Answer
Notes: Account for only 3% of all live births, they responsible of a disproportionate share of perinatal morbidity and mortality
History
- Accelerated weight gain
- Hyperemesis gravidarum
- Sensation of moving of more than one fetus
- Infertility treatment by ovulation-inducing agents or gamete/zygote transfer
- family history of dizygotic twins
Notes: certain race like Africa has higher risk factor to have multiple pregnancies.
Physical examination
- Presence of more than 2 poles (need to excludes fibroid)
- Usually, the abdomen size is bigger than corresponds date
- Polyhydramnios
- Presence of two or more fetal heart sounds on pinnard auscultation.
Classification of multiple pregnancies
a) Number of fetus (twin, triplet, quadruplets)
b) Number of fertilized egg (zygosity; mono,di)
c) Number of placenta (chorionicity)
d) Number of amniotic cavity (amnionicity)
Complication of multiple pregnancies
To the mother
1) Hyperemesis gravidarum and in fact all physiological response towards pregnancy will be exaggerated.
2) Exacerbation of chronic illness
3) Severe anemia in pregnancy
4) DIC secondary to fetal death.
5) Miscarriage
6) Preterm labour.
7) Polyhydramnios
8) Pre eclampsia.
9) Placenta abruptio
10) Post partum hemorrhage.
11) Higher risk for developing GDM
Others: acute fatty liver, pulmonary embolism
To the fetus
1) IUD of one fetus
2) IUGR
3) Fetal abnormality
4) Pre term delivery
5) Low birth weight
6) Acute respiratory distress syndrome.
7) Congenital abnormality (mental retardation, Siamese twin, cerebral palsy)
Others: twin-to-twin transfusion syndrome, Twin reversed arterial perfusion (TRAP)/ acardiac twinning