Download - Gemelos
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Embarazo Gemelar
› Gestación simultánea de dos fetos
Embarazo Múltiple
› Gestación simultánea de tres o más fetos
Frecuencia
› 1 x 80 ----- 1 x 90 (Ley de Hellin)
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Gemelos 1 x 80 emb.
Triples (80 2) 1 x 6.400 emb.
Cuádruples (803) 1 x 512.000 emb.
Quíntuples (80 4)1 x 40.960.000 emb.
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Anamnesis
› Antecedentes familiares.
› Drogas
› Síntomas de gestosis exagerada
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Examen Físico
› Mayor ganancia ponderal
› Altura uterina > EG estimada
› Palpación múltiples partes fetales
› Polihidroamnios
› Auscultación de dos focos de LCF
› Edema / Palidez
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Exámenes Complementarios
› ECOGRAFÍA
› Radiografía abdomen simple
› Monitorización electrónica FCF
› Electrocardiografía fetal
› HCG, HLP, E 3 urinario
› Hematocrito
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Embarazo de mayor Edad gestacional
Macrosomía Fetal
Polihidramnios asociado a Tumor
abdominal (miomas, ovario)
Hidrops Fetal
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Embarazo gemelar
BicigóticoMonocigótico
Bicorial Biamniótico
Monoamniótico Biamniótico
Monocorial
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Univitelino o Monocigótico (33%)
› Bicorial - Biamniótico (30%)
› Monocorial - Biamniótico (65 %)
› Monocorial - Monoamniótico (5%)
Bivitelino o Bicigótico (66%)
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GEMELO
MONOCIGOTICO
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GEMELOS
MONOCIGOTICOS
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Embarazo Gemelar
Monocigótico
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BI-BI BI-BI
M-BI M-M
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Complicaciones Sindrome Transfusión Feto-Fetal
› Gemelo transfusor o donante
› Gemelo transfundido o receptor
Gemelo Acárdico
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Definición
Es el desequilibrio, agudo o crónico entre
gemelos monocoriónicos, que
comparten anastomosis vasculares
placentarias, produciéndose transfusión
sanguínea de un feto al otro ( donante y
receptor).
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Incidencia
› 5 a 17% de los embarazos monocoriónicos.
Mortalidad
› 100% sin tto. Si se presenta antes de las 26
sem.
› 55 a 80 % sin tto. Si se presenta a las 28 sem.
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Superficiales
Arteria - arteria 64 %
Veno venosa 19 %
Profundas
Arteria - venosa 58 %
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Anemia en el feto donante , valores
de hemoglobina mayor del 5%
Cardiomegalia y edema en feto
pequeño
Palidez en placenta del donante y
plétora sanguínea en la placenta
del receptor
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Amniocentesis de reducción
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Septostomia o micoseptostomia
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Ablación selectiva con láser de los vasos
sanguíneos anastomóticos de la placenta
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Coagulación selectiva del cordón
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Clasificación según sitio de unión anatómica de los fetos
› Simétricos
toracópagos
craneópagos
pigópagos
› Asimétricos Epignatos
Teratópagos
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Gemelas Hensel: bicéfalas.
Nacieron con una tercera extremidad superior, atrófica, que
fue amputada
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El teratoma
sacro-
coxígeo
puede ser la
expresión de
un parásito
sin forma
humana.
Parásito en el
que se
reconocen
miembros
malformados
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FETUS IN
FETUS
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GEMELO ACARDICO
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GEMELOS BICIGOTICOS
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GEMELOS BICIGOTICOSDOBLE FECUNDACION (FERTILIZACIÓN)
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DOBLE
IMPLANTACION
(NIDACION)
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IMPREGNACION: Ambos óvulosprovienen del mismo ciclo sexual y sonfecundados en el mismo coito
SUPERIMPREGNACION: Cuando cadaovulo es fecundado en coito diferente:
SUPERFECUNDACIÒN: Los óvulos provienendel mismo ciclo (poli ovulación), perofecundados en coitos diferentes
SUPERFETACION: Los óvulos provienen deciclos distintos
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BIOVARICA BIFOLICULAR: Cadaovulo proviene de folículos de distintosovarios
MONOOVARICA BIFOLICULAR: Losóvulos provienen de dos folículos delmismo ovario
MONOOVARICA MONOFOLICULAR:Ambos óvulos provienen del mismofolículo
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Factores asociados
› Raza (afroamericana)
› Herencia
› Paridad (a mayor paridad)
› Edad Materna (a mayor edad materna)
› Drogas (tratamiento de infertilidad)
› Técnicas reproductivas
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24
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Otros = Metrorragia III T. (= P.P./ DPNI)
Feto muerto in úteroMalformaciones congénitas
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Parto prematuro
Sindrome Hipertensivo
Anemia materna
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Crecimiento fetal discordante
Sindrome de transfusión feto-fetal
Muerte de uno de los gemelos
Malformaciones congénitas
Gemelo acárdico
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Mortalidad neonatal 51/1000 nv
Mortalidad fetal 28/1000 nv
Biamniótico-bicorial 10%
Biamniótico-monocorial 25%
Monoamniótico-monocorial 50%
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Prematurez 15.9 /1000 nv
Retardo de crecimiento intrauterino
15.1/1000nv
Transfusión feto fetal 11.7/1000nv
Anomalías congénitas 10.1/1000nv
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