Multiple Pregnancy: Recent Advances in Management of Multiple Pregnancy

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. 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:
Section I: Background 1. Epidemiology/Incidence of Multiple Pregnancy Tiran Dias and Amarnath Bhide 1.1 Introduction 1.2 Ethnic Variation 1.3 Familial Tendency 1.4 Geographical Variation 1.5 Genetics of Twins 1.6 Reproductive Age 1.7 Assisted Reproductive Techniques 2. Classification of Multiple Pregnancy Tiran Dias and Amarnath Bhide 2.1 Introduction 2.2 Classification of Multiple Pregnancy 3. Mechanism of Multiple Pregnancy/Aetiology Tiran Dias 3.1 Introduction 3.2 Zygosity 3.3 Chorionicity and Amnionicity 4. Placentation in Multiple Pregnancy AAH Priyani 4.1 Introduction 4.2 Zygosity 4.3 Placentation in Multiple Pregnancy 4.4 Placental Growth During Pregnancy 4.5 Twin Growth Discordance and Related Placental Characteristics 4.6 Vascular Anastomoses and Related Complications 4.7 Monoamniotic Twinning Section II: Antenatal Management of Multiple Pregnancy: Early Pregnancy 5. Confirmation of Viability and Assessing Number of Fetuses Tiran Dias and Amarnath Bhide 5.1 Introduction 5.2 Confirmation of Viability and Assessing the Number of Fetuses 5.3 Vanishing Twin 6. Assessment of Gestational Age Tiran Dias and Amarnath Bhide 6.1 Introduction 6.2 Crown-Rump Length or Last Menstrual Period to Date the Pregnancy? 6.3 Can Singleton Charts be Used Reliably to Date Twin Pregnancies? 6.4 Should Pregnancy be Dated by Measurements of the Larger Twin, Smaller Twin or Their Average? 6.5 Gestational Age Assessment After the First Trimester 6.6 Gestational Age Assessment in IVF Multiple Pregnancy 7. Assessment of Chorionicity Tiran Dias and Amarnath Bhide 7.1 Introduction 7.2 Ultrasound Determination of Chorionicity 8. Antenatal Labelling Tiran Dias and Amarnath Bhide 8.1 Introduction 8.2 Antenatal Labelling Section III: Aneuploidy Risk Assessment in Multiple Pregnancy 9. Principles of Aneuploidy Screening in Multiple Pregnancy Tiran Dias 9.1 Introduction 9.2 Assessment of the Aneuploidy Risk with Regard to Zygosity, Chorionicity and Maternal Age 10. Aneuploidy Risk in Multiple Pregnancy and Assessment: Ultrasound and Serum Biochemistry Tiran Dias 10.1 Introduction 10.2 First-Trimester Risk Assessment Using Nuchal Translucency in Twin Pregnancy 10.3 First-Trimester Combined Screening 10.4 Second-Trimester Maternal Serum Screening 10.5 Integrated Screening for Chromosomal Aneuploidy in Twins 10.6 Second-Trimester Ultrasound Screening for Aneuploidy in Twin Pregnancies 11. Non-invasive Methods of Risk Assessment in Twins Tiran Dias 11.1 Introduction 11.2 Fetal Gender Determination in Twin Pregnancy 11.3 Twin Zygosity Determination Using Maternal Plasma DNA Analysis 11.4 Fetal Chromosomal Aneuploidy Detection Using Sequencing of Maternal Plasma DNA 11.5 Prenatal Diagnosis of Pregnancy Complications 11.6 Noninvasive Prenatal Diagnosis of Twins Using Circulating MicroRNAs in Maternal Plasma 12. Invasive Methods of Screening in Multiple Pregnancy Tiran Dias 12.1 Introduction 12.2 Counselling in Invasive Testing 12.3 Principles of Invasive Diagnostic Procedures 12.4 Amniocentesis 12.5 Chorionic Villus Sampling 13. Managing Twins Divergent for Karyotypic Abnormalities Tiran Dias 13.1 Introduction 13.2 Preliminary Counselling 13.3 Selective Reduction of Multifetal Pregnancies Section IV: Antenatal Care in Multiple Pregnancy: Late Pregnancy 14. Antenatal Fetal Monitoring Tiran Dias 14.1 Introduction 14.2 Uncomplicated MCDA Twins 14.3 Uncomplicated DCDA Twins 14.4 Uncomplicated MCTA or DCTA Triplets 14.5 Uncomplicated TCTA Triplets 14.6 Assessments at Each Ultrasound Scan 14.7 Nutritional Supplements 14.8 Separate Growth Reference Ranges 15. Perinatal Morbidity and Mortality in Twins Tiran Dias 15.1 Introduction 15.2 Potential Contributors for Morbidity 15.3 Cerebral Palsy 15.4 Cognitive Impairment 15.5 Any Major Disability 15.6 Early Pregnancy Loss in Twins Section V: Planning of Delivery in Multiple Pregnancy 16. Planning of Delivery in Multiple Pregnancy Tiran Dias 16.1 Introduction 16.2 Timing of Delivery 17. Mode of Delivery Tiran Dias 17.1 Introduction 17.2 Intrapartum Management of Multiple Pregnancies 17.3 Route of Delivery 17.4 Time Gap Between Delivery of Twins 17.5 Anaesthesia (Pain Relief in Multiple Pregnancies) 17.6 Caesarean Section 17.7 Vaginal Birth After Caesarean Section in Twin Pregnancy Section VI: Maternal Implications in Multiple Pregnancy 18. Physiological Changes in Pregnancy Carmeline Motha 18.1 Introduction 18.2 Cardiovascular System 18.3 Renal System 18.4 Respiratory System 18.5 Haematological System 18.6 Endocrine System 18.7 Glucose Metabolism 18.8 Lipid Metabolism 18.9 Protein Metabolism 19. Implications of Multiple Pregnancy on Physiological Adaptations Carmeline Motha 19.1 Introduction 19.2 Physiological Adaptations Section VII: Problem-Based Management of Twin Pregnancy Complications in First Trimester 20. Chromosomal Defects and Twinning Tiran Dias and Amarnath Bhide 20.1 Introduction 20.2 Chromosomal Defects and Twinning 21. Complications Unique to Egg Splitting Tiran Dias and Amarnath Bhide 21.1 Introduction 21.2 First-Trimester Detection of Fetal Structural Anomalies 21.3 Monoamniotic Twins 21.4 Twin Reversed Arterial Perfusion 21.5 Conjoined Twins (Siamese Twins) 21.6 Fetus in Fetu 22. Vanishing Twin Sequence Tiran Dias and Amarnath Bhide 22.1 Introduction 22.2 Vanishing Twin Sequence Section VIII: Problem-Based Management of Twin Pregnancy Complications in Second Trimester 23. Twin-to-Twin Transfusion Syndrome (TTTS) Tiran Dias 23.1 Introduction 23.2 Twin-to-Twin Transfusion Syndrome 24. Selective Fetal Growth Restriction (sFGR) 236 Tiran Dias and Amarnath Bhide 24.1 Introduction 24.2 Classifi cation of sFGR 24.3 Type I sFGR 24.4 Type II sFGR 24.5 Type III sFGR 24.6 Late-onset sFGR 25. Twin Anaemia-Polycythaemia Sequence (TAPS) Tiran Dias and Amarnath Bhide 25.1 Introduction 25.2 Diagnosis and Classification of TAPS 25.3 Treatment 25.4 Outcome 26. Discordant Amniotic Fluid Index 258 Tiran Dias 26.1 Introduction 26.2 Amniotic Fluid Index 26.3 Physiology of Amniotic Fluid Production 26.4 Discordant Amniotic Fluid Index 27. Congenital Malformations in Twins Tiran Dias 27.1 Introduction 27.2 Congenital Malformations in Twins 28. Co-twin Demise Tiran Dias 28.1 Introduction 28.2 Definition 28.3 Factors Causing the Risks to the Remaining Co-Twin 28.4 Pathophysiology 28.5 Management Section IX: Problem-Based Management of Twin Pregnancy Complications in Third Trimester 29. Discordant Fetal Size and Fetal Growth Restriction Thilina Palihawadana 29.1 Introduction 29.2 Growth Discordance 29.3 Fetal Growth Restriction 29.4 High Perinatal Mortality 30. Preterm Delivery Thilina Palihawadana 30.1 Introduction 30.2 Delivery in Monoamniotic Twins Section X: Medical Complications of Multiple Pregnancy 31. Medical Complications of Twin Pregnancy Carmeline Motha 31.1 Introduction 31.2 Gestational Diabetes Mellitus 31.3 Hypertensive Disorders in Pregnancy 31.4 Hyperemesis Gravidarum 31.5 Peripartum Cardiomyopathy Section XI: Management of Delivery Complications in Multiple Pregnancy 32. Malpresentations in Twin Vaginal Delivery Thilina Palihawadana 32.1 Introduction 32.2 Proportion and Risks of Malpresentation and Malpositions 32.3 Twin Delivery in the Presence of Malpresentations and Malpositions 32.4 Malpresentations in the Twins at Vaginal Delivery and Perinatal Outcome 32.5 Delivery of Second Twin in a Nonvertex Presentation 33. Intertwin Delivery Interval at Vaginal Delivery of Twin Pregnancies Thilina Palihawadana 33.1 Introduction 33.2 Mechanisms of Prolonged Intertwin Delivery at Twin Vaginal Delivery 33.3 Intertwin Delivery Interval and the Perinatal Outcome 33.4 Optimal Time for Intervention in Prolonged Intertwin Delivery Section XII: Obstetric Emergencies in Twin Pregnancy 34. Epidemiology of Antepartum Haemorrhage (APH)/Postpartum Haemorrhage (PPH) and Other Obstetric Emergencies in Twins Tiran Dias 34.1 Introduction 34.2 Antepartum Haemorrhage 34.3 Morbidly Adherent Placenta 34.4 Placental Abruption 34.5 Velamentous Cord Insertion and Vasa Praevia 34.6 Postpartum Haemorrhage Index