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Multiple Pregnancies

Multiple pregnancies can involve twins, triplets or more. Risks increase with the number of fetuses and include premature birth and mortality. Multiple pregnancies are more common in older mothers, those of African descent, and due to fertility treatments. Twins can be either monozygotic (identical) or dizygotic (fraternal) depending on whether they originate from one or two zygotes. Monozygotic twins share the same DNA while dizygotic twins are genetically unique individuals. Complications can arise when twins share chorionic and amniotic sacs.

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649 views26 pages

Multiple Pregnancies

Multiple pregnancies can involve twins, triplets or more. Risks increase with the number of fetuses and include premature birth and mortality. Multiple pregnancies are more common in older mothers, those of African descent, and due to fertility treatments. Twins can be either monozygotic (identical) or dizygotic (fraternal) depending on whether they originate from one or two zygotes. Monozygotic twins share the same DNA while dizygotic twins are genetically unique individuals. Complications can arise when twins share chorionic and amniotic sacs.

Uploaded by

veegeer
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Multiple pregnancies(births)

• When more than one fetus is carried to the


term in a single pregnancy,
• it is called “multiple pregnancy”.
• Common multiples are twins and triplets.
MULTIPLE PREGNANCIES
• Higher risks of fetal morbidity and mortality.
• Risks increase with increase in number of
fetuses.
• More common because of ovulation
inducing drugs and IVF techniques.
• Older females have increased chance.
• Women of African descent also have more
chances of multiple pregnancy.
Multiple pregnancies in humans are
usually delivered before the full
term (of 40 weeks) gestation.

The average length of multiple


pregnancy is around;
36 weeks for twins,
34 weeks for triplets,
32 weeks for quadruplets.
Twins and fetal membranes
• Twins originating from two zygotes are
dizygotic(DZ) or fraternal twins.
• Twins originating from one zygote are
monozygotic(MZ) or identical twins.
• About 2/3 of twins are DZ.
• The frequency of MZ is about the same in
all populations.
• The rate of DZ twinning increases with
maternal age.
What is Hellin’s law?
Hereditary influence
• DZ twinning shows a tendency to repeat in
families.
• If the first born are twins,a repetition of
twining is about five times more likely in
the next pregnancy.
DZ twins
• Formed by the fertilization of two oocytes
by different sperms.
• Could be of same sex or different sex.
• Genetically not alike.
• “Womb mates”.
• Always have two amnions and two
chorions but the chorions and placentas
may fuse.
MZ twins
• Formed by the fertilization of one oocyte
and develop from one zygote.
• Are of the same sex,genetically identical
and very similar in physical appearance.
• Physical differences if any are caused by
the environment
• (e.g.,anastomosis of placental vessels)
In triplets, all the three babies need not
be of the same sex.
• It is possible to have a combination of MZ and DZ.

•Example
• a triplet may have one fraternal
baby from one egg plus identical
twins from the other.
•This is called “polyzygotic birth”.
MZ twinning
• Usually begins in blastocyst stage around
the first week and results in the division of
the inner cell mass into two embryo blasts.
• Each has its own amnion and share a
common placenta
• (monochorionic –diamniotic twin placenta)
MZ twinning

Uncommonly,early separation of
blastomeres(during 2-8cell stage)results in
MZ twins with two chorions, two amnions
and two placentas( which may fuse).
MZ twinning
MZ twinning

How identical twins can be formed.


A divides at two cell stage (most identical).
B: divides at about 5 days, creates mirror
image identical twins
C: divides around day 9, mirror image twins,
but now only one sac (dangerous because
cords can become tangled).
If division happens after day 10, can create
conjoined twins.
MZ twins
• Late division of the embryonic disc(during
second week) results in MZ twins having
one amnion and one chorionic sac.
•A monochorionic-monoamniotic twin
placenta is associated with a 50%fetal
mortality.

•Their umbilical vessels are so


entangled that it results in cutting off
circulation to one or both fetuses.
TTTS(Twin To Twin Transfusion Syndrome)
Also sometimes known as 'FFTS' (Feto-Fetal
Transfusion Syndrome), and as 'TOPS' (Twin
Oligohydramnios-Polyhydramnios Sequence),
TTTS is a disease of identical twin fetuses caused
by abnormal connecting blood vessels in the twins'
placenta.
This results in an imbalanced flow of blood
from one twin to another.
This could be very serious for the survival and health
of both twins.
Once thought to be extremely rare, TTTS is now
believed to affect as many as 1 in 1000.
TTTS(Twin-twin transfusion syndrome)
(Unbalanced blood supply)
Acardiac twin

TRAP
(Twin Reversed Arterial Perfusion)
sequence in MZ
Acardiac twin
If placentas fuse, it is impossible to
determine whether the twins are DZ
or MZ.
One has to wait till
The color of the eyes or
the finger prints develop to do so.

Monochorionic diamnionic
twin placenta
zygosity Single chorion Two chorions

MZ Single amnion Two amnions Fused Two


placentas placentas
Very rare 65% 25% 10%

DZ - 40% 60%

rare
superfaetation
• Formation of a fetus when there is another fetus
already in the uterus (seen only lower animals).

Super fecundation
The fertilization of two or more oocytes around the
same time by sperms from different men.
This is commonly seen in
some mammals(cats and dogs).

DZ twins with different fathers have been


confirmed by genetic markers.
Conjoined (Siamese)twins
The developing embryo begins to
split into identical twins but stops
midway to result in a conjoined
fetus.
• 1/50,000 to 1/100,000 are
conjoined twins.

.70% are female


•75% are still born or die within
24 hours.

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