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This Concept Map, created with IHMC CmapTools, has information related to: Multiple Gestation, Multiple Gestation Epidemiology Twins 1:90 term births Triplets 1:8000 Quads 1:730K, Multiple Gestation Clinical Sx Large-for-dates uterus ɰcm fundal ht diff Excessive wt gain Very high hCG, AFP U/S possible at 7wga R/O hydramnios, mole, Multiple Gestation Mom Complications Late Complications -Placenta previa -bigger placenta -Velamentous cord insertion -PROM in 25% (2x more) -PTL in 50% of twins, 7x higher -Malpresentation-10x higher -ᡪ% C/S -50% Cephalic-Cephalic -30% Ceph-Breech -10% Breech-Ceph -10% transverse, Multiple Gestation Fetal Complications -3-4x increased neonatal morbidity (PTL) Fetal Malformations -3x higher than singleton, Multiple Gestation DI/DI -most common Cleavage at Egg/Morula - DAY 0-3 (If monozygotic) Can be result of fertility Tx Diff gender in 30%->dizygotic Diff blood type, same sex in 27%, Multiple Gestation MO/MO Cleavage at Disk - DAY 9-12, Multiple Gestation Epidemiology 1% Spontaneous 10% Clomiphene 30% gonadotropin, Multiple Gestation Mom Complications Nutritional Anemias (Fe, folate) -higher need in multip gest PIH - 3x more likely IUGR in 25% Polyhydramnios Postpartum atony, hemorrhage -because overdistended Cesarean delivery in 50%, Multiple Gestation Fetal Complications -3-4x increased neonatal morbidity (PTL) Umbilical Cord-in MO/MO -two-vessel cord-3-4% -vasa previa -velamentous insertion-7% -marginal insertion -cord entanglement, Multiple Gestation MANAGEMENT Increased nutritional needs PTL recognition-low back pain, pelvic pressure, vaginal d/c PIH counseling U/S q4wk after 20wga -estimate AFI, fetal growth -BPP Delivery -Vaginal if first twin is vertex -Then int or external version -C/S if breech, g, Multiple Gestation MO/DI Cleavage at Blastocyst - DAY 4-6, Multiple Gestation Fetal Complications -3-4x increased neonatal morbidity (PTL) Twin-Twin Transfusion ᡑ% size discordance -unequal blood from placenta -larger twin w/ polycythemia, polyhydramnios -recipient w/ better Px, anemic, oligo, pale