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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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6

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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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