Editor
Shailesh
Kore
MD DNB MNAMS FCPS DGO DFP DICOG MICOG
Professor and Unit Head Department of Obstetrics and Gynecology Lokmanya Tilak Municipal Medical College (LTMMC) and General Hospital (LTMGH)
Sion, Mumbai,
Maharashtra,
India
Chairperson, Genetic and Fetal Medicine Committee, FOGSI
Secretary, Website Committee, FOGSI Member, Managing Committee, Mumbai Obstetric and Gynecological Society (MOGS)
Forewords
Narendra
Malhotra
Suchitra N
Pandit
11Foreword
18192021222324
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Multiple Gestations: Basics and Beyond
First Edition: 2016
9789385891991
Printed at
5Dedicated to
All FOGSIANs and the Members of
Genetic and Fetal Medicine Committee
Federation of Obstetrics and Gynaecological Societies of India (FOGSI)
Presidents (FOGSI)
Hema Divakar
2013
Suchitra N Pandit
2014
Prakash Trivedi
2015
Vice-Presidents
Alpesh Gandhi
2013
Indrani Ganguli
2014
Sujata Misra
2015
Chairperson
Shailesh Kore
(2013–15)
7Contributors
- Aditi Shah
- Consultant, Fetal Medicine
- Bangalore Fetal Medicine Centre
- Bengaluru, Karnataka, India
- Alia K Zaidi MS
- Consultant
- Department of Obstetrics and Gynecology
- Akash Hospital
- Indore, Madhya Pradesh, India
- Alpana Utture MD (Ped) DM (Neonatol) Fellow (RNSH, Sydney)
- Associate Professor
- Department of Neonatology
- LTM Medical College
- Sion, Mumbai, Maharashtra, India
- Ameya C Purandare MD DNB FCPS DGO DFP MNAMS FICMCH FICOG Fellowship in Gyn-Endoscopy (Germany)
- Consultant Obstetrician and Gynecologist
- Mumbai, Maharashtra, India
- Chairperson, Food & Drug and Equipment Committee, FOGSI
- Anita Kaul MS (Obs—Gyne) FRCOG
- Senior Consultant and Director
- Apollo Centre for Fetal Medicine
- Indraprastha Apollo Hospitals
- New Delhi, India
- Ankesh R Sahetya MBBS DNB DGO MNAMS
- Speciality Medical Consultant
- KB Bhabha Municipal General Hospital
- Consultant, Pushpa Hospital
- Mumbai, Maharashtra, India
- Anupama Rao MD DGO
- Consultant
- Department of Obstetrics and Gynecology
- Dr LH Hiranandani and
- Fortis Hospitals
- Mumbai, Maharashtra, India
- Aparna Kulkarni MD FRCOG MPhil
- Consultant
- Fetal Medicine
- Deenanath Mangeshkar Hospital
- Pune, Maharashtra, India
- Archana Baser MS DNB FRCOG
- Consultant Gynecologist and
- IVF Specialist
- Director, Akash Hospital and IVF Centre
- Indore, Madhya Pradesh, India
- Chairperson, Imaging Science Committee, FOGSI
- Arya Rajendran
- Junior Resident
- Department of Obstetrics and Gynecology
- Government Medical College
- Amritsar, Punjab, India
- Consultant
- Fetal Medicine
- Mumbai, Maharashtra, India
- Chaitra Thunga MBBS
- Senior Registrar
- Department of Obstetrics and Gynecology
- LTMMC and LTMGH
- Sion, Mumbai, Maharashtra, India
- Chanchal Singh MD MRCOG
- Consultant
- Department of Fetal Medicine
- Apollo Centre for Fetal Medicine
- Indraprastha Apollo Hospitals
- New Delhi, India
- Deepraj Hegde MD (Ped) DM (Neonatol)
- Department of Neonatology
- LTMMC and LTMGH
- Sion, Mumbai, Maharashtra, India
- Divya Kadam MD FCPS DGO
- Consultant
- Department of Obstetrics & Gynecology and Infertility
- Ashirwad Group of Hospitals
- Mumbai, Maharashtra, India
- Garima Sharma MD (Obs–Gyne)
- Speciality Medical Consultant
- Dr RN Cooper Medical College and Hospital
- Mumbai, Maharashtra, India
- Geetha Balsarkar MD DGO
- Consultant
- Department of Obstetrics and Gynecology
- Nowrosjee Wadia Maternity Hospital
- Professor and Unit Head
- Seth GS Medical College
- Mumbai, Maharashtra, India
- Chairperson, Young Talent Promotion
- Committee, FOGSI
- Indrani Ganguli MBBS MD FICOG FIMSA FICMCH
- Emeritus Consultant Professor
- Ganga Ram Institute of Postgraduate Medical Education and Research (GRIPMER)
- Head of the Department and Chairperson
- Institute of Obstetrics and Gynecology
- Sir Ganga Ram Hospital
- New Delhi, India
- Jayashree A Mondkar MD (Ped)
- Professor and Head
- Department of Neonatology
- LTMMC and LTMGH
- Sion, Mumbai, Maharashtra, India
- Kirti Bendre MD DGO
- Associate Professor
- Department of Obstetrics and Gynecology
- KJ Somaiya Medical College
- Sion, Mumbai, Maharashtra, India
- Madhusudan Dey MS (Obs–Gyne)
- Reader
- Department of Obstetrics and Gynecology
- Armed Forces Medical College
- Pune, Maharashtra, India
- Assistant Professor
- KEM Hospital and Seth GS Medical College
- Mumbai, Maharashtra, India
- Mala Srivastava FICOG DGO DNB MBBS
- Senior Consultant
- Institute of Obstetrics and Gynecology
- Sir Ganga Ram Hospital
- New Delhi, India
- Mamta Dagar MBBS MD FICMCH MRCOG FICOG
- Consultant
- Institute of Obstetrics and Gynecology
- Sir Ganga Ram Hospital
- New Delhi, India
- Michelle Fonseca MD DNB DGO FCPS DICOG DFP
- Professor and Unit Head
- Department of Obstetrics and Gynecology
- LTMMC and LTMGH
- Sion, Mumbai, Maharashtra, India
- Nikhil Kapoor DMRD
- Senior Consultant, Radiology
- Sattva Fetal Medicine Centre
- New Delhi, India
- Pooja Bandekar MD DNB FCPS DGO DFP
- Additional Professor and Unit Head
- Department of Obstetrics and Gynecology
- Nowrosjee Wadia Maternity Hospital
- Mumbai, Maharashtra, India
- Pradnya Supe MS
- Assistant Professor
- LTMMC and LTMGH
- Sion, Mumbai, Maharashtra, India
- Prathima Radhakrishnan FRCOG Diploma in Fetal Medicine (FMF, UK) Diploma in Advanced Obstetric Ultrasound (RCOG-RCR, UK)
- Director and Consultant
- Fetal Medicine
- Bangalore Fetal Medicine Centre
- Bengaluru, Karnataka, India
- Pratik Tambe MD FICOG
- ART Consultant and
- Gynec-Endoscopic Surgeon
- Thane, Maharashtra, India
- Punit S Bhojani MS DNB FCPS DGO DFP
- Consultant
- Department of Obstetrics and Gynecology
- Kohinoor, Masina and KJ Somaiya Hospitals
- Mumbai, Maharashtra, India
- Rashmi Patil Raydurg
- MBBS MS (Obs–Gyne) DNB FMAS
- Senior Registrar
- St Marthas Hospital
- Bengaluru, Karnataka, India
- Reena Wani MD MRCOG DNB FCPS DGO DFP FICOG
- Professor and Unit Head
- Department of Obstetrics and Gynecology
- Dr RN Cooper Municipal Medical College and Hospital
- Chairperson, Perinatology Committee, FOGSI (2015–17)
- Professor and Unit Head
- Department of Obstetrics and Gynecology
- Lokmanya Tilak Municipal Medical College and General Hospital
- Sion, Mumbai, Maharashtra, India
- Chairperson, Genetic and Fetal Medicine Committee, FOGSI
- Secretary, Website Committee, FOGSI
- Member, Managing Committee,
- Mumbai Obstetric and Gynecological Society (MOGS)
- Sheetal Barhate MS (Obs–Gyne)
- Senior Resident
- Department of Obstetrics and Gynecology
- LTMMC and LTMGH
- Sion, Mumbai, Maharashtra, India
- Shilpa Agarwal DGO FCPS DNB FNB Fellowship in High-risk Pregnancy and Fetal Medicine
- Consultant, High-risk Pregnancy, and Fetal Medicine Specialist
- Jaslok Hospital and Research Centre
- Mumbai, Maharashtra, India
- Shilpa Birthare MS
- Assistant Professor
- Chhattisgarh Institute of Medical Sciences
- Bilaspur, Chhattisgarh, India
- Siddhi Kore MD DGO
- Speciality Medical Consultant
- Madan Mohan Malviya Shatabdi Hospital
- Mumbai, Maharashtra, India
- Sujata Sharma MD DGO
- Professor and Head
- Department of Obstetrics and Gynecology
- Government Medical College
- Amritsar, Punjab, India
- Suseela Vavilala DGO DNB MICOG Fellowship in Fetal Medicine
- Head
- Department of Fetal Medicine
- In-charge, Twins Clinic
- Fernandez Hospital
- Hyderabad, Telangana, India
- Swati Manerkar MD (Ped) Fellow (MUHS)
- Associate Professor
- Department of Neonatology
- LTMMC and LTMGH
- Sion, Mumbai, Maharashtra, India
- Trupti Nadkarni MD DNB FCPS DGO
- Additional Professor
- Nowrosjee Wadia Maternity Hospital and Seth GS Medical College
- Mumbai, Maharashtra, India
- Vandana Chaddha MS (Obs–Gyne) Certification, Medical Genetics, SGPGI Lucknow, Uttar Pradesh, India Post-Doct Fellowship, Maternal and Fetal Medicine, University of Toronto, Toronto, Canada
- Director
- Sattva Fetal Medicine Centre
- New Delhi, India
- Varsha Mahajan DGO
- Junior Consultant
- Akash Hospital
- Indore, Madhya Pradesh, India
Multiple gestations are associated with serious maternal and fetal complications. Though birth of twins can be a happy moment for a woman, it can be a stressful experience for the couple and the family. Maternal and perinatal morbidity and mortality rates increase manyfold for multiple gestations. Though majority of twin pregnancies would go through gestational period and labor uneventfully, yet a high percentage of those, particularly complicated ones, poses a challenge to the medical practitioners.
Management of multiple gestations would change from country to country or rather clinician to clinician. Apart from case-related factors, various other factors, such as the experience of attending physician, availability of the facilities and expertise, will play a vital role in the outcome of the pregnancy. Though multifetal reduction is an option for converting high-risk multiple gestations into relatively low-risk singleton pregnancies, ideal goal should be to prevent the occurrence of multiple gestations, at least an iatrogenic one. Guidelines made by various professional organizations would help in making this happen.
This book is a monogram on multiple gestations, dealing with a wide range of related topics covered in depth. Most of the contributors of this book are leading, well-known and experienced specialists in fetal medicine and imaging, having vast experience in the management of multiple gestations. Thus, this book provides a complete gamut of material on the topic of multiple gestations to the practicing obstetricians and postgraduate students.
Many compliments to the Genetic and Fetal Medicine Committee of FOGSI, the Editor and all the contributors of this book, for this highly praise-worthy effort, which provides a rich and scientific treatise.
Narendra Malhotra
MBBS MD FICMCH FIAJAGO FICOG FICMU FRCOG FICS
FOGSI Representative to FIGO
Secretary General, SAFOG
President-Elect ISPAT and ISAR
Past President, FOGSI
Director, Ian Donald School
Professor, Dubrovnik International University
Managing Director, Global Rainbow Healthcare
13Foreword
The last few decades have seen expansion in the technology and expertise in medical field, which has led to earlier and more precise diagnosis along with better management options having greater success rate, for the multiple gestations. Prognosis of complicated cases in multiple gestations has improved with availability of the various newer treatment options. It is important for a busy practicing clinician to keep updated with these newer developments. Books play an important role in disseminating knowledge to a large number of clinicians. FOGSI has always been committed to educating its members and keeping them updated with the recent advances. I am happy that Genetic and Fetal Medicine Committee of FOGSI, under the Chairmanship of Dr Shailesh Kore, took a keen interest in writing this book Multiple Gestations: Basics and Beyond. Today, with increased usage of assisted techniques of reproduction, incidence of multiple gestations has also risen. This book provides a complete and comprehensive information on the subject of multiple gestations, along with its complications and management.
Multiple gestations are high-risk pregnancies requiring a special care. Also, the management of complicated multiple gestations is a challenge to obstetricians. I have a personal experience of successfully carrying out the delivery of a case of spontaneously conceived quintuplets, at 29 weeks, first of this kind in India. Thereafter, I have carried out the deliveries of almost 60 sets of twins. It requires a very vigilant management plan ready to intervene when required.
I congratulate Dr Shailesh Kore, for editing this book, which is equally challenging and a herculean job, requiring dedication and commitment. The editorial team of this book has done a wonderful job of publishing a sort of monogram on the topic and needs to be congratulated for this effort. I am sure this book will provide very useful information to all the practicing clinicians and postgraduate students.
Suchitra N Pandit
MBBS MD DNB DFP MRCOG FICOG MNAMS
Consultant and Head
Department of Obstetrics and Gynecology
Kokilaben Dhirubhai Ambani Hospital
Mumbai, Maharashtra, India
President, Organization Gestosis
President, FOGSI (2014–15)
15Preface
It is indeed a great pleasure to bring out the book Multiple Gestations: Basics and Beyond to you. Subjects of fetal medicine and emergency obstetrics have been very close to my heart. My passion for teaching and interest in the topic of multiple gestations, led me to come out with a book on this subject, comprehensively covering all the practical aspects about multiple gestations. When I took over as the Chairperson of Genetic and Fetal Medicine Committee, FOGSI, I had set my agenda of coming out with a publication on multiple gestations during my tenure. At the time of finishing my tenure as the Chairperson, I feel happy and content that I have been able to achieve that. It is because of the support and encouragement that I received from all my teachers, seniors and fellow FOGSIANs, I could accomplish this agenda.
Dr Prof Narendra Malhotra, FOGSI Representative to FIGO and Past President, FOGSI, has always been my source of inspiration. I feel honored to receive a Foreword for this book from him. Dr Suchitra N Pandit, Past President, FOGSI, has been a guiding force throughout my career. It was in her tenure as FOGSI President, this project actually started. I am also happy to receive a Foreword from her for this publication.
I am thankful to all my teachers and seniors for their support and help. I would also like to thank all my hospital colleagues, especially, Dr YS Nandanwar, Head of the Department, at our institute, for the constant encouragement and support.
Multiple gestations, though fascinating, are often associated with maternal and fetal complications. For a woman carrying multiple gestations, it can be a moment of joy and anxiety at the same time. Birth of twins, particularly, after a period of infertility, can be a moment of fulfillment of the dream for a woman and her family, but it can soon turn into a nightmare with stress and difficulties of bringing up two or more children together. Also, management of multiple gestations, particularly complicated ones, is a challenge to the obstetrician on many occasions.
With the increasing maternal age at conception and use of assisted reproductive technology, the incidence of multiple gestations and multiple births is increasing. With the advent of newer technology and expertise, more management avenues are available now, which, sometimes, can increase the management dilemmas.
These issues prompted us to come out with this practical reference book on multiple gestations, covering wide range of related topics—from basics to recent advances. Most of the contributors of this book have immense experience in imaging and fetal medicine, some of them actually running twin clinics.
As a Chairperson of Genetic and Fetal Medicine Committee of FOGSI and the Editor of this book, I take this opportunity to thank all the contributors, for their valuable contributions. I also thank all FOGSI office bearers and office/support staff for their help.
Last but not least, I would like to thank Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their cooperation in bringing out yet another publication for FOGSI. They are always helpful in changing our dreams into a reality.
We are sure that this monogram on multiple gestations will be of great use as a reference book, not only for practicing clinicians, but also for teaching faculties and postgraduate students.
“What is in the realm of research today, will be in clinical practice tomorrow”.
17Acknowledgments
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