MULTIPLE CHILDBIRTH

COMPLICATIONS

Aurodeep DasguptaB.P.T. 4th Year

BIMLSBURDWAN

INTRODUCTION A multiple birth is the culmination of one

multiple pregnancy, wherein the mother delivers two or more offspring.

In humans, the average length of pregnancy (two weeks fewer than gestation) is 38 weeks with a single fetus. This average decreases for each additional fetus: to thirty-six weeks for twin births, thirty-two weeks for triplets, and thirty weeks for quadruplets. With the decreasing gestation time, the risks from immaturity at birth and subsequent viability increase with the size of the sibling group. Only as of the twentieth century have more than four all survived infancy.

Recent history has also seen increasing numbers of multiple births. In the United States, it has been estimated that by 2011, 36% of twin births and 78% of triplet and higher-order births resulted from conception by assisted reproductive technology.

TERMINOLOGY Terms used for multiple births or the

genetic relationships of their offspring:Monozygotic – multiple (typically two)

fetuses produced by the splitting of a single zygote

Di-zygotic – multiple (typically two) fetuses produced by two zygotes

Poly-zygotic – multiple fetuses produced by two or more zygotes

Terms used for the number of offspring in a multiple birth:Two offspring - twinsThree offspring - tripletsFour offspring - quadrupletsFive offspring - quintupletsSix offspring - sextupletsSeven offspring - septupletsEight offspring - octupletsNine offspring - nonuplets

An example of twin brothers

FACTORS THAT INCREASE THE CHANCE OF MULTIPLE CHLDBIRTH

Naturally Occurring Ways of Increasing the Chance of Multiple BirthsHeredity

A family history of multiple pregnancy increases the chances of having twins.

Older Age Women over 30 have a greater chance of a

multiple birth. Multiple births more common due to today's

increase in the number of births later in women's lives.

High Parity Having one or more previous multiple

pregnancies increases the chances of having multiples.

Race African-American women are more likely to have

twins than any other race. Caucasian women, especially those over age 35,

have the highest rate of higher-order multiple births (triplets, quadruplets etc.).

Unnatural Methods in Increasing the Chance of Multiple BirthsOvulation-stimulating Technologies

Help produce many eggs, which if fertilized, can result in multiple births.

Assistive Reproductive Technologies Allows multiple eggs to be fertilised & then

returned to the uterus to develop. Example= In-vitro fertilization(IVF).

HOW MULTIPLE PREGNANCY OCCURS Fraternal Twinning

The result of the release & fertilisation of two eggs cells at ovulation

Non identical- produced from different sperm and egg. Differs in gender.

Maternal twinning Result of one egg fertilization and becomes

zygote. It then divides into two or more embryos, developing into different babies.

Identical twins- embryos are of same genetic make-up. Are of same gender.

FRATERNAL VS. MATERNAL TWINS

DIAGNOSIS Diagnosis mainly done by-

History of (i) ovulation inducing drugs. (ii) family history.

General examinationAbdominal examination-

Inspection Palpation Auscultation

INVESTIGATION Sonography-

A diagnostic imaging technique based on the application of ultrasound. It is used to see internal body structures such as tendons, muscles, joints, vessels and internal organs. Its aim is often to find a source of a disease or to exclude any pathology. The practice of examining pregnant women using ultrasound is called obstetric ultrasound, and is widely used.

In this case, it is used to examine the foetus in intra-uterine state.

An Indian woman gave birth to 11 live babies on 11/11/11.

COMPLICATIONS MEDICAL COMPLICATIONS:-

Anemia is more due to increased iron and folate requirement by the two fetuses. Deficiency of folic acid leads to increased incidence of megaloblastic anemia.

Preeclampsia is increased three times over singleton pregnancy. Exposure to superabundance of chorionic villi is the possible explanation.

Nausea and vomiting occurs with increased frequency and severity.

Preterm Labour Nearly half of all twins or higher-order multiples

are premature births (born before 37 weeks) The higher the number of fetuses in the

pregnancy=greater risk of early birth Premature babies: born before body & organs

have not fully matured They are small & may need help breathing,

eating, fighting infection, & staying warm

Birth Defects Multiple birth babies have about twice the

risk of congenital abnormalities including neural tube defects and heart abnormalities.

Miscarriage More likely in multiple pregnancies More than one fetus is diagnosed, but

vanishes (or is miscarried), usually in the first trimester (three months)

Sometimes accompanied by bleeding. The risk of pregnancy loss is increased in later trimesters as well.

Twin-to-Twin Transfusion SyndromeCondition of the placentaOnly develops with identical twins that

share a placentaBlood vessels are connected within the

placenta and divert blood from one fetus to the other

Occurs in about 1 in 7 twins with a shared placenta.

Abnormal Amounts of Amniotic FluidMore common in multiple pregnancies,

especially for twins that share a placenta Caesarean Delivery

Abnormal fetal positions increases chances of caesarean birth

Postpartum Haemorrhage In many multiple pregnancies; the large

placental area places mother at risk of bleeding after delivery

NON-MEDICAL COMPLICATIONS:- Many mothers of multiple births find

breast-feeding their babies difficult. Different diets and lifestyles are required to produce enough breast-milk for the multiple babies.

Severe lack of sleep is a common problem with a single child, but with multiple births, many parents require respite programs to help with the difficult situation.

REFERENCES DC Dutta’s Textbook of OBSTETRICS WIKIPEDIA SlideShare

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