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Obstetrics > Multiple Gestations > Flashcards

Multiple Gestations Flashcards

1
Q

Risk factors of multiple gestations

A

IVF
Maternal age
Family History
Black race

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2
Q

Classifying multiple pregnancies is based on…

A

of fetus
# of fertilized eggs (Zygosity)
# of placenta (chorionicity)
# of amniotic cavities (amniocity)

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3
Q

Fraternal twins (non-identical)

A

Dizygotic
Dichorionic
Diamniotic

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4
Q

Monozygotic twins (Identical)

A

Monozygotic
Same-sex
Mono/Di chorionic
Mono/Di amniotic

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5
Q

Etiology of dizygotic twins

A

IVF
Induction
Familial
Racial

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6
Q

Types of monozygotic depends on

A

when split occurs

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7
Q

If monozygotic split occurs within 3 days of conception

A

Pregnancy will be
Dichorionic
Diamniotic

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8
Q

If monozygotic split occurs within 4-8 days, pregnancy will be

A

monochorionic
diamniotic

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9
Q

Maternal and fetal effects of multiple gestation

A

Maternal: physio changes are exaggerated
Fetal: monochorionic placenta has unique ability to develop vascular connection btwn fetal circulations (increases complications)

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10
Q

Complications of multiple gestation

A
  1. Miscarriage + Severe preterm
  2. Increased Perinatal mortality
  3. Increased stillbirths in monochorionic pregnancies
  4. Death of one fetus
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11
Q

The avg Gestational age @ delivery for multi-preg

A

37 wks

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12
Q

Percentage of twins born preterm

A

50%

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13
Q

Percentage of babies requiring NICU in twin pregnancy

A

20-25%

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14
Q

Perinatal mortality is how many times higher in multiple gestation

A

5.5 times higher than singleton

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15
Q

The intrauterine death of one twin in the first trimester increases the chance of

A

poor outcome for co-twin and complications (DIC)

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16
Q

Mono/ DI chorionic differences in death of one fetus

A

Dichorionic: death of one twin in 2nd or 3rd tri. associated with onset of labour

Monochorionic: death of one twin leads to complications , death and/or brain damage in survivor twin (30%)

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17
Q

Mono/Di chorionic differences in FGR multiple pregnancies

A

Dichorionic : x2 the risk of low fetal birth weight. avoid delivery before 28-30 wks.

Monochorionic: death of one twin results in handicap or death of co twin due to secondary hypotenstion to placental anastamoses.
Prolong delivery without risk to co-twin

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18
Q

Di/Mono chorionic differences in Fetal anomalies

A

Dichorionic: x2 risk of structural anomalies like spina bfida

Monochorionic: x4 risk of anomalies

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19
Q

Management of Multi pregnancy where one fetus has anomaly

A

Monitor and manage accordingly or fetocide given in lethal conditions where healthy twin is @ risk (ex: Anacephaly causing polyhydramnios and preterm labour of both)

20
Q

Chromosomal anomalies in monozygotic twins

A

Anomaly will effect both or neither due to identical genetic make up

21
Q

Complication of Monochorionic pregnancy

A

Placental vascular anastomoses allows communication between to feto-placental circulations.
Imbalance of bloodflow leads to Twin to Twin Transfusion Syndrome

22
Q

Twin to Twin transfusion syndrome

A

One twin is overperfused and other is under-perfused

23
Q

What happens to underperfused twin in TTTS

A

hypovolemic, oliguric, oligohydramnios

24
Q

What happens to overperfused twin in TTTS

A

hypervolemic, polyuria, polyhydramnios, myocardial damage, high output cardiac failure

25
Q

Diagnosing TTTS

A

via U/S in 2nd trimester. Over perfused baby will have increased abdominal girth

26
Q

Treatment of TTTS

A

Amniocentesis every 1-2 wks prolongs pregnancy and increases survival

Fetoscopal laser coagulation to disrupt communication

27
Q

Complication of monoamniotic

A

Increase in cord accidents.
Opt for CS @ 32-34 wks

28
Q

Differential Diagnosis of Multi Preg

A

Any large for date preg
Polyhydramnios
Uterine fibroids
Urinary retention
Ovarian masses

29
Q

Antenatal Managment of multi preg

A

Routine care: HTN + Gestational DM more likely in multiple pregnancy
ROutine supplementation of iron and folic acid due to increase in demand

30
Q

When and how to determine chorionicity

A

via U/S in late first trimester (10-12wks).
Dichorionic= V shaped extension of placentaltissue into base of inter-twin membrane (lambda or twin peak)
Monochorionic : T shape

31
Q

Test for fetal abnormalities

A

Trisomy 21 @ 12 wks
Rest optimally @ 20wks

32
Q

Monitoring of fetal growth + wellbeing done via

A

U/S including fetal measurement, activity, lies and amniotic fluid volume

33
Q

Signs of TTTS via U/S

A

Difference in
1. fetal size
2. fetal activity
3. bladder volumes
4. amniotic fluid
5. cardiac size

34
Q

Threatened preterm labour

A

Maternal steroid therapy (fetal lung)
Educate on signs of preterm labour
Advanced planning
Screen for strep B

35
Q

Diagnosing preterm labour via

A

Transvaginal/Cervical U/S most promising predictor

36
Q

Intrapartum prep

A

Twin CTG
portable U/S for delivery
Standard oxytocin IV for 2nd twin
Second higher oxytocin dose in case of PPH
2 neonatal resucitation sets
2obstetricians + 2 paediatricians

37
Q

Analgesic given in Multi-preg labour

A

Epidural recommended, kept running through second stage of labour

38
Q

Fetal well-being during labour

A

Monitor FHR continuously
abnormal HR assessed via scalp sampling.
Abnormal HR in 2nd baby-> CS (watch for cord prolapse or placenta separation)

39
Q

Vertex-Vertex Delivery how to assess lie of 2nd baby

A

via abdominal palpation and U/S

40
Q

If lie is cephalic (vertex-vertex)

A

wait for descent of head then amniosotomy w/ contractions

41
Q

When to give oxytocin in vertex vertex delivery

A

If no contractions after 1st baby for 5-10 mins

42
Q

If 1st baby cephalic, 2nd breech

A

Breech extraction can be performed

43
Q

If 2nd baby is transverse

A

Perform ECV
if fails
internal podalic can take place, rupture membrane as late as possible

44
Q

Non vertex 1st twin

A

ELective CS

45
Q

Requirements of twin delivery

A

Large room
Operating theatre ready
Anaesthesiologist present
Senior Obs
2 midwives
Twin resucitation
Forceps at hand
Blood
IV access
Neonatologists
Oxytocin infusions

46
Q

Postpartum Haemorrhage

A

Increased risk in multi pregnancies. High dose of oxytocin given after delivery as prophylaxis

47
Q

Higher multiples (3+ babies)

A

IVF main cause
Increased risks
Median G.A= 33wks
CS usually

Obstetrics (15 decks)

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