Ques. 1 What is twin pregnancy?
Ans. Definition : The simultaneous development of two embryos in the uterus is spoken of as twin pregnancy.
- Twins developed from two ova are known as Binovular twins. In biological sense, they are not really twins, but simply two individual fetuses which happen to have been conceived at or about same time. Therefore, they may be of same sex or of chorion, and amnion. Binovular twins are more common than single-ovum twins.
- Twins developed from a single ovum are known as Uniovular or “identical” twins and are only true twins in the biological sense. These are always of the same sex and are mirror image of each other. They represent complete cleavage of the blastodermic vesicle.
Causes – Exact cause is unknown (heredity is one cause).
Ques. 2 What are the clinical features signs and symptoms of twin pregnancy?
Ans. Clinical Feature – Symptoms – 1.
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QuesPost-partum haemorrhage. 9. Pre-eclampsia. 10. Hydramnios.
Differential Diagnosis –
Ques. 4 How can we diagnose the twin case of pregnancy?
Ans. Radiography provides after the 4th month, the only certainty of diagnosis during pregnancy, and without that aid, it should not be said that twins are present. In later months strong evidence is provided by the palpation of two hearts which would have a difference of at least ten beats per minute.
Ques. 5 How can a case of twin pregnancy be managed?
Ans. MANAGEMENT –
- During Labour –
- First stage – (a) rest, sedation. (b) close observation
- Second Stage – (i) usually delivery of first baby spontaneous and requires no interference ; (ii) wait and watch – if delay or distress of maternal or foetal – delivery by forceps of breech extraction ; (iii) after delivery of first baby clamp the cord of first baby distally and proximally before division to prevent bleeding from second foetus; (iv) wait an watch for second baby till uterine contraction returns (half hour). (v) with rupture of membranes- vaginal examination to exclude prolapsed of cord or limb;
In longitudinal lie, spontaneous delivery is awaited. If there is transverse lie, attempt is made to correct it by external version either cephalic, if possible, or podalic. If external version is not successful, internal podalic version is done as soon as pains start of in case of delayed onset of pains, after rupturing membranes and thereby augmenting process of labour.
After delivery of first baby, one is to clamp the cord of the first baby distally and proximally before division to prevent bleeding from second foetus in uniovular twins. – Then wait and watch for half an hour after delivery of the first baby, as the uterus usually returns its contractions at a variable period within half an hour. After birth of the baby, the lie and presentation (and also F.H.S.) of the second baby are examined per abdomen and vagina..
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