12 - Obs - Multiple Pregnancy - Antepartum MGMT Flashcards
All multiples:
Early ???: Screening for ?abnormalities offered as normal. Chorionicity most accurately ascertained in ? trim – in ?? twins, dividing membrane is thicker as meets ? (? sign), in MC twins it is ? (T sign) and ? to the shared placenta. Nuchal translucency can also predict risk of ?? twin compx – greater when >?% discord.
USS Chr first DC placentas Lambda thin perpendicular MC >20
All multiples:
General: Preg = ? risk, care ?
led. Iron and ? ? given. Multiple pregs incr maternal ? and ?. ? home help discussed.
ID of risk of preterm delivery: ????? of ? length may show those at most risk. Policy of inserting cervical ? in short cervix not advised but apprt if v ?, v ?.
high consultant folic acid tiredness anxiety postnatal
TVUSS cervical sutures short early
All multiples:
Selective Reduction: To a twin preg at ?wks discussed w women w ? or higher. Slightly incr risk of ?, reduces chance of ? birth and ? ?. Reduction to twin singleton not advised. May also be done if one twin has ? abnormality. Safest before ? weeks.
ID of IUGR: More common and more ? to detect in multiple pregs vs singletons, serial ??? for ? usually routine done at ?, ? and 36wks.
12 triplets miscarriage preterm cerebral palsy congen 14
difficult USS growth 28 32
MC twins
USS surveillance starts at ?wks. TTTS most commonly diagnosed ?-?wks, by careful ??? inc ? regurg, or as ? around recipient causes abdo ?. Unless v ?, laser ? of placental ? using USS and ?
best -> lower neonatal ? rate than ?. MC twins also at higher risk of ???? and in utero ?, usually scanned every ?wks.
12 16-22 USS tricuspid polyhydramnios distension mild photocoagulation anastomoses fetoscopy handicap amnioreduction IUGR death 2
Fetal Abnormality
Where one twin abnormal selective ??? discussed. In DC twins can be by ? injection of KCl 24wks), it can be offered after ?wks so if deliv ensues remaining twin will survive. In ?? twins the cord must be ? using bipolar diathermy, or its insertion ?, as circ is ?.
TOP intracardiac 14 late 32 MC occluded ablated shared
