PB-YSR-20 - Repositori Universitas Andalas

Medan 2013
Obstetri Ginekol-o8i lndonesia 20
Hotel'
Penemuan llmiah Tahunan Persatuan
16 September 2013,lw Mariot
,,woRK

Dibacakan pada

SHop

or"i*i,'tJult*souND"

gestation anomalies
Ultrasound evaluation of multiple
ylt.\rdudti
DT'M JamiliFK Unand Padang
Divisi Fetomaternal, Bagian OBGYNIRS

Background

ald
we hal'e been able to better understand
Tluough atlvalces in ultasound technology
'Iwin to twin transfusio[
and abuorrnal multiple pregrancy
normal
of
physiologl
the
document
of interest to
lnade at delivery and hence lvas mole
s-wdrome *'as once a diagnosis
events so
aod obstetricians havc a wildow to in-utero
paediatricians. Fetal medicine specialists
Multiple pregnancies accoutrt tbr a
TTI-S is an ultrasorLnd-based diagnosis'

thal no\r

disproportionateshareofmajoratlverseperinataloutcomes.Inadditiontotheincreasedratesof
perinatalmortalityandmorbiditt,attributedtopretermdelivery'multiplepregnanciesarealsoat
stillbirth' fetal gotth restriction' delivery
lrigher risk of miscarriage, fetal abnormalitl'
cornplicationsandneurodevelopmentalimpairmentTheratesofmLrltiplepreEmanc-Y!Bn'
worldwidervithtiizy-.goustrr,inningandlrighor.dermtrltipleratesalfcctedbymatemalage.parit-v,
tu iruring
techniques' The inctdence of Lnonozygous
etlmicit}, and the usc of assisted reproductive
tlre
rnultiple gestation rates lrave increased over
is rclativel-v constalrt. In developcd counffies,
last 40 vears and account for up to 2%

ofall births'

Zygosity, chorionici6 and amnionicity

Zygosir-'.describesthenumbelofseparatefertilisedova,Clrorionicit;-referstothe

numberofchorionswlrichcorrespo[dstotlrenumbffofplacerrtae.emnionicityreferstotlre
are normally classified by the nurnber of
number of amniotic sacs. Multiple ple$lancies
rnurtipre preg arcy may arise lhrough the
place,tas and trre nunber of amnioric sacs. A
or from thc spolltaneous splitting of a
fertilization of : more thao one oocyte (multiz)'gotic)
sillglez-vgote(monoz}.gotic).onetlrirdoftr,r,insaremolozygoticandtll,o.thirdsaredi4'gotic.
o\T un but very rarelv can arise from zygotic
Higher order multiples usuall-v arise from multiple
dil'ision occurs before
splittilg and therr rc-splitring lf Multizygotic or monoz]'gotic
(i e dichorionic) and separate amniotic cavities lf
'
irnplantation they rvill have separate placentas
$
the division occrus after irnplantation tben the]-

ill

share the placenta (i.e.. rnonochorionic) and

have their
either share tlre amniotic cavlt) (i €'. monoamniotic) or

o*n (i e ' diamniotic)

The
1

lndonesia 20 Medan 2013
Persatuan Obstetri Ginekologi
Hotel'
Pertemuan llmiah Tahunan
16 september 2013' JW'Mariot
;Dv;*iiJ

Dibacakan pada

'woRK

sHoP

"t*otou*'"

(MCDA) Sotne rnono4 gotic
be monochononic-diamniotic
will
tu'rns
monozl'gotic
of
nujoriq
(DCDA)
'in 7) will have separate placentae and be dichorionic-diamniotic
i
(approx
t*ins
witinul DNA
trvins zygositl cannot be detemlined
Hence. io same sex dichorionic{iamniotrc

first trimester using
be accurately established in the
can
tesring. Chorioniciry and amnioniciry

of a multiple
choriomcity to enable the risk stratification
establish
to
important
It
is
ultrasound.
pregn rn-v.

Monoamniotic Pregnancies
fetuses
when tlrcre is a single placenta' tu'o
Approximately 1% of t*rns' on ultrasound

andnointer.tl,indiridingmembrane.Umbilicalcordentanglernentisamajorcomplication.The
risk of t'etal
tqTns are due to cold entangleme The
rnajoritv of fetal deaths in monoamniotic
30 weeks
from 15 weeks gcstation and lotals 30-400'o by
death increases b1 2-50'6 esery week
gestation.

Twin-to-twin transfusion syad rome(TTTS)
TTTSisthemajorcomplicationofMCpregnancieswheretwinsslrareasingleplacenta.
one tivin sac' whilst the odler
the dereloprnent of poll'hydramnios io
polyhydramnios usually rssults in prernanue delivery
oligolr-vdramnios Ultreato4 the

lt is characterised by
develops

and the loss of both twins'

Pathophysiologr

join

twin,s

the t}'o
anastomos€s on tlre surface that
MC tuins have a shared placenta and ha\'e
are generall-v baranced, but in about l0-15% of
circulations. These anastomotic patterns

MCthereisanunbalancedtransfusionofb,loodfromouet'*.intotheotlrcrresultinginthe
olltput
loses its blood volume and decreases its unne
development of T1'TS .The donor nvin
The reciprent hlin increases ils ttrine
rrhjch results in the de\eloprDent of oligohy.&amnios.
pol.vhl-dranurios TTTS is diagnosed on ultrasound

production resulting in lhe developm€nt of

rshenlhedeepestpocketofaurnioticfluidaroundthedonorttlinis