SHARIFAH ROQAIYAH BT SYED MUD PUADNURUL HUSNA BT ALIAS

SITI SARAH BT MOHD SAIFUDDINYIP SOOK HAN

NOOR ASYIKIN BT KAMARAZAMAN

Pregnant mothers often suspect that they are carrying more than one baby (or more). Suddenly your pregnancy is filled with double and delight, probably a double dose of anxienty also. People are very fascinated with twins and other multiples. It seems mysterious how one pregnancy can result in more than one baby.

One day, Pn. Laila received the surprise of her life. She is having pregnant!” Her mind is whiring with question. How do I know its twin ? It is twins ? Could you behaving more than one ? How do I know its twins ? What are some of the signals of a multiple pregnancy ? How twins are made ? How did this happen ? If I’ve had twins, how can find out whether my babies are identical or none identical ?

You as a doctor, what would you tell Pn. Laila regarding to twins pregnancy ?

Facts Ideas Learning issue Action plan

1. Pregnant mother suspected that they are carrying more than one baby.

2. Suddenly her pregnancy is filled with double delight and probably a double dose anxiety also.

1. Genetic is one of the factors getting twins.

2. Old folks saying that when pregnant women get filled with double delight they will get twins.

1. How to know it is twin or single baby?

2. What is the comparison between identical and non-identical twin?

3. How twins will form?

4. What is the symptom having twin?

1. Get an ultrasound confirmation.

2. Use Doppler heartbeat count.

3. Get HcG ( Human Chrionic Gonatropin level test.

4. Make AFP (Alphafetoprotein) screening.

5. Surfing on internet about twins.

ULTRASOUND CONFIRMATION

DOPPLER HEARTBEAT COUNT

HcG (HUMAN CHORIONIC GONADOTROPIN) LEVELS TEST

AFP (ALPHAFETOPROTEIN) SCREENING

ULTRASOUND CONFIRMATION

AN IMAGING TEST THAT USES SOUND WAVES TO SEE HOW A FETUS DEVELOPING IN THE MOTHER WOMB.

A CLEAR, WATER-BASED GEL WILL BE PLACED ON MOTHER’S BELLY AND PELVIS AREA AND THEN MOVES A HAND-HELD PROBE OVER THE AREA.

THE GEL HELPS THE PROBE TRANSMIT SOUND WAVES.

THESE WAVES BOUNCE OFF THE BODY STRUCTURES, INCLUDING THE DEVELOPING FETUS, TO CREATE A PICTURE ON THE ULTRASOUND MACHINE.

TWIN ULTRASOUND PICTURE

15 WEEKS

DOPPLER HEARTBEAT COUNT

Using harmless sound waves, a Doppler systems can detect fetal heartbeat.

If there are more than one heartbeat detected,

indicating a multiple pregnancy. HAND-HELD DOPPLER

HcG (HUMAN CHORIONIC GONADOTROPIN) LEVELS TEST

HcG is a glycoprotein hormone detectable in pregnant women's blood or urine about 10 days post-conception.

It increases at a rapid rate, peaking about 10 weeks into the pregnancy.

Twins may produce an elevated level of HcG.

However, the standard HcG level for twins also falls within the normal range for singletons.

HCG PREGNANCY TEST

AFP (ALPHAFETOPROTEIN) SCREENING

Alpha-fetoprotein screening is a blood test that measures the level of alpha-fetoprotein in the mothers' blood during the second trimester.

AFP is a protein normally produced by the fetal liver and is present in the fluid surrounding the fetus (amniotic fluid), and crosses the placenta into the mother's blood.

Abnormal levels of AFP may indicate twin pregnancy .

This is because more than one fetus is making the protein.

Facts Ideas Learning issue Action plan

3. People are very fascinated with twins and other multiples.

4. It seems mysterious how one pregnancy can result in more than one baby.

5. One day Pn. Laila received the surprise of her life. She having pregnant.

3. Once a woman getting twins it is harder for them to have another child.

4. Some people find a rapid rate in grow in their uterus which leads some to suspect twins.

5. Sometimes multiple heart beats are heard, leading your practitioner to believe that there is than one bundle in your uterus.

5. There are 3 different ways that identical twins can develop. How it develop?

6. Ask a doctor to get conformation about the symptom of having twins.

7. Go to the library to get some books that are related to the problem.

8. Ask someone that experienced had twins?

Pregnant mother suspected that they are carrying more than one baby. Suddenly her pregnancy is filled with double delight and probably a double dose anxiety also. People are very fascinated with twins and other multiples.It seems mysterious how one pregnancy can result in more than one baby. One day Pn. Laila received the surprise of her life. She having pregnant.

1) How to know it is twin or single baby?

If the pregnancy is twin, it have a big difference with carrying for just one baby. The pregnant mother will know whether her pregnancy is twin or not by : Checking their weight. When a woman carries twins, she gains more weight than average and her uterus is also larger than normal for her projected due dates.

Check if you having a more symptoms than expected like experienced an increase in morning sickness) and it effects might be more severe than normal Verify for hcG level, if it is abnormal high level of this hormone, maybe the pregnant mother carry a twins. Find out if there is more than one fetal heartbeat in uterus. If you are having twins, a doctor should be able to hear two different heartbeats when he places a doppler device (doptone) on your abdomen.

Take a routine ultrasound. During a routine ultrasound, your doctor should be able to detect whether or not you are actually pregnant with twins.

2 ) What is the comparison between identical and non-identical twin?

Identical twins Differences Non- identical twins

Only one ovum is impregnated by only one

spermatozoid, but the egg divides in 2 embryos

afterwards.

Fertilization Two separate eggs have been impregnated by 2 separate spermatozoa.

One zygote formed Formation of zygote Two zygote formed

Have exactly the same chromosomes

Genetic constitution (chromosome)

Each have a different chromosome make-up

1 or 2 placenta Number of placenta 2 placenta

1or 2 amniotic sac Number of amniotic sacs 2 amniotic sac

Same sex Sex Same or different sex

Have a perfect resemblance Physical characteristics Don't look alike

3) How twin are form?

• Fraternal (Non-identical) twins are formed when two egg cells are fertilized; each egg by a different sperm so that two embryos are formed. Fraternal twins can be of the same or opposite sex and they don't have to look at all alike.

• Identical twins are formed when one egg after being fertilized by one sperm, divides into two halves. The two halves are genetically identical. Identical twins are usually of the same sex.

• Conjoined (Siamese) twins are formed exactly like identical twins, but during the split, the embryo does not separate completely to form two separate babies and the twins develop attached to one another.

4 ) What are the common symptoms of twin pregnancy ?

Weight Gain

Early weight gain of up to ten pounds in the first trimester can result due to increased blood volume and uterine size.

By the end of the second trimester, most mothers of twins have gained fifteen to twenty-five pounds, whereas singleton pregnancies usually produce gains of ten to twenty pounds.

Measuring large for gestational age

Increased uterus size can be a strong indicator of multiple pregnancy.

Severe morning sickness symptoms, including nausea, fatigue and vomiting

Abnormally high results from an alphfetoprotein (AFP) test

Feeling Fetal Movement Early In Pregnancy

5 ) There are 3 different way that identical twins can develop. How it

develop?

і) Only one placenta that feeds the babies, but there can be two amniotic sacs.

There is 1 placenta and 2 amniotic sacs then the pregnancy is referred to as having a “ mono-chorial ” placenta and is “ bi-amniotic “.

іі) Only one placenta and one amniotic sac

The pregnancy is referred to as having a “ mono-chorial” placenta and is “ mono-amniotic”

ііі) Two placentae and each embryo has its own amniotic sac

There are two placentas and two amniotic sacs Referred to as having a “bi-chorial” pregnancy and is “ bi-amniotic”.

6 ) What are the types of twins?

twins

dizygoticmonozygotic

Bi-chorial and Bi-amniotic

Mono-chorialAnd Bi-amniotic

Mono-chorial and mono-amniotic

Siamese twin