CBL 4 - Twins and vaginismus and PPD Flashcards
What should you include in assessment of clients w chronic pelvic pain? (4)
- Building a therapeutic relationship – validate.
- Pain History OLDCARTS
- Psychosocial factors
- Assessment of gynecological pain contributors
What twin care is in our scope?
Di di w consultation
Incidence of twin birth in Canada?
2-3 %
How often does twin pregnancy occur spontaneously?
1/80-90 all pregnancies
Factors that predispose spontaneous twinning? (6)
Familial – through maternal
Higher Nutritional status
Elevated pituitary gonadotropins
Maternal parity
35 or older
African descent
Risks of multifetal gestation? (13)
Major: PTL (40-50%)
Twin to twin transfusion
IUGR
Hypertensive disorders preg
PPH (2x)
Umbilical cord accidents
Fetal demise
Vasa previa
Uterine antony
Malpresentation
Polyhydramnios
Discordant growth
Fetal anomalies
Maternal risk of twins (concise)? (3)
HDP (hypertension)
PPH
++Discomforts of preg
Fetal risk of twins (concise)? (8)
- PTB
- IUGR both or one
- TTTS (twin to twin)
- Congenital abnormalities
- Polyhydramnios
- Malpresentation
- Cord prolapse
- Perinatal mortality
When does the evidence show twins should be induced?
Uncomplicated didi 37+6
Monomono by 34
Management of twin vag labour?
EFM
IV access
And lots of other stuff lol
Surprise twin steps? (6)
- Call for help obvi
- Delivery twin A clamp and cut cord (mark as twin A)
- Assess Twin B’s lie and get them longitudinal, no Ves
- Wait for EMS, IV, cont doppler, draw blood
- If twin b born double clamp and cut cord
- THEN active mgmt and double CCT
Ideal length bw twins?
<30 mins (controversial)
Faster if ab FHR
What is zygosity for twins?
Number of fertilized ova
What is placentation classification for twins?
Number of placentas
Chorionic and amnionic sacs
What are monozygotic twins?
One fertilized ovum, identical
30%
When optimal timing to diagnose chroionicity of twins?
10-14 wks
What is the recommendation for twin birth with midwives?
In a hospital with OB and OR, nurses, anaesthesia, neonatal staff present and trained in twin delivery
How many twins will remain undiagnosed until labour without US?
20 %
Common maternal discomforts of twin birthers?
More nausea/vomiting
More acid reflux
More anemia
More aches and pains
More wait gain/edema
More fetal activity
Additional T1 tests offered to twin birthers?
Enhanced first trimester screen (looking at placentation and NT?)
Twin monitoring?
Early establish if mono mono, mono di, didi etc
Routine
AND 16-20 for fetal anomalies
AND T3 serial US
EFM in labour
Monomono - every 2 weeks after 16 wks
Associated maternal complications twin birthers? (4)
GDM
Pyelonephritis
Antepartum hemorrhage
Hypertensive disorders of pregnancy
What are some indications your client is twinning without US?(6)
- Measuring large for GA, yet no fetal movement detected yet
- More broad and round growth
- Inexplicable weight gain
- Hyperemesis gravidarum
- Feeling multiple poles, parts feel smaller than you’d expect
- 2 distinct FHR readings
Who is twin A who is twin B?
Twin A – who is presenting lower in uterus
Twin B – who is presenting higher in uterus
Keep track going forward (fetal sex can help)
What are dizygotic twins?
2 distinct ova fertilized (fraternal)
70 %
What is a mono di twin?
Monochorionic, diamniotic
Share the same placenta but have different amniotic sacs (amnion)
Most monozygotic are mono di >70 %
What are mono mono twins?
Monochorionic, monoamniotic
Share the same placenta and the same sac (amnion)
Must be identical
1 % super rare
What are di di twins?
Dichorionic, diamniotic
Have distinct placentas and sacs (amnions)
Sometime placentas fuse
All dizygotic twins are didi, 30 % monozygotic twins are didi
Perinatal mortality of the monomono twins?
50-60 % :0
Historical defn vaginismusus and dyspurnia?
Vaginismusus – involuntary spasm of outer third of vagina that interferes w intercourse
Dyspurnia – pain with insertion into pelvic area
Prevelance of pelvic pain with insertion?
5-17 % (but way more actually)
Up to date pelvic pain term?
CPP chronic pelvic pain
-multifactorial, needs a multidisciplinary approach
EPDS Scoring?
Total score 14 or more – MH specialist
12-13 -Monitor and support
Anxiety – 6 or more monitor, support, and offer education
Self harm (10) – assessment and intervention and consider MH referral
Who could be considered for vag twin birth?
Di di
Mono di
-multifactorial, needs a multidisciplinary approach
