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BOOK TITLE: Principles and Practice of Assisted Reproductive Technology
A brief discussion on multiple order births has been presented in this chapter. Incidence of multiple order birth has risen due to an increase in the number of couples seeking fertility treatments. Exact etiology of multifetal pregnancy remains unknown. A variety of factors seem to be associated with a rise in the number of multiple births. Most common associated causes are maternal age and parity, race and ethnicity, socioeconomic status, genetic, use of fertility drugs, and assisted reproductive techniques. Zygosity of twins is determined according to the time when splitting occurs after fertilization. Monozygous twins occur after an ovum is fertilized by a single sperm and this fertilized ovum then splits within 48 hours leading on to the formation of amnion and chorion separately. Diagnosis of a pregnant women carrying multiple pregnancy is based on history, clinical examination, and imaging studies. Management of multifetal pregnancy is directed toward the type of multiple gestation. Maximum risk in the antenatal period is associated with monochorionicmonoamniotic twins, hence, these pregnancies should be given extra care.