Etiology of Multiple Fetuses Dizygotic twins Monozygotic twins

Frequency of Twins Race Heredity Maternal age & Parity Nutritional factors Pituitary gonadotropin Infertility

Determination of Zygosity Assessing obstetrical risks Guiding management Sonography Placental examination Infant sex

Differential Diagnosis Multiple pregnancy H-mole Elevation or uterus by a distended bladder Uterine myoma

Pregnancy Outcome Abortion Malformation Birthweight Duration of gestation Preterm birth Prolonged pregnancy

Unique Complications Monoamnionic twins ¾ Intertwining of umbilical cords Conjoined twins Acardiac twin Vascular

Conjoined Twin Thoracopagus : anterior fusion ¾ 대부분이 이에 속한다. Pyopagus : posterior Craniopagus

Twin-to-Twin Transfusion Syndrome Criteria for diagnosis ¾ Same sex ¾ Monochorionic, placental vascular connections

Pathology Donor twin ¾ Hypovolemia ¾ Dehydration ¾ Hypoglycemia ¾ Oligohydramnios : stuck twin

Pathology Recipient twin ¾ Hypervolemia ¾ Polycythemia ¾ Congestive heart failure ¾ Hypertension ¾

Death of One Twin Vanishing twin Fetus compresus Fetus papyraceous

Delivery of Twin Fetuses Presentation & position ¾ Cephalic-cephalic: 42% ¾ Cephalic-breech: 27% ¾

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Etiology of Multiple Fetuses Dizygotic twins Monozygotic twins Chimerism Superfetation & Superfecundation

Dizygotic Twinning

Monozygotic Twinning

Superfecundation

Frequency of Twins Race Heredity Maternal age & Parity Nutritional factors Pituitary gonadotropin Infertility therapy ¾ Ovulation induction ¾ Assisted Reproductive Technology

Determination of Zygosity Assessing obstetrical risks Guiding management Sonography Placental examination Infant sex

Sonographic Finding

Placenta & Membranes

Membrane Partition

Differential Diagnosis Multiple pregnancy H-mole Elevation or uterus by a distended bladder Uterine myoma Inaccurate menstrual history Hydramnios Closely attached adnexal mass Fetal macrosomia late in pregnancy

Pregnancy Outcome Abortion Malformation Birthweight Duration of gestation Preterm birth Prolonged pregnancy

Unique Complications Monoamnionic twins ¾ Intertwining of umbilical cords Conjoined twins Acardiac twin Vascular communications between twins ¾ Twin-to-twin transfusion syndrome ¾ Weight discordance Death of one twin

Intertwining of umbilical cords

Conjoined Twin Thoracopagus : anterior fusion ¾ 대부분이 이에 속한다. Pyopagus : posterior Craniopagus : cephalic fusion Ischiopagus : caudal fusion

Thoracopagus & Ischiopagus

Discordant Twins

Twin-to-Twin Transfusion Syndrome Criteria for diagnosis ¾ Same sex ¾ Monochorionic, placental vascular connections ¾ Weight difference > 20% ¾ Polyhydramnios in large twin ¾ Oligohydramnios in small twin (stuck twin) ¾ Hemoglobin difference > 5 g/d. L

Pathology Donor twin ¾ Hypovolemia ¾ Dehydration ¾ Hypoglycemia ¾ Oligohydramnios : stuck twin ¾ Growth retardation ¾ Anemia ¾ Pressure deformity

Pathology Recipient twin ¾ Hypervolemia ¾ Polycythemia ¾ Congestive heart failure ¾ Hypertension ¾ Polyhydramnios ¾ Edema or hydrops ¾ Occlusive thrombosis

Death of One Twin Vanishing twin Fetus compresus Fetus papyraceous

Delivery of Twin Fetuses Presentation & position ¾ Cephalic-cephalic: 42% ¾ Cephalic-breech: 27% ¾ Cephalic-transverse: 18% ¾ Breech-breech: 5% ¾ Others: 8%