Obstetrics

Jun 13th, 2016
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University of Washington School of Medicine. Harborview Medical Center
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the best notes on multiple pregnancies

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MULTIPLE PREGNANCIESObjectives To understand the pathogenesis of multiple pregnancyTo understand the types of multiple pregnancyTo understand the associated complicationsTo internalize the associated clinical featuresTo understand the general principles of managementIntroductionMay be monozygotic twins (identical twins) which occur in approximately 2.3 4 per 1000pregnancies in all races-not influenced by heredity, maternal age or other factorsDizygotic twins (fraternal twins)-from separately fertilized ova-make nearly 70% of twins-has hereditary determinantsIncidence of twins and higher order multiple gestations has increased-primarily due to ovulation inducing drugs and assisted reproductive technology (ART twins,comprise 25 30% of all deliveries)-now 3% of all pregnanciesPathogenesisa) Monozygotic Multiple GestationFrom fertilization of single ovum by single spermMay develop differently depending on time of pre-implantation divisionNormally share same physical characteristics (hair, skin, eye colour, body build)Normally share same genetic features (blood characteristics e.g. ABO, and histocompatiblegenes hence skin grafting possible)Often mirror image of one another e.g. if one left handed the other right handedDiffer in finger printsMay be opposite of one another in the very earliest splits which results in:o Simultaneous

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