1.www.totalpregnancycare.com www.totalpregnancycare.com

2. Multiple PregnancyDr Shantala Vadeyar MD, FRCOG, DM (UK) Advanced Obstetric Ultrasound (RCO/RCR) Subspecialist in Maternal-Fetal Medicine (RCOG)Consultant Obstetrics, Fetal & Maternal Medicine Kokilaben Dhirubhai Ambani Hospital, Mumbai www.totalpregnancycare.com 3. Incidence Increased with Assisted Reproduction Clomiphene citrate / Letrozol/ HMG, hCG Advanced Age Race Afro-carribeans 1:80-100www.totalpregnancycare.com 4. www.totalpregnancycare.com 5. www.totalpregnancycare.com 6. www.totalpregnancycare.com 7. Risks inMultiple Pregnancy www.totalpregnancycare.com 8. www.totalpregnancycare.com 9. DC twins - lambdasignwww.totalpregnancycare.com 10. MC twins - T sign www.totalpregnancycare.com 11. Chorionicity v/s Zygositywww.totalpregnancycare.com 12. www.totalpregnancycare.com 13. www.totalpregnancycare.com 14. www.totalpregnancycare.com 15. www.totalpregnancycare.com 16. Techniques for invasive testingwww.totalpregnancycare.com 17. Loss rates: Amniocentesis in Twinswww.totalpregnancycare.com 18. Chorionic Villous Sampling in Twinswww.totalpregnancycare.com 19. Selective Fetocide / ER www.totalpregnancycare.com 20. Management:AntenatalMaternal and Fetal Surveillancewww.totalpregnancycare.com 21. Ultrasound in Multiples Diagnosis and Chorionicity determinaiton Dating, Chromosomal & Structural Normality Growth, Dopplers Amniotic fluid assessment Twin twin transfusion syndrome Invasive procedures amniocentesis, CVS Cervical length and funnelling Prediction of preterm labour Timing of delivery Dopplers, BPS in IUGR, etc www.totalpregnancycare.com 22. Complications in Twins:Based on ChorionicityEVENTDICHORIONIC MONOCHORIONIC Miscarriage (11-23 weeks) 2%10%Perinatal Death (>23 weeks)2% 4%Fetal Growth Restriction (one /both)20%30% Preterm delivery (