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Obstetrics I - OSCE > Multifetal Pregnancy > Flashcards

Multifetal Pregnancy Flashcards

1
Q
A
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2
Q

Incidence of Multifetal Pregnancy

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3
Q

Determination of zygosity

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4
Q

RF for Dizygotic Twins

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5
Q

Complications of Multifetal Pregnancy

A
  • Maternal
  • Fetal
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6
Q

Complications of Multifetal Pregnancy During Pregnancy

  • Maternal
A
  • During pregnancy
  • During Labor
  • During Puerperium
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7
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

A
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8
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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9
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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10
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

  • PIH
A

Usually of early onset.

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11
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

  • Anemia
A

Due to increased requirements & plasma expansion.

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12
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

  • Malpresentation
A
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13
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

  • Pressure Manifestations
A
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14
Q

Maternal Complications of Multifetal Pregnancy During Pregnancy

  • Psychological
A

Due to prolonged rest & hospitalization.

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15
Q

Maternal Complications of Multifetal Pregnancy During labor

A
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16
Q

Maternal Complications of Multifetal Pregnancy During Puerperium

A
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17
Q

Fetal Complications of Multifetal Pregnancy

A
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18
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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19
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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20
Q

Fetal Complications of Multifetal Pregnancy

  • IUGR
A

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

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21
Q

Fetal Complications of Multifetal Pregnancy

  • TTTS
A

….

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22
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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23
Q

Fetal Complications of Multifetal Pregnancy

  • umbilical Cord Problems
A
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24
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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25
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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26
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.
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27
Q

Incidence of TTTS

A

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

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28
Q

Pathology in TTTS

A
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29
Q

Dx of TTTS

A
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30
Q

Managment of TTTS

A
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31
Q

Synonyms of Conjoint Twins

A

Siamese twins or disomata

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32
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)
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33
Q

Types of Conjoint Twins

A
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34
Q

Dx of Conjoint Twins

A
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35
Q

Managment of Conjoint Twins

A

CS or vaginal delivery in extreme prematurity.

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36
Q

Def of Locked Twins

A

One fetus impedes descent & delivery of the other.

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37
Q

Incidence of Locked Twins

A

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

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38
Q

Types of Locked Twins

A
39
Q

Risks of Locked Twins

A
40
Q

Dx of Locked Twins

A

Early diagnosis is rare but it must be anticipated.

41
Q

Prevention of Locked Twins

A

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

42
Q

Managment of Locked Twins

A
43
Q

Managment of Locked Twins

  • Collision, impaction & compaction
A
44
Q

Managment of Locked Twins

  • Chin to chin interlocking
A
45
Q

Dx of Multifetal Pregnancy

A
  • During Pregnancy
  • During Labor
46
Q

Dx of Multifetal Pregnancy

  • During Pregnancy
A
47
Q

Dx of Multifetal Pregnancy During pregnancy

  • Hx
A
48
Q

Dx of Multifetal Pregnancy During pregnancy

  • General Ex
A
49
Q

Dx of Multifetal Pregnancy During pregnancy

  • Abdominal Examination
A
50
Q

Dx of Multifetal Pregnancy During pregnancy

  • US
A
51
Q

US of Multifetal Pregnancy During pregnancy

A
52
Q

US of Multifetal Pregnancy During pregnancy

  • frequency
A

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

53
Q

US of Multifetal Pregnancy During pregnancy

  • Value
A
54
Q

US of Multifetal Pregnancy During pregnancy

  • determination of Chorionicity & Amnionicity
A
55
Q

US of Multifetal Pregnancy During pregnancy

  • Lambda Sign
A
56
Q

US of Multifetal Pregnancy During pregnancy

  • T sign
A
57
Q

Dx of Multifetal Pregnancy During Labor

A
58
Q

Managment of Multifetal Pregnancy

  • During Prenancy
A
59
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).
60
Q

Managment of Multifetal Pregnancy During Pregnancy

  • General Lines
A
61
Q

Managment of Multifetal Pregnancy During Pregnancy

  • Observation
A
62
Q

Managment of Multifetal Pregnancy During Pregnancy

  • Selective Fetal Reduction
A
63
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.

64
Q

Selective Fetal Redution in Multifetal Pregnancy

  • Time
A

Performed at 9-12 weeks.

65
Q

Selective Fetal Redution in Multifetal Pregnancy

  • Techniques
A

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

66
Q

Selective Fetal Termination in Multifetal Pregnancy

A
67
Q

Selective Fetal Termination in Multifetal Pregnancy

  • Def
A

Selective destruction of abnormal fetuses.

68
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).
69
Q

Selective Fetal Termination in Multifetal Pregnancy

  • Techniques
A

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

70
Q

Managment of Multifetal Pregnancy

  • Delivery
A
71
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.
72
Q

Managment of Multifetal Pregnancy in Delivery

  • Place
A

In well-equipped hospital.

73
Q

Managment of Multifetal Pregnancy in Delivery

  • Methods
A
  • Vaginal or CS
74
Q

Vaginal Delivery in Multifetal Pregnancy

A
75
Q

Vaginal Delivery in Multifetal Pregnancy

  • Indications
A

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

76
Q

Vaginal Delivery in Multifetal Pregnancy

  • Prerequesities
A
77
Q

Vaginal Delivery in Multifetal Pregnancy

  • managment of 1st stage
A
78
Q

Vaginal Delivery in Multifetal Pregnancy

  • Managment of 2nd Stage
A
79
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).

80
Q

Vaginal Delivery in Multifetal Pregnancy

  • After Delivery of 1st fetus
A
81
Q

Vaginal Delivery in Multifetal Pregnancy

  • delivery of 2nd Fetus
A
82
Q

Vaginal Delivery of 2nd Fetus in multifetal Pregnancy

  • If there is amniotic Sac (diamniotic twins & no ROM) & there is no fetal distress
A
83
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.

84
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
85
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.
86
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
87
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.

88
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.

89
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.

90
Q

Vaginal Delivery in Multifetal Pregnancy

  • managment of 3rd Stage
A
91
Q

CS in Multifetal Pregnancy

  • indications
A
92
Q

Managment of Multifetal Pregnancy

  • Neonatal Care
A

For detection & management of any complication.

93
Q

Managment of Multifetal Pregnancy

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

Obstetrics I - OSCE (32 decks)

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