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Gyne > Multiple Gestations > Flashcards

Multiple Gestations Flashcards

1
Q

What are the types of twin that we have?

A
  • dizigotic (two eggs & two sperms)

- monozygotic (1 egg & 1sperm)

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2
Q

In dizygotic twins the only option we have regarding placenta and sac is

A

2 sac and 2 placenta (wither close or far)

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3
Q

In monozygotic twins the options we have regarding placenta and sac is

A
  • 2 sac 2 placenta
  • 2 sac 1 placenta
  • 1 sac 1 placneta
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4
Q 
From day 
1-3 
4-8
9-13 
>13
What do we expect the sac and placenta to be?
A
  • 2 sac & 2placenta
  • 2sac 1 placenta
  • 1 sac 1 placenta
  • risk of congoined
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5
Q

MC monozygotic twin sac and placenta

A

2 sacs & 1 placenta

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6
Q

Which type of monozygotic twins carry the highest risk of complication?

A

The later 9-13

1 sac and 1 placenta

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7
Q

MC twins are (mono or dizygotic)

A

Dizygotic

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8
Q

Which one is influnced by family hx, ethnicity & maternal age
(MZ or DZ)

A

DZ

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9
Q

What is the relation between maternal age and twinning

A

With increase there’s increase in twining

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10
Q

What can be contrirbuting factor to twinning (DZ)

A
  • use of clomiphene

- gonadotropic therapy

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11
Q

What could give you a clue of MZ or DZ in early fetal US

A
  • monochornioc: MZ

- dichorionic & different sex: DZ

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12
Q

What does lambda sign indicate in US

A

DC twins

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13
Q

What does T sign indicate in US

A

Monochrionic

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14
Q

Name abn of the twinning process

A
  • conjoined twins
  • interplacental vascular anastomosis
  • TTTS
  • fetal malformation
  • umbilical cord abnormalities
  • retained dead fetus syndrome
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15
Q

What is the majority of cases of conjoined twin

A

Thoracopagus

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16
Q

What is the mode of delivery in conjoined twin

A

CS

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17
Q

Interplacental vascualr anastomoses commonly occur in

MZ or DZ

A

Monochorionic

18
Q

What is the MC type of interplacental vascular anastomses

A

Arterial-arterial

19
Q

When do we start seeing compliactions in interplacental vascular anastomoses?

A

Twin-twin: unbalanced interplacental vascular anastomoses (arterial-venous)

20
Q

What is twin-twin transfusion

A

Donor transfuse recepient

21
Q

What is the outcome for the donor in TTTS?

A
  • anemia
  • IUGR\IUGD
  • oligohydraminos
  • hypovoulemia & hypotension
22
Q

What is the outcome for the recipient in TTTS?

A
  • Hypervoluemia, hyperviscosity, Polycythemia
  • HF & Hydrops fetalis
  • cardiomegaly
  • thrombi
23
Q

If one twin dies, the other will follow, why is this?

A

Hypovolemia

24
Q

How to treat TTTs?

A
  • serial amniocentesis
  • laser photocoagulation of anastomotic vessels
  • delivery
25
Q

Which of the two treatments for TTTs is definitive

A

Photocoagulation

26
Q

Name an important complication of TTTS

A

Acardiac twin

27
Q

When is umbilical artery abn of great significance?

A

If the baby is small

28
Q

What to screen in baby in case of umbilical cord abnormalitis?

A

Heart and renal system

29
Q

With multiple gestations, there’s an increased risk of: (maternal)

A
  • preterm labor & C\s
  • anemia
  • pre-eclampsia
  • orthostatic hypotension
  • compromised renal function
  • post-partum uterine atony
30
Q

How to clinically suspect multiple gestations

A
  • worsening symptoms of morning sickness

- fundal height is larger than expected

31
Q

How to confirm multiple

A

US

32
Q

With multiple gestations, there’s an increased risk of: (fetal)

A
  • Malpresentation
  • placenta peevia & abruption
  • PROM
  • umbilical coed prolapse
  • IUGR
  • congenital anomalies
  • morbidity & mortality
33
Q

What is the antepartum management of multiple gestations?

A
  • 1st\2nd: frequent visit, optimize diet, assess cervix

- 3rd: prevent preterm, follow growth & wellbeing, pre-eclampsia & DM.

34
Q

How to prevent preterm labor

A

Vaginal progestrone

35
Q

For a mother with multiple gestation who’s at risk of developing pre-eclampsia, we give her …. as prophylaxis

A

Asprin before 16 weeks

36
Q

What are the pre-requisits for intrapartum management in multiple gestations

A
  • secondary tertiary hospital
  • equipped delivery room w\ C-s
  • fluid & blood & large bore IV
  • monitor 2 HR simontanously
  • US for presentation
  • 2 obstetrician
  • 2 pediatrician
  • enough nurses
37
Q

What if the mother with multiple gestations was to deliver preterm, how will you manage the baby?

A

1- steroid for lung maturity
2- MgSO4 for neuroprotection
3- EONGBS prophylaxis if unkown status
4- tocolysis if need for transportation

38
Q

What are teh contrainidcations of tocolysis?

A

GA > 34 - preeclampsia - IUGR - abnormal fetal testing - chorioaminitis

39
Q

When we can do vaginal delivery and when we must do C\S in multiple gestations

A

1- monoamniotic: C\S at 32-34

2- diamniotic: VD if first or both twin are cephalic

40
Q

What are the causes of morbidity and mortality in twins

A
  • RDS
  • Cerebral hemorrhage
  • birth aspyhxia & anoxia
  • still birth
  • prematurity
  • conginital anomalies

Gyne (18 decks)

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