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Multifetal Flashcards

1
Q

Def of Multifetal Pregnancy

A

Pregnancy that results in > 1 fetus.

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2
Q

Incidence of Multifetal Pregnancy

A
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3
Q

Types of Multifetal Pregnancy

A
  • Monozygotic Twins
  • Dizygotic Twins
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4
Q

Percentage of Monozygotic Twins

A

33%

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5
Q

Synonyms of Monozygotic Twins

A

Uniovular twins, identical twins or
homologous twins

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6
Q

Incidence of Monozygotic Twins

A

1/250 of deliveries

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7
Q

Mechanism of Monozygotic Twins

A
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8
Q

RF for Monozygotic Twins

A

Not related to risk factors

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9
Q

Characters of Monozygotic Twins

A

They are similar in sex, morphological features, psychological & mental profile & HLA typing

  • Differ in finger prints, iris pattern & voice
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10
Q

Percentage of Dizygotic Twins

A

67%

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11
Q

Synonyms of Dizygotic Twins

A

Binovular twins, non-identical twins or
heterologous twins

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12
Q

Incidence of Dizygotic Twins

A

Varies according to risk factors

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13
Q

Mechanism of Dizygotic Twins

A
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14
Q

RF for Dizygotic Twins

A

Related to certain risk factors

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15
Q

Characters of Dizygotic Twins

A

Sex & morphological features are as
any sisters or brothers

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16
Q

Determination of zygosity

A
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17
Q

RF for Dizygotic Twins

A
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18
Q

Complications of Multifetal Pregnancy

A
  • Maternal
  • Fetal
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19
Q

Complications of Multifetal Pregnancy During Pregnancy

  • Maternal
A
  • During pregnancy
  • During Labor
  • During Puerperium
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20
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

A
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21
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

  • PROM
A
  • 3 times more common than singleton pregnancy specially if associated è polyhydramnios or abnormal presentation.
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22
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

  • APH
A
  • Due to placenta previa (due to large placenta encroaching on LUS) or placental abruption (due to higher incidence of PIH).
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23
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

  • PIH
A

Usually of early onset.

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24
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

  • Anemia
A

Due to increased requirements & plasma expansion.

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25
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

  • Malpresentation
A
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25
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

  • Pressure Manifestations
A
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26
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

  • Psychological
A

Due to prolonged rest & hospitalization.

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27
Q

Maternal Complications of Multifetal Pregnancy During labor

A
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28
Q

Maternal Complications of Multifetal Pregnancy During Puerperium

A
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29
Q

Fetal Complications of Multifetal Pregnancy

A
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30
Q

Fetal Complications of Multifetal Pregnancy

  • IUFD
A
  • More in monozygotic type than in dizygotic type due to less placental perfusion & increases chance of vascular connections.
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31
Q

Fetal Complications of Multifetal Pregnancy

  • Intrapartum Fetal Death
A

Death of 1st fetus:
- Due to cord prolapse or locked twin.

Death of 2nd fetus:
- Due to excessive sedation, premature separation of placenta, hypoxia, constriction ring or operative manipulation.

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32
Q

Fetal Complications of Multifetal Pregnancy

  • IUGR
A

Due to relatively deficient resources that may affect one fetus > other.

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33
Q

Fetal Complications of Multifetal Pregnancy

  • TTTS
A

….

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34
Q

Fetal Complications of Multifetal Pregnancy

  • Increased Incidence of Congenital Anomalies
A
  • Major anomalies develop in 2% & minor anomalies develop in 4% of twins.
  • Incidence in monozygotic type is twice that in dizygotic type.
  • Incidence increaeses in monoamniotic type.
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35
Q

Fetal Complications of Multifetal Pregnancy

  • umbilical Cord Problems
A
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36
Q

Fetal Complications of Multifetal Pregnancy

  • Cerebral Palsy
A
  • times more common in twins than in singleton pregnancy & it occurs due to single fetal demise, IUGR, discordant growth or TTTS.
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37
Q

Fetal conditions unique to multifetal pregnancy

A
  • Vanishing Twin syndrome
  • Single fetal Demise
  • Discordant Growth
  • TTTS
  • Conjoint Twins (Siamese twins or disomata)
  • Locked Twins
  • Retained 2nd Twin
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38
Q

Def of Vanishing twin syndrome

A
  • 1st trimesteric spontaneous loss or arrest of development è subsequent resorption of at least 1 embryo or fetus which was viable & previously confirmed ultrasonically.
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39
Q

Dx of Vanishing twin syndrome

A
  • Viable multifetal pregnancy is diagnosed by ultrasound in ist trimester & not confirmed on later ultrasound examination.
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40
Q

Def of Single fetal demise

A
  • Death of 1 fetus remote from term but pregnancy continues è ≥ 1 living fetus.
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41
Q

Incidence of Single fetal demise

A

6% of twins.

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42
Q

RF for Single fetal demise

A

Monochorionicity, same sex fetuses & weight discordancy.

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43
Q

Complications of Single fetal demise

A
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44
Q

Def of Discordant Growth

A

Size inequality of fetuses that may be sign of pathological UGR in one fetus.

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45
Q

Incidence of Discordant Growth

A

10-15% of twins.

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46
Q

Etiology of Discordant Growth

A
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47
Q

Complications of Discordant Growth

A
  • Increased incidence of congenital anomalies.
  • Physical & intellectual sequels late in life.
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48
Q

Dx of Discordant Growth

A
  • ≥ 15% difference in estimated fetal weight by ultrasound (larger twin is used as index)
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49
Q

Def of TTTS

A
  • Blood transfusion from one fetus (donor) to the other (recipient) due to presence of uncompensated intraplacental A-V shunts è preferential blood flow () 2 fetuses.
50
Q

Incidence of TTTS

A

15% of monochorionic twins (it is rare in dichorionic twins).

51
Q

Pathology in TTTS

A
52
Q

Dx of TTTS

A
53
Q

Managment of TTTS

A
54
Q

Synonyms of Conjoint Twins

A

Siamese twins or disomata

55
Q

Def of Conjoint Twins

A
  • Twins bodies are fused in certain sites.
  • 0.5% of monozygotic twins & is more in female than male fetuses (3:1)
56
Q

Types of Conjoint Twins

A
57
Q

Dx of Conjoint Twins

A
58
Q

Managment of Conjoint Twins

A

CS or vaginal delivery in extreme prematurity.

59
Q

Def of Locked Twins

A

One fetus impedes descent & delivery of the other.

60
Q

Incidence of Locked Twins

A

1/50000 of deliveries & it is more common in primigravidas.

61
Q

Types of Locked Twins

A
62
Q

Risks of Locked Twins

A
63
Q

Dx of Locked Twins

A

Early diagnosis is rare but it must be anticipated.

64
Q

Prevention of Locked Twins

A

By performing elective CS if 1st twin is breech & 2nd twin is cephalic.

65
Q

Managment of Locked Twins

A
66
Q

Managment of Locked Twins

  • Collision, impaction & compaction
A
67
Q

Managment of Locked Twins

  • Chin to chin interlocking
A
68
Q

Def of Retained 2nd Twin

A

Failure of delivery of 2nd twin vaginally after delivery of 1st one for > 30 minutes.

69
Q

Risks of Retained 2nd Twin

A
70
Q

Managment of Retained 2nd Twin

A

CS

71
Q

Dx of Multifetal Pregnancy

A
  • During Pregnancy
  • During Labor
72
Q

Dx of Multifetal Pregnancy

  • During Pregnancy
A
73
Q

Dx of Multifetal Pregnancy During pregnancy

  • Hx
A
74
Q

Dx of Multifetal Pregnancy During pregnancy

  • General Ex
A
75
Q

Dx of Multifetal Pregnancy During pregnancy

  • Abdominal Examination
A
76
Q

Dx of Multifetal Pregnancy During pregnancy

  • US
A
77
Q

US of Multifetal Pregnancy During pregnancy

A
78
Q

US of Multifetal Pregnancy During pregnancy

  • frequency
A

Frequency:
- In dichorionic twins: Every 4-6 weeks.
- In monochorionic twins: Every 2 weeks.

79
Q

US of Multifetal Pregnancy During pregnancy

  • Value
A
80
Q

US of Multifetal Pregnancy During pregnancy

  • determination of Chorionicity & Amnionicity
A
81
Q

US of Multifetal Pregnancy During pregnancy

  • Lambda Sign
A
82
Q

US of Multifetal Pregnancy During pregnancy

  • T sign
A
83
Q

Dx of Multifetal Pregnancy During Labor

A
84
Q

DDx of Multifetal Pregnancy

A

Other causes of oversized uterus.

85
Q

Prevention of Multifetal Pregnancy

A

A) Proper use of vulation induction drugs.

B) Single embryo transfer in IVF programs è cryopreservation of other embryos.

86
Q

Managment of Multifetal Pregnancy

A
  • During pregnancy
  • During Labor
87
Q

Managment of Multifetal Pregnancy

  • During Prenancy
A
88
Q

Managment of Multifetal Pregnancy During Pregnancy

  • Adequate ANC
A
  • As any high-risk pregnancy (visits are every 2 weeks till 28 weeks then every week till 36 weeks then hospitalization).
89
Q

Managment of Multifetal Pregnancy During Pregnancy

  • General Lines
A
90
Q

Managment of Multifetal Pregnancy During Pregnancy

  • Observation
A
91
Q

Managment of Multifetal Pregnancy During Pregnancy

  • Selective Fetal Reduction
A
92
Q

Selective Fetal Redution in Multifetal Pregnancy

  • Def
A

Reduction of selected fetus or fetuses in dichorionic multifetal pregnancy to enhance survival of other fetuses.

93
Q

Selective Fetal Redution in Multifetal Pregnancy

  • Time
A

Performed at 9-12 weeks.

94
Q

Selective Fetal Redution in Multifetal Pregnancy

  • Techniques
A

Ultrasound guided KCI injection into heart or thorax of each selected fetus.

95
Q

Selective Fetal Termination in Multifetal Pregnancy

A
96
Q

Selective Fetal Termination in Multifetal Pregnancy

  • Def
A

Selective destruction of abnormal fetuses.

97
Q

Selective Fetal Termination in Multifetal Pregnancy

  • Time
A
  • Performed later in pregnancy than selective reduction (because anomalies are typically not discovered till 2nd trimester).
98
Q

Selective Fetal Termination in Multifetal Pregnancy

  • Techniques
A

a) Ultrasound guided intracardiac KCI injection.
b) Fetoscopic ligation or laser coagulation of umbilical cord.

99
Q

Managment of Multifetal Pregnancy

  • Delivery
A
100
Q

Managment of Multifetal Pregnancy in Delivery

  • Time
A
  • The ideal time for delivery of uncomplicated multifetal pregnancy is uncertain however, pregnancies shouldn’t go beyond 40 weeks because postmaturity is difficult to deal è in twin pregnancy.
101
Q

Managment of Multifetal Pregnancy in Delivery

  • Place
A

In well-equipped hospital.

102
Q

Managment of Multifetal Pregnancy in Delivery

  • Methods
A
  • Vaginal or CS
103
Q

Vaginal Delivery in Multifetal Pregnancy

A
104
Q

Vaginal Delivery in Multifetal Pregnancy

  • Indications
A

It is the rule in twin pregnancies unless CS is indicated.

105
Q

Vaginal Delivery in Multifetal Pregnancy

  • Prerequesities
A
106
Q

Vaginal Delivery in Multifetal Pregnancy

  • managment of 1st stage
A
107
Q

Vaginal Delivery in Multifetal Pregnancy

  • Managment of 2nd Stage
A
108
Q

Vaginal Delivery in Multifetal Pregnancy

  • Delivery of 1st fetus
A

Is according to ordinary rules of labor è avoidance of
AROM, difficult forceps or ventouse (if cephalic) & breech extraction (if breech).

109
Q

Vaginal Delivery in Multifetal Pregnancy

  • After Delivery of 1st fetus
A
110
Q

Vaginal Delivery in Multifetal Pregnancy

  • delivery of 2nd Fetus
A
111
Q

Vaginal Delivery of 2nd Fetus in multifetal Pregnancy

  • If there is amniotic Sac (diamniotic twins & no ROM) & there is no fetal distress
A
112
Q

Vaginal Delivery of 2nd Fetus in multifetal Pregnancy

  • If there is amniotic Sac (diamniotic twins & no ROM) & there is no fetal distress
  • Cephalic
A

Moderate fundal pressure to guide head in birth canal then do AROM & leave for spontaneous delivery.

113
Q

Vaginal Delivery of 2nd Fetus in multifetal Pregnancy

  • If there is amniotic Sac (diamniotic twins & no ROM) & there is no fetal distress
  • Breech
A
114
Q

Vaginal Delivery of 2nd Fetus in multifetal Pregnancy

  • If there is amniotic Sac (diamniotic twins & no ROM) & there is no fetal distress
  • Oblique & Transverse
A
  1. ECV or EPV then delivery as cephalic or breech.
  2. IPV on intact membrane during period of uterine quiescence then AROM followed by breech extraction.
115
Q

Vaginal Delivery of 2nd Fetus in multifetal Pregnancy

  • If there is NO amniotic Sac (monoamniotic twins or ROM) or there is cord prolapse or fetal distress or if delivery of 2nd fetus is delayed > 1/2 an hour
A
116
Q

Vaginal Delivery of 2nd Fetus in multifetal Pregnancy

  • If there is NO amniotic Sac (monoamniotic twins or ROM) or there is cord prolapse or fetal distress or if delivery of 2nd fetus is delayed > 1/2 an hour
  • Cephalic
A

Cephalic presentation:
1. Head is engaged: Ventouse or forceps.
2. Head isn’t engaged: IPV followed by breech extraction.

117
Q

Vaginal Delivery of 2nd Fetus in multifetal Pregnancy

  • If there is NO amniotic Sac (monoamniotic twins or ROM) or there is cord prolapse or fetal distress or if delivery of 2nd fetus is delayed > 1/2 an hour
  • Breech
A

Breech extraction.

118
Q

Vaginal Delivery of 2nd Fetus in multifetal Pregnancy

  • If there is NO amniotic Sac (monoamniotic twins or ROM) or there is cord prolapse or fetal distress or if delivery of 2nd fetus is delayed > 1/2 an hour
  • Oblique or transverse
A

IPV followed by breech extraction.

119
Q

Vaginal Delivery in Multifetal Pregnancy

  • managment of 3rd Stage
A
120
Q

CS in Multifetal Pregnancy

  • indications
A
121
Q

Managment of Multifetal Pregnancy

  • Neonatal Care
A

For detection & management of any complication.

122
Q

Managment of Multifetal Pregnancy

  • Postnatal Care
A
  1. Observation of patient during puerperium.
  2. Contraception.
123
Q

Prognosis of Multifetal Pregnancy

A

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