dc2217e123002433621' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9dc2217e123002433621' value='Hide Transcript'><button id='bg-showmore-action-69e9dc2217e123002433621' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9dc2217e123002433621' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number twenty<br \/>\n00:02<br \/>\nmulti fetal gestation since nineteen<br \/>\n00:05<br \/>\neighty there has been a 70 percent<br \/>\n00:06<br \/>\nincrease in the frequency of twins and a<br \/>\n00:08<br \/>\nfour hundred percent increase in triplet<br \/>\n00:10<br \/>\nand higher order births these rates are<br \/>\n00:13<br \/>\nrising as a result of an increase in<br \/>\n00:14<br \/>\nmaternal age and the increased use of<br \/>\n00:16<br \/>\nassisted reproductive technologies and<br \/>\n00:18<br \/>\novulation induction agents the<br \/>\n00:20<br \/>\nobjectives of this video are to list<br \/>\n00:22<br \/>\nrisk factors for multi fetal gestation<br \/>\n00:24<br \/>\nto describe the embryology diagnosis and<br \/>\n00:27<br \/>\nmanagement of multi fetal gestation and<br \/>\n00:29<br \/>\nto describe the unique maternal and<br \/>\n00:32<br \/>\nfetal physiologic changes and<br \/>\n00:33<br \/>\ncomplications associated with multi<br \/>\n00:35<br \/>\nfetal gestation monozygotic twins<br \/>\n00:37<br \/>\notherwise known as identical twins<br \/>\n00:39<br \/>\nresult when a fertilized ovum divides<br \/>\n00:41<br \/>\nafter conception the timing of when this<br \/>\n00:44<br \/>\ndivide occurs will decide the Corey<br \/>\n00:45<br \/>\nAnissa T if division occurs within the<br \/>\n00:48<br \/>\nfirst three days after fertilization<br \/>\n00:49<br \/>\nthere will be two core eons to am neons<br \/>\n00:56<br \/>\nto placentas and here are the fetuses<br \/>\n01:04<br \/>\nthese will be died a me on ik die<br \/>\n01:05<br \/>\nchorionic twins if division occurs<br \/>\n01:08<br \/>\nwithin days four to eight after<br \/>\n01:09<br \/>\nfertilization the chorion has already<br \/>\n01:11<br \/>\ndeveloped and there&#8217;ll be two am neons<br \/>\n01:12<br \/>\none placenta and here are the fetuses<br \/>\n01:17<br \/>\nthese are died amniotic monochorionic<br \/>\n01:19<br \/>\ntwins if division occurs between days<br \/>\n01:22<br \/>\nnine through twelve there&#8217;ll be one Cory<br \/>\n01:24<br \/>\non one am me on one placenta and the<br \/>\n01:28<br \/>\nfetuses will be in a common sac<br \/>\n01:30<br \/>\nthese are monochorionic mono amniotic<br \/>\n01:32<br \/>\ntwins if division occurs after day 12<br \/>\n01:35<br \/>\nthen conjoined twins will develop<br \/>\n01:37<br \/>\ndizygotic twins known as fraternal twins<br \/>\n01:40<br \/>\noccur when two separate OVA are<br \/>\n01:42<br \/>\nfertilized by two separate spur the<br \/>\n01:44<br \/>\ndistinction between zygosity and Coriana<br \/>\n01:46<br \/>\ncity can be confusing for new learners<br \/>\n01:48<br \/>\nso let&#8217;s spend a moment here to<br \/>\n01:49<br \/>\nemphasize some key concepts dizygotic or<br \/>\n01:53<br \/>\nfraternal twins are all died a me otic<br \/>\n01:55<br \/>\ndied chorionic monozygotic twins or<br \/>\n01:58<br \/>\nidentical twins can be any of the three<br \/>\n02:00<br \/>\nCoriana cities monozygotic twin rates<br \/>\n02:03<br \/>\nare fairly constant around the world at<br \/>\n02:05<br \/>\n1 out of 250 pregnancies in contrast<br \/>\n02:09<br \/>\ndizygotic twin rates are markedly<br \/>\n02:11<br \/>\ndifferent in various populations<br \/>\n02:13<br \/>\nrisk factors from multi fetal gestation<br \/>\n02:15<br \/>\nare one increasing maternal age to<br \/>\n02:18<br \/>\nincreasing parity and three there are<br \/>\n02:20<br \/>\nincreased rates among mothers of<br \/>\n02:21<br \/>\nfamilies with twins all multi fetal gist<br \/>\n02:24<br \/>\nstations are at an increased risk of<br \/>\n02:25<br \/>\nprematurity twins are delivered at an<br \/>\n02:28<br \/>\naverage of 35 weeks<br \/>\n02:29<br \/>\ntriplets at 32 weeks and quadruplets at<br \/>\n02:32<br \/>\nan average of 30 weeks all multi fetal J<br \/>\n02:35<br \/>\nstations are also to increase risks of<br \/>\n02:37<br \/>\npreeclampsia congenital abnormalities<br \/>\n02:39<br \/>\nintrauterine growth restriction and<br \/>\n02:41<br \/>\nplacental abruption<br \/>\n02:42<br \/>\nlet&#8217;s now move on to risks associated<br \/>\n02:44<br \/>\nwith the specific Koreana cities die<br \/>\n02:47<br \/>\namniotic monochorionic twins referred to<br \/>\n02:49<br \/>\nas DiMeo twins are at increased risks of<br \/>\n02:52<br \/>\ndeveloping twin twin transfusion<br \/>\n02:53<br \/>\nsyndrome this is one of the most serious<br \/>\n02:55<br \/>\ncomplications of die mode twins this<br \/>\n02:58<br \/>\noccurs when there is net flow from one<br \/>\n03:00<br \/>\ntwin to another secondary to vascular<br \/>\n03:02<br \/>\nanastomosis between the fetuses there<br \/>\n03:04<br \/>\nwill be a donor twin and a recipient<br \/>\n03:06<br \/>\ntwin the donor twin can have impaired<br \/>\n03:09<br \/>\ngrowth anemia hypovolemia all ago Hydra<br \/>\n03:12<br \/>\nmeiosis and other problems the recipient<br \/>\n03:15<br \/>\ntwin can develop hypervolemia<br \/>\n03:16<br \/>\nhypertension polycythemia congestive<br \/>\n03:19<br \/>\nheart failure and polyhydramnios<br \/>\n03:21<br \/>\nendoscopic intrauterine laser ablation<br \/>\n03:24<br \/>\nof the vascular anastomosis is the<br \/>\n03:26<br \/>\nfirst-line therapy now for twin twin<br \/>\n03:28<br \/>\ntransfusion syndrome mono amniotic<br \/>\n03:31<br \/>\nmonochorionic twins otherwise known as<br \/>\n03:33<br \/>\nmomo twins are at increased risk of cord<br \/>\n03:36<br \/>\nentanglement and fetal death since the<br \/>\n03:38<br \/>\ntwo fetuses are sharing the same space<br \/>\n03:40<br \/>\nwithin the same amniotic sac let&#8217;s now<br \/>\n03:43<br \/>\nmove on to diagnosis early ultrasound<br \/>\n03:46<br \/>\ncan determine the number of fetuses<br \/>\n03:47<br \/>\nestimate the gestational age and<br \/>\n03:49<br \/>\nimportantly determine the Coriana City<br \/>\n03:51<br \/>\nCoriana City should be determined as<br \/>\n03:53<br \/>\nearly in the pregnancy as possible<br \/>\n03:55<br \/>\noptimally in the late 1st or early<br \/>\n03:57<br \/>\nsecond trimester here is an ultrasound<br \/>\n04:00<br \/>\nof a diam iana chorionic twin gestation<br \/>\n04:02<br \/>\nnote the wedge-shaped protrusion into<br \/>\n04:05<br \/>\nthe inter twin space called the lambda<br \/>\n04:07<br \/>\nsign here is an ultrasound of<br \/>\n04:09<br \/>\nmonochorionic mono amniotic twins note<br \/>\n04:12<br \/>\nthat there is no membrane between the<br \/>\n04:13<br \/>\nfetuses in contrast this ultrasound<br \/>\n04:16<br \/>\ndemonstrates dye amniotic monochorionic<br \/>\n04:18<br \/>\ntwins with the blue arrow pointing to<br \/>\n04:20<br \/>\nthe amnion that separates the fetuses<br \/>\n04:22<br \/>\nonce the diagnosis of twins has been<br \/>\n04:24<br \/>\nmade then unique care must be given to<br \/>\n04:26<br \/>\naddress the<br \/>\n04:27<br \/>\npotential concerns of multi fetal<br \/>\n04:28<br \/>\ngestation so let&#8217;s move on to management<br \/>\n04:30<br \/>\nmany medical complications are more<br \/>\n04:33<br \/>\ncommon in multi fetal gestation<br \/>\n04:34<br \/>\nthese include hyperemesis gravidarum<br \/>\n04:36<br \/>\ngestational diabetes mellitus and<br \/>\n04:38<br \/>\npostpartum depression additional<br \/>\n04:40<br \/>\nmaternal concerns that need to be<br \/>\n04:42<br \/>\naddressed are adequate nutrition twin<br \/>\n04:44<br \/>\npregnancies require an extra 300<br \/>\n04:46<br \/>\ncalories per day there is also an<br \/>\n04:49<br \/>\nincreased risk of blood loss at delivery<br \/>\n04:51<br \/>\nso pregnant women with twins should take<br \/>\n04:52<br \/>\niron to try to prevent anemia women with<br \/>\n04:55<br \/>\ntwins are also at increased risk of<br \/>\n04:57<br \/>\ndeveloping pregnancy-induced<br \/>\n04:58<br \/>\nhypertension therefore frequent blood<br \/>\n05:00<br \/>\npressure monitoring should be performed<br \/>\n05:02<br \/>\nfetal concerns include the increased<br \/>\n05:04<br \/>\nrisk of preterm labor and contractions<br \/>\n05:06<br \/>\nand patients should be educated about<br \/>\n05:08<br \/>\nthe signs of labor and assessments of<br \/>\n05:10<br \/>\nthe cervix should be performed every one<br \/>\n05:11<br \/>\nto two weeks starting in the mid<br \/>\n05:13<br \/>\ntrimester when available this should be<br \/>\n05:15<br \/>\nperformed through ultrasound assessments<br \/>\n05:17<br \/>\nof cervical length all multi fetal G<br \/>\n05:20<br \/>\nstations are at increased risk of<br \/>\n05:21<br \/>\ndiscordant growth<br \/>\n05:22<br \/>\nthus periodic ultrasound examinations<br \/>\n05:24<br \/>\nare performed to assess fetal weight<br \/>\n05:26<br \/>\nlet&#8217;s now move to timing of delivery<br \/>\n05:28<br \/>\nthis also depends on the Coriana City<br \/>\n05:31<br \/>\nuncomplicated die amniotic dye chorionic<br \/>\n05:34<br \/>\nor dye dye twins can be delivered at 38<br \/>\n05:36<br \/>\nweeks uncomplicated dye a me Attic<br \/>\n05:39<br \/>\nmonochorionic or dye move twins can be<br \/>\n05:41<br \/>\ndelivered between 34 and 37 and six<br \/>\n05:44<br \/>\nweeks uncomplicated mono amniotic<br \/>\n05:46<br \/>\nmonochorionic pregnancies or Momo twins<br \/>\n05:49<br \/>\nshould be delivered between 32 and 34<br \/>\n05:51<br \/>\nweeks this early delivery is secondary<br \/>\n05:53<br \/>\nto the risk of cord entanglement and<br \/>\n05:55<br \/>\nsubsequent fetal death the route of<br \/>\n05:57<br \/>\ndelivery will depend on the Coriana City<br \/>\n05:59<br \/>\nfetal presentation gestational age and<br \/>\n06:02<br \/>\nexperience of the clinician performing<br \/>\n06:04<br \/>\nthe delivery momo twins are often<br \/>\n06:06<br \/>\ndelivered by caesarian delivery<br \/>\n06:08<br \/>\nsecondary to the risk of cord<br \/>\n06:09<br \/>\ncomplication die die and die mode twin<br \/>\n06:13<br \/>\npregnancies are candidates for vaginal<br \/>\n06:15<br \/>\ndeliveries after 32 weeks the presenting<br \/>\n06:18<br \/>\nfetus needs to be in a cephalic<br \/>\n06:19<br \/>\npresentation 40% of twins enter labor<br \/>\n06:22<br \/>\nwith both twins in the cephalic<br \/>\n06:23<br \/>\npresentation after delivery of the first<br \/>\n06:27<br \/>\ntwin if the second twin remains cephalic<br \/>\n06:29<br \/>\nthen the second twin can be delivered<br \/>\n06:30<br \/>\nalso by vaginal delivery if the second<br \/>\n06:33<br \/>\ntwin flips two non cephalic after the<br \/>\n06:35<br \/>\ndelivery of the first win or if it<br \/>\n06:37<br \/>\nstarts out as non cephalic then<br \/>\n06:39<br \/>\nexternal cephalic version can be used to<br \/>\n06:41<br \/>\ngently guide this second twin into<br \/>\n06:43<br \/>\ncephalic presentation or the second twin<br \/>\n06:46<br \/>\ncan be delivered by breached vaginal<br \/>\n06:48<br \/>\ndelivery the approach to how best<br \/>\n06:50<br \/>\ndeliver the second twin will also factor<br \/>\n06:52<br \/>\nin clinician experience with non<br \/>\n06:54<br \/>\ncephalic presentations in summary mol\u00e9<br \/>\n06:57<br \/>\nmol\u00e9 pregnancies are delivered by<br \/>\n06:58<br \/>\ncaesarian delivery DiMeo and die die<br \/>\n07:01<br \/>\npregnancies can be delivered by vaginal<br \/>\n07:03<br \/>\ndelivery if the presenting twin is<br \/>\n07:04<br \/>\ncephalic however since all twin<br \/>\n07:06<br \/>\npregnancies are at increased risk of<br \/>\n07:08<br \/>\ncaesarean delivery some patients and<br \/>\n07:10<br \/>\nsome clinicians may choose to perceive a<br \/>\n07:12<br \/>\ncaesarean delivery with all twinges<br \/>\n07:14<br \/>\nstations regardless of Korena City and<br \/>\n07:15<br \/>\npresentation this concludes the aapko<br \/>\n07:18<br \/>\nvideo on multi fetal gestation we<br \/>\n07:20<br \/>\nreviewed the risk factors and Embryology<br \/>\n07:21<br \/>\nof these pregnancies and reviewed the<br \/>\n07:23<br \/>\nunique maternal and fetal considerations<br \/>\n07:25<br \/>\nassociated with multiple gestation<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 7:42<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":46,"menu_order":20,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-210","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/210","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/comments?post=210"}],"version-history":[{"count":4,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/210\/revisions"}],"predecessor-version":[{"id":1285,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/210\/revisions\/1285"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/media?parent=210"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}