Chapter 16: Multiple Pregnancy Flashcards
MULTIPLE PREGNANCY You are a trainee intern in an antenatal ward admitting Emeni, a 24 year old G1 P0 Tongan woman who is pregnant with twins and who has developed polyhydramnios at 24 weeks’ gestation. She has been told that the polyhydramnios has been caused by twin-to-twin transfusion. Which of the following statements about her twins is CORRECT?
Twin to twin transfusion is a complication of dizygotic twinning
Emeni’s twins must share a single amnion
The twins must share a single chorion
Emeni’s twins must be non-identical
Monozygotic twins most commonly have a single chorion and one amnion
The twins must share a single chorion
MULTIPLE PREGNANCY You are a trainee intern in birthing suite admitting Lynn, a 34 year old G1 P0 NZ European woman with dichorionic twins who is in early labour at 35 weeks. Her antenatal course has been unremarkable for a twin pregnancy. The cervix is 3cm dilated and fully effaced, with the presenting part at the level of the ischial spines. Which of the following observations, if made on admission to birthing suite, is MOST LIKELY to cause you to advise Lynn to have a caesarean section?
The membranes of the leading twin are bulging.
The blood pressure is 150/100 and there is proteinuria ++
There is pitting oedema of Lynn’s lower legs, almost to her knees
Her blood pressure is 150/100
The leading twin is a flexed breech presentation and twin 2 is cephalic
The leading twin is a flexed breech presentation and twin 2 is cephalic
MULTIPLE PREGNANCY You are a trainee intern at an antenatal clinic with Ashanti, a 38 year old West African primigravida who is 12 weeks pregnant with twins. The twins have 1 chorion and 2 amniotic sacs. Ashanti conceived with IVF and one embryo was transferred on day 5. She has a BMI of 32. Her mother was a twin, and her husband has non-identical twin brothers. Which of the following is the MOST likely to have predisposed her to this twin pregnancy?
The paternal family history
Her racial/ethnic origin
The IVF treatment
Her obesity
Her maternal family history
Her age
The IVF treatment
MULTIPLE PREGNANCY You are a trainee intern at an antenatal clinic with Mackenzie, a 24 year old Pākehā primigravida who is 12 weeks pregnant with a dichorionic diamniotic twin pregnancy. The twin pregnancy was diagnosed at the time of her nuchal translucency scan. Mackenzie has a BMI of 23 and no significant past medical or family history. So far, she has felt well in her pregnancy. Which of the following antenatal complications is Mackenzie MOST likely to develop?
Twin-to-twin transfusion
Polyhydramnios
Pre-eclampsia
Hyperemesis gravidarum
Gestational diabetes
Hyperemesis gravidarum
MULTIPLE PREGNANCY You are a trainee intern on birthing suite with Steph, a 28 year old Pākehā woman who is 36 weeks pregnant with twins. Steph is having an induction of labour for pre-eclampsia. She is para 1 and has had a previous normal birth at term. Her twins are appropriately grown and the first twin is cephalic and the second twin is breech. Steph’s blood pressure is 150/100 and she has been prescribed oral labetalol. Her bloods tests show normal platelets, creatinine and transaminases. She has no proteinuria. Steph is currently 3cm dilated with bulging membranes. Steph would like some pain relief. What analgesia is MOST APPROPRIATE for Steph’s labour and birth?
Epidural
Intramuscular morphine
Nitrous oxide
Acupuncture
General anaesthesia
Epidural
MULTIPLE PREGNANCY Rewa Parata is a 34 year old Māori school teacher who is 12 weeks pregnant with twins. She has just had a scan that shows that her twins are di chorionic, di amniotic (DCDA). Which of the following statements is TRUE about her twins?
Dichorionic twins may be monozygotic or dizygotic
Monochorionic twins result from fertilisation of different oocytes by different sperm
Dizygotic twins are always identical
Dichorionic twins result from division of the embryo at 9-13 days
Division of a single embryo before day 3 leads to twins with a shared placenta but separate amnions (MCDA)
Dichorionic twins may be monozygotic or dizygotic
MULTIPLE PREGNANCY Chu Young is a 34 year old G2P1 engineer of Chinese ethnicity who has just found out that she is 8 weeks pregnant with twins. In her previous pregnancy Chu had 1 hospital admission with hyperemesis. At her morphology scan her placenta was low lying but at a 32 week follow up scan this was no longer the case. Chu developed pregnancy induced hypertension at 41 weeks’ gestation and required an induction of labour. She subsequently had a caesarean section for fetal distress and an atonic PPH of 1200mls. Chu and her wife are very excited about the pregnancy but nervous too. Chu asks you about complications of a twin pregnancy. Which of the following is more likely in a SINGLETON pregnancy than a twin pregnancy?
Hyperemesis
Placenta praevia
Post-dates gestation
Hypertensive disorders of pregnancy
Caesarean Section
Post-partum haemorrhage
Post-dates gestation
