Multifetal Gestation Flashcards
What are the two types of twins?
Dizygotic and monozygotic
In which Populations are dizygotic twins more popular?
More common in blacks, maternal family history of twins, extremes of age, high parity, abundant nutrition, geographic areas with more sunlight, induction of ovulation
How do the various types of monozygotic twins form?
- if the zygote splits in the morula stage (about day 3) twins will be dichorionic- diamniotic
- if the zygote splits in the blastular stage the twins will be monochrionic, diamniotic
- a later split - monochrionic- monoamniotic
- split after the embryonic disk is formed - results in conjoint twins
How do you diagnose a multiple pregnancy in the first trimester
- Maternal side family history, race, fertility drugs, older age
- exaggerated symptoms of pregnancy
- ultrasound: multiple gestational sacs in the uterus
How do you diagnose a multiple pregnancy in the second trimester
- uterus larger than dates
- ultrasound: two similar segments of the foetuses
- early onset GPH
- polyhydramnios
- occurrence of complications
- two foci of auscultation of fetal heart
How do you diagnose a multiple pregnancy in the third trimester
- Very large abdomen
- fetal head small for abdominal size
- multiple fetal poles or limbs
- 2 or more fetal hearts
- abnormal lies, polyhydramnios
What are the complications of multiple pregnancy in the first trimester?
- abortion
- hyperemesis gravidarum
- vanishing twin
- increased risk of fetal malformations
What are the complications of multiple pregnancy in the second trimester?
- anaemia
- urinary tract infection
- intrauterine death
What are the complications of multiple pregnancy in the third trimester?
- pre term labour
- GPH
- antepartum haemorrhage
- polyhydramnios
- malpresentations
- IUGR
- gestational diabetes
- monoamniotic twins: cord entanglement
- twin to twin transfusion
When and how should monoamniotic twins be delivered?
By should be delivered by csection at 36 weeks or when their lungs are mature
They should be monitored twice weekly
What is a multi fetal gestation?
Two or more fetuses are present in the uterus at the same time
What is the management of multiple gestation in the 2nd and 3rd trimester?
2nd trimester:
- adequate diet
- adequate rest
- prevention of uti and anaemia
3rd trimester:
- as for second trimester
- weekly antenatal visit
- monthly growth monitoring by echography
- do not allow past EDD: rather induce labour
- thorough scan at 22 weeks to look for malformations
What are the fetal complications of a twin pregnancy?
- prematurity
- slow growth
- twin to twin transfusion
- congenital anomaly
- twin reversed arterial perfusion
What are indications for csection before the onset of labour?
- Majority would be the same as for singletons
2. When the presentation of the leading twin is anything other than the occiput
When would a csection for the second twin be indicated?
- fetus is much larger than the first one and head does not engage
- presenting part is breech
- external version could not turn the fetus from a transverse lie
- cervix had already closed
- CTG Iindicates fetal distress with no prospect of immediate delivery
- there is a massive haemorrhage due to untimely separation of the placenta of the first or both fetuses
