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HMB2201 Complex Midwifery > Multiple birth > Flashcards

Multiple birth Flashcards

1
Q

What is the difference between monozygotic twins and dizygotic twins

A

Monozygotic twins - Identical twins. Ova splits. The two fetuses share a placenta.
Dizygotic twins - Fraternal twins. 2 eggs are fertilised and implant. Each fetus has it’s own placenta.

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2
Q

What is twin to twin transfusion?

A

A risk factor of monozygotic twins. One twin receives more nutrients than the other. Resulting in both baby’s not being well. One fetus is IUGR.

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3
Q

What are the influencing factors for dizygotic twins?

A
  • Maternal age (35-39yrs)
  • Higher parity
  • Tall stature
  • Family hx of twins
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4
Q

How is a twin pregnancy diagnosed?

A

Ultrasound and abdominal examination (inspection, palpation, auscultation)

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5
Q

What is monochorionicity?

A

When there the twins share a placenta.

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6
Q

What are the ultrasound schedule for twins?

A

First trimester scan, 4 weekly for fraternal and 2 weekly for identical.

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7
Q

What are the risks of multiple pregnancy?

A
  • congenital abnormalities
  • minor disorders
  • anaemia
  • polyhydramnios
  • miscarriage
  • extreme preterm birth and mortality
  • pregnancy-induced HTN
  • pre-eclampsia
  • twin to twin transfusion
  • IUGR
  • antepartum haemorrhage
  • umbilical cord entanglement
  • threatened preterm labour
  • C/S
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8
Q

Twins have a ____ risk of congenital abnormalities than singleton pregnancies.

A

higher.

Dichorionic - twice the risk. monochorionic - four times the risk.

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9
Q

How is one baby with an anomaly managed?

A

Expectantly or selective fetocide of affected twin.

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10
Q

What is polyhydramnios?

A

Excess amniotic fluid in uterine cavity. Can be indicative of fetal abnormality and is associated with monochorionic twin pregnancy.

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11
Q

Acute polyhydramnios in the second trimester can lead to ……….

A

miscarriage or preterm birth.

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12
Q

What is amnioreduction?

A

Removal of excess fluid by aminocentesis.

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13
Q

What is the average gestation at birth for spontaneous birth of twins?

A

37 weeks

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14
Q

What does pregnancy-induced HTN increase the rate of?

A

PIH, severe pre-eclampsia and clotting disorders due to increased hormone production.

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15
Q

What issues do Donor baby’s have vs recipient babys in twin-to-twin transfusion?

A

Donor - Anaemia due to hypovolaemia, growth restriction, oliguria
Recipient - Hypervolemia, polyuria, polycythaemia.

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16
Q

What signs does the woman have of twin-to-twin transfusion?

A

Sudden increase in abdominal size and extreme discomfort.

17
Q

What is the treatment for twin-to-twin transfusion?

A

Amniocentesis (every 1-2 weeks and draining amniotic fluid)
Prolong pregnancy to improve outcomes.
Fetal surgery to separate placental blood vessels connecting babies’ circulation.

18
Q

What are the influences that can cause IUGR?

A

PIH, smoking, diet, infection, fetal abnormality (twin-to-twin transfusion).

19
Q

Antepartum haemorrhage can occur in multiple pregnancy for what reasons?

A
  • Larger placental size.
  • Occurrence of placenta praevia and placental abruption.
  • Increase chance of placenta in lower uterine segment.
  • The uterus size is larger (increases chance of abruption - SROM and PIH)
20
Q

What can occur with umbilical cord entanglement?

A

Blood supply to one fetus is compromised.

21
Q

Can those with umbilical cord entanglement have a vaginal birth?

A

No

22
Q

When there is a threatened preterm labour what needs to be considered?

A
  • screening for bacterial vaginosis
  • GBS screening
  • maternal steroid therapy
23
Q

When is IOL organised for twins?

A

38 weeks

24
Q

What are some of the various combinations of presentation for twins?

A
  • vertex and vertex
  • vertex and breech
  • breech and vertex
  • breech and breech
  • vertex and transverse
  • breech and transverse
25
Q

How can contractions be different in a multiple pregnancy than to a singleton?

A

Uterine dysfunction due to distention of the uterus. Accurate monitoring of contraction pattern is needed and a synto infusion may be required.

26
Q

After the birth of twin 1 what must be done regarding twin 2?

A
  • lie, presentation and position established by abdominal palpation.
  • FHR
  • Maternal BP and HR
  • ECV if necessary (C/S if baby does not turn from transverse)
27
Q

What do you do if twin 2 is not engaged in the pelvis?

A

apply fundal pressure before ARM to reduce risk of cord prolapse.

28
Q

How long should it take after twin 1’s birth for contractions to start?

A

5 mins. If not start an oxytocin infusion.

29
Q

If there are no signs of distress how long should be allowed between babies’ births?

A

30-45 mins

30
Q

What needs to be done regarding the placenta and cords after delivery?

A

Examine and look at the number of amnions and chorions. Send to pathology to determine zygosity.

31
Q

What are some of the complications associated with labour and birth?

A
  • malpresentations
  • PROM
  • Cord prolapse
  • prolonged labour
  • locked twins
  • delayed birth of twin 2
  • premature expulsion of the placenta
32
Q

What is locked twins?

A

A rare occurrence where the twins heads are ‘locked’ together preventing vaginal delivery.

33
Q

What can be the risks of delayed birth of twin 2?

A
  • intrauterine hypoxia
  • birth asphyxia (due to premature separation of placenta)
  • sepsis from ascending infection of twin 1’s umbilical cord
  • delay in re-formation of lower uterine segment (needed for cervical dilation to be reached again)
34
Q

What can speed up the birth of twin 2?

A

Putting twin 1 at the breast helps stimulate the release of oxytocin from maternal pituitary gland.

35
Q

What is the danger of premature expulsion of the placenta?

A

Asphyxia and death of twin 2 can occur. If twin 2’s birth is delayed can increase the risk of intrapartum haemorrhage.

36
Q

How does the risk of cerebral palsy increase with multiples?

A
  • twins x4 increase
  • triplets x20 increase
  • If one twin develops CP than the other twin has a 12% chance.
  • When twin increases the other twins risk of developing CP by 5%.
    Higher risk in identical twins.
37
Q

Why do conjoined twins occur?

A

Abnormal or incomplete division of zygote. It can only occur in monozygotic twins.

38
Q

What is Acardiac twins?

A

One twin is dependant on the other twin’s cardiovascular system.

39
Q

Why is there an increasing incidence of mutliples?

A
  • IVF transfer of multiple embryos

- Ovulation induction can cause more than 1 egg to be released

HMB2201 Complex Midwifery (8 decks)

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