Multiple Pregnancy: Recent Advances in Management of Multiple Pregnancy

Description

The incidence of multiple pregnancies has increased with the increasing use of assisted reproductive techniques. This super-specialty title intends to cover basic epidemiology, associated complications and management of multiple pregnancy.

Key Features

• The aim of this book is to provide a comprehensive, up to date and an evidenced-based discussion of multiple pregnancy and recent advances in its
• management. The chapters are divided in such a way that all three trimesters are discussed separately with all the relevant details. Pedagogical features
• like learning objectives, key learning points, text in highlighted boxes throughout the chapters provide the essential knowledge.
• Ideal for postgraduate students – MS and DNB, practitioner segment in obstetrics and gynaecology

Table of Contents

1. Section I: Background
   1. 1. Epidemiology/Incidence of Multiple Pregnancy
      1. Tiran Dias and Amarnath Bhide
      2. Introduction
      3. Ethnic Variation
      4. Familial Tendency
      5. Geographical Variation
      6. Genetics of Twins
      7. Reproductive Age
      8. Assisted Reproductive Techniques
   2. 2. Classification of Multiple Pregnancy
      1. Tiran Dias and Amarnath Bhide
      2. Introduction
      3. Classification of Multiple Pregnancy
   3. 3. Mechanism of Multiple Pregnancy/Aetiology
      1. Tiran Dias
      2. Introduction
      3. Zygosity
      4. Chorionicity and Amnionicity
   4. 4. Placentation in Multiple Pregnancy
      1. AAH Priyani
      2. Introduction
      3. Zygosity
      4. Placentation in Multiple Pregnancy
      5. Placental Growth During Pregnancy
      6. Twin Growth Discordance and Related Placental Characteristics
      7. Vascular Anastomoses and Related Complications
      8. Monoamniotic Twinning
2. Section II: Antenatal Management of Multiple Pregnancy: Early Pregnancy
   1. 5. Confirmation of Viability and Assessing Number of Fetuses
      1. Tiran Dias and Amarnath Bhide
      2. Introduction
      3. Confirmation of Viability and Assessing the Number of Fetuses
      4. Vanishing Twin
   2. 6. Assessment of Gestational Age
      1. Tiran Dias and Amarnath Bhide
      2. Introduction
      3. Crown–Rump Length or Last Menstrual Period to Date the Pregnancy?
      4. Can Singleton Charts be Used Reliably to Date Twin Pregnancies?
      5. Should Pregnancy be Dated by Measurements of the Larger Twin,
      6. Smaller Twin or Their Average?
      7. Gestational Age Assessment After the First Trimester
      8. Gestational Age Assessment in IVF Multiple Pregnancy
   3. 7. Assessment of Chorionicity
      1. Tiran Dias and Amarnath Bhide
      2. Introduction
      3. Ultrasound Determination of Chorionicity
   4. 8. Antenatal Labelling
      1. Tiran Dias and Amarnath Bhide
      2. Introduction
      3. Antenatal Labelling
3. Section III: Aneuploidy Risk Assessment in Multiple Pregnancy
   1. 9. Principles of Aneuploidy Screening in Multiple Pregnancy
      1. Tiran Dias
      2. 9.1 Introduction
      3. 9.2 Assessment of the Aneuploidy Risk with Regard to Zygosity, Chorionicity and Maternal Age
   2. 10. Aneuploidy Risk in Multiple Pregnancy and Assessment: Ultrasound and Serum Biochemistry
      1. Tiran Dias
      2. Introduction
      3. First-Trimester Risk Assessment Using Nuchal Translucency in Twin Pregnancy
      4. First-Trimester Combined Screening
      5. Second-Trimester Maternal Serum Screening
      6. Integrated Screening for Chromosomal Aneuploidy in Twins
      7. Second-Trimester Ultrasound Screening for Aneuploidy in Twin Pregnancies
   3. 11. Non-invasive Methods of Risk Assessment in Twins
      1. Tiran Dias
      2. Introduction
      3. Fetal Gender Determination in Twin Pregnancy
      4. Twin Zygosity Determination Using Maternal Plasma DNA Analysis
      5. Fetal Chromosomal Aneuploidy Detection Using Sequencing of Maternal Plasma DNA
      6. Prenatal Diagnosis of Pregnancy Complications
      7. Noninvasive Prenatal Diagnosis of Twins Using Circulating MicroRNAs in Maternal Plasma
   4. 12. Invasive Methods of Screening in Multiple Pregnancy
      1. Tiran Dias
      2. Introduction
      3. Counselling in Invasive Testing
      4. Principles of Invasive Diagnostic Procedures
      5. Amniocentesis
      6. Chorionic Villus Sampling
   5. 13. Managing Twins Divergent for Karyotypic Abnormalities
      1. Tiran Dias
      2. Introduction
      3. Preliminary Counselling
      4. 13.3 Selective Reduction of Multifetal Pregnancies
4. Section IV: Antenatal Care in Multiple Pregnancy: Late Pregnancy
   1. 14. Antenatal Fetal Monitoring
      1. Tiran Dias
      2. Introduction
      3. Uncomplicated MCDA Twins
      4. Uncomplicated DCDA Twins
      5. Uncomplicated MCTA or DCTA Triplets
      6. Uncomplicated TCTA Triplets
      7. Assessments at Each Ultrasound Scan
      8. Nutritional Supplements
      9. Separate Growth Reference Ranges
   2. 15. Perinatal Morbidity and Mortality in Twins
      1. Tiran Dias
      2. Introduction
      3. Potential Contributors for Morbidity
      4. Cerebral Palsy
      5. Cognitive Impairment
      6. Any Major Disability
      7. Early Pregnancy Loss in Twins
5. Section V: Planning of Delivery in Multiple Pregnancy
   1. 16. Planning of Delivery in Multiple Pregnancy
      1. Tiran Dias
      2. Introduction
      3. Timing of Delivery
      4. 17. Mode of Delivery
      5. Tiran Dias
      6. Introduction
      7. Intrapartum Management of Multiple Pregnancies
      8. Route of Delivery
      9. Time Gap Between Delivery of Twins
      10. Anaesthesia (Pain Relief in Multiple Pregnancies)
      11. Caesarean Section
      12. Vaginal Birth After Caesarean Section in Twin Pregnancy
      13. Section VI: Maternal Implications in Multiple Pregnancy
   2. 18. Physiological Changes in Pregnancy
      1. Carmeline Motha
      2. Introduction
      3. Cardiovascular System
      4. Renal System
      5. Respiratory System
      6. Haematological System
      7. Endocrine System
      8. Glucose Metabolism
      9. Lipid Metabolism
      10. Protein Metabolism
   3. 19. Implications of Multiple Pregnancy on Physiological Adaptations
      1. Carmeline Motha
      2. Introduction
      3. Physiological Adaptations
6. Section VII: Problem-Based Management of Twin Pregnancy Complications in First Trimester
   1. 20. Chromosomal Defects and Twinning
      1. Tiran Dias and Amarnath Bhide
      2. Introduction
      3. Chromosomal Defects and Twinning
   2. 21. Complications Unique to Egg Splitting
      1. Tiran Dias and Amarnath Bhide
      2. Introduction
      3. First-Trimester Detection of Fetal Structural Anomalies
      4. Monoamniotic Twins
      5. Twin Reversed Arterial Perfusion
      6. Conjoined Twins (Siamese Twins)
      7. Fetus in Fetu
   3. 22. Vanishing Twin Sequence
      1. Tiran Dias and Amarnath Bhide
      2. Introduction
      3. Vanishing Twin Sequence
7. Section VIII: Problem-Based Management of Twin Pregnancy Complications in Second Trimester
   1. Twin-to-Twin Transfusion Syndrome (TTTS)
      1. Tiran Dias
      2. Introduction
      3. Twin-to-Twin Transfusion Syndrome
   2. Selective Fetal Growth Restriction (sFGR) 236
      1. Tiran Dias and Amarnath Bhide
      2. Introduction
      3. Classifi cation of sFGR
      4. Type I sFGR
      5. Type II sFGR
      6. Type III sFGR
      7. Late-onset sFGR
   3. Twin Anaemia-Polycythaemia Sequence (TAPS)
      1. Tiran Dias and Amarnath Bhide
      2. Introduction
      3. Diagnosis and Classification of TAPS
      4. Treatment
      5. Outcome
   4. Discordant Amniotic Fluid Index 258
      1. Tiran Dias
      2. Introduction
      3. Amniotic Fluid Index
      4. Physiology of Amniotic Fluid Production
      5. Discordant Amniotic Fluid Index
   5. Congenital Malformations in Twins
      1. Tiran Dias
      2. Introduction
      3. Congenital Malformations in Twins
   6. Co-twin Demise
      1. Tiran Dias
      2. Introduction
      3. Definition
      4. Factors Causing the Risks to the Remaining Co-Twin
      5. Pathophysiology
      6. Management
8. Section IX: Problem-Based Management of Twin Pregnancy Complications in Third
9. Trimester
   1. Discordant Fetal Size and Fetal Growth Restriction
      1. Thilina Palihawadana
      2. Introduction
      3. Growth Discordance
      4. Fetal Growth Restriction
      5. High Perinatal Mortality
   2. Preterm Delivery
      1. Thilina Palihawadana
      2. Introduction
      3. Delivery in Monoamniotic Twins
10. Section X: Medical Complications of Multiple Pregnancy
    1. Medical Complications of Twin Pregnancy
       1. Carmeline Motha
       2. Introduction
       3. Gestational Diabetes Mellitus
       4. Hypertensive Disorders in Pregnancy
       5. Hyperemesis Gravidarum
       6. Peripartum Cardiomyopathy
11. Section XI: Management of Delivery Complications in Multiple Pregnancy
    1. Malpresentations in Twin Vaginal Delivery
       1. Thilina Palihawadana
       2. Introduction
       3. Proportion and Risks of Malpresentation and Malpositions
       4. Twin Delivery in the Presence of Malpresentations and Malpositions
       5. Malpresentations in the Twins at Vaginal Delivery and Perinatal Outcome
       6. Delivery of Second Twin in a Nonvertex Presentation
    2. Intertwin Delivery Interval at Vaginal Delivery of Twin Pregnancies
       1. Thilina Palihawadana
       2. Introduction
       3. Mechanisms of Prolonged Intertwin Delivery at Twin Vaginal Delivery
       4. Intertwin Delivery Interval and the Perinatal Outcome
       5. Optimal Time for Intervention in Prolonged Intertwin Delivery
12. Section XII: Obstetric Emergencies in Twin Pregnancy
    1. Epidemiology of Antepartum Haemorrhage (APH)/Postpartum Haemorrhage (PPH) and Other Obstetric Emergencies in Twins
       1. Tiran Dias
       2. Introduction
       3. Antepartum Haemorrhage
       4. Morbidly Adherent Placenta
       5. Placental Abruption
       6. Velamentous Cord Insertion and Vasa Praevia
       7. Postpartum Haemorrhage
       8. Index

Author Biography

Thiran Dias

Amarnath Bhide

Affiliations and Expertise
Consultant in Maternal-Fetal Medicine and Obstetrics, St. George’s Hospital, London, UK Honorary Senior Lecturer, St. George’s University of London Scientific Editor, BJOG: An International Journal of Obstetrics & Gynaecology Formerly, Professor and Unit Head, Nowrosjee Wadia Maternity Hospital, Mumbai, India