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Dr. Imelda, SpOG
Maternal- Fetal Evidence Based Guidelines p 273-284
Current Obstetric & Gynecology Diagnosis & Treatment p 315-3251
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D
EF
IN
I
S
I
Gestasi > 1 fetus
Monozygotic (MZ)
1fertilizedovum membelah
menjadi dua
individu, sebagian
besar kembarIDENTIK
Dizigotic (DZ) 2
ovum difertilisasioleh 2 sperma
yang berbeda
individu yang
secara genetikberbeda
Insiden : 4/1000
Insiden bervariasi
(ras, usia, paritas,
riwayat keluarga)
ART
meningkatkan
insidensi
2
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DZ : berasal dari 2fertilized
ovum yang berbeda SELALU
dichorionic/ diamniotic (DC/DA)
MZ : berasal dari 1fertilizedovum
yang membelah bisa berbagai tipe,
tergantung dari waktu pembelahan
ovum
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4
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5
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F l
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FetalSpontaneous reduction
Spontaneous loss
Anomali kongenital &kromosom
IUGR & discordant growth
Single fetal demise
Preterm birth
Imaturitas
Komplikasi intrapartum
Kerusakan neurologis perinatal
Mortalitas perinatal
Maternal
Preeklampsia
Solusio Plasenta
Trombositopenia
Akut Fatty Liver
Diabetes Gestasional
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Twin- twintranfusion
syndromeInsidens : 10- 15% MC/DA,
1/2500 kehamilan
Etiologi :
1 plasenta, anostomosis AA, VV,AVimbalance sirkulasi
donor twin anemia & efekresultan (IUGR, oligohidramnion)
Resipien twin polihidramnion,polisitemia, heart failure
Diagnosis : USG
Prognosis : buruk
Monoamniotic
twinsInsiden : 1 : 10.000 kehamilan
Diagnosis : USG
Acardiac twin (twin reversalarterial perfusion TRAP)
MZ/MC 1/35.000 kehamilanUSG doppler (pump twin)
IUFD 35-50%
Conjoined twin insiden 1/10-000- 1/50.000 kelahiran
klasifikasi (anatomi + pagus) menentukan manajemen &
prognosis
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Staging fo TTTSStage 1 MC/ DA gestation with oligohidramnion
(MVP < 2 cm) dan Polyhidramnions(MVP > 8 cm)
Stage 2 Absent (empty) bladder (in donor)
Stage 3 Abnormal Doppler
Stage 4 Hydrops
Stage 5 Death of one twin
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Embryo & Fetal Pathology, Color Atlas withUltrasound Correlation, 2004
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Embryo & Fetal
Pathology,
Color Atlas with
Ultrasound
Correlation, 2004
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T
RA
P18
Embryo & Fetal Pathology, Color Atlas with Ultrasound Correlation,
2004
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AntepartumTesting
USG
FetalGrowth
Amniotic
Fluid
Fetalsurveillance
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