gemelli 2 juli 2011
TRANSCRIPT
GEMELLIMentor:
Dr. Pim Gonta, SpOG
Presentant:RenieMariaRicco
Grace AlvinaSteffanus S
SteffiVera
DEFINITION
Pregnancy with two fetus or more.
EpidemiologyGreulich (1930), the frequency of
gemelli in 121 pregnancies are:◦Gemelli 1 : 85◦Triplet 1 : 7.629◦Kuadruplet 1 : 670.743◦Quintiplet 1 : 41.600.000
`
UK data showing temporal trend since 1985 in incidence of twin (solid line, left y axis) and triplet pregnancies (dashed line, right y axis)/1000
maternities (Source: UK Office National Statistics).
Factors that influencing twinningRace.Heredity.Maternal age.Parity.Drugs for ovulation induction and
in vitro fertility (clomid and gonadotropin hormone).
Classification Monozygotic Twins/
identical Dizygotic twins/fraternal
1 ovum, 1 sperm cell and can divide into 2 parts.
Separation time:◦ 3rd /72 hours : 2
amnions, 2 chorions, 2 placentas.
◦ 4th-8th : monozygot, diamnion, monochorion.
◦ 8th-13th :monozygotic, monoamnion, monochorion.
◦ >13th : have embrionic discuscojoined twins/ siamse twins.
2 ovums, 2 sperm cell.
Will have 2 amnions, 2 chorions, 2 placentas but sometimes the placentas can grow to become 1.
TYPE
1. Monozygotic→ from one egg.- Identical twin.- 1/3 from all gemelli.- Death rate ↑
2. Dizygotic→ from two eggs.- Fraternal twin.- 2/3 from all gemelli.
FETAL GROWTHLower birth weight than singleton
pregnancy.Higher incidences for preterm labor.In monozygotic blood vessel
anastomosed to blood vessel in placenta→ anomalies (monstrum) and fetal transfusion syndrome.
In dizygotic one of the fetus is death and still left inside the uterus, become a papiraseus fetal or become a mola.
Segmentation is delayed → after the primitive streak → conjoined twin.
Conjoined twin: ◦thoracophagus (40%).◦sipho-omphalophagus (35%).◦phigophagus (18%).◦ischiophagus (16%).◦craniophagus (12%).
Conjoined twins delivered at 22
weeks and showing a
shared liver.
Conjoined twins in which one was anencephalic.
PositionsBoth of Head presentation : 45 %1 head presentation, 1 breech
presentation : 35 %Both of breech presentation :
10%1 vertical, 1 horizontal : 3%Both of horizontal : 1%
POSITION AND PRESENTATION
SIGN AND SYMPTOMPreterm labor.Anemia.Hydramnion.Pre-eclampsy and eclampsy.Solutio placenta.Shortness of breath, polyuria,
oedema and varices in lower extremities and vulva.
DIAGNOSTICProbably Gemelli :1. Uterine size bigger than ussual.2. Uterine growth faster in several
examination.3. Maternal weight gain over than
normal which not due to oedema or obesity.
4. Many small parts of fetus are palpable.
5. Three or more big parts are palpable.
6. Two ballotements are palpable.
DIAGNOSIS
1. Feel two heads, two buttocks and one or two backs.
2. Hear two fetal heart with different speed at least ten times per minute.
3. Sonogram for diagnosis gemelli in first trimester.
4. Rontgen. 5. USG.
DIFFERENTIAL DIAGNOSIS
1. Hidramnion.2. Pregnancies with myoma uterine
or ovarium cyst.
COMPLICATIONMother :
◦ Anemia◦ Hypertension◦ Preterm labor◦ Atonia uterine◦ Postpartum
bleeding
Fetus :◦ Hydramnion◦ Malpresentation◦ Placenta previa◦ Solutio placenta◦ Premature rupture of
membrane◦ Funiculus prolapsed◦ Delayed fetal growth◦ Congenital
anomalies◦ Perinatal morbidity
and mortality ↑
PREGNANCY CAREAntenatal care. More bed rest is recommended. Use of korset.
INTRAPARTUM CAREPrepare the resucitation for the
baby.Indication for SC : first fetal in
transverse position, funiculus prolapsed, placenta previa.
PROGNOSISMore dangerous in mother.Perinatal mortality is high.Mortality of second child is
higher.Mortality of monozygotic is
higher than dizygotic.
THANK YOU