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INCIDENCE
Highest rate of twins in Nigeria
Lowest rate in Japan In India ,1 in 80 pregnancies
TYPES OF TWINS
DIZYGOTIC OR BINOVULAR TWINS OR
DIZYGOTIC TWINS
It is the commonest
Results from the fertilization of two ova either from
same or both the ovaries during a single ovarian cycle each by a separate sperm All dyzygotic twins have two placentae which are dichorionic and diamniotic
MONOZYGOTIC TWINS
Arises from a single fertilized oocyte by a single sperm
Conjoined twins
When splitting occurs after the 13th day of fertilization
Thoracopagus
Omphalopagus
Pyopagus
Craniopagus
Ischiopagus
DETERMINATION OF ZYGOSITY
ETIOLOGY
Ethnicity
Hereditary predisposition High parity
Maternal age
Nutrition Iatrogenic; ART,ovulation induction by clomiphene
Diagnosis
History
Symptoms General examination
Abdominal examination
INVESTIGATIONS *Sonography
Radiography
Biochemical tests
*Maternal serum chorionic gonadotrophin *Maternal serum alpha feto protein *Unconjugated oestriol
DIFFERENTIAL DIAGNOSIS
Hydramnios
Big baby Fibroid or ovarian tumour with pregnancy
of the mother specially of the cardiovascular system Cardiac output is higher Plasma volume during pregnancy is much greater Haematocrit and haemoglobin is lower than in singleton pregnancy
*Dicordant twins
Vanishing twin
Acute intertwin transfusion Chronic intertwin transfusion
Superfetation
Superfecundation Fetus acardiacus
Fetus papyraceous
COMPLICATIONS
Maternal during pregnancy
*Nausea and vomitting *Anaemia *Pre-eclampsia *Hydramnios *Antepartum haemorrhage *Malpresentation *Preterm labour *Mechanical distress
During labour
Early rupture of membranes
Cord prolapse Increased operative interference
Bleeding
Postpartum haemorrhage
During puerperium
Subinvolution
Infection Lactation failure
FETAL COMPLICATIONS
Abortion
Prematurity Intra uterine death
PROGNOSIS
management
Antenatal management