Multiple Gestations Flashcards
What are the types of twin that we have?
- dizigotic (two eggs & two sperms)
- monozygotic (1 egg & 1sperm)
In dizygotic twins the only option we have regarding placenta and sac is
2 sac and 2 placenta (wither close or far)
In monozygotic twins the options we have regarding placenta and sac is
- 2 sac 2 placenta
- 2 sac 1 placenta
- 1 sac 1 placneta
From day 1-3 4-8 9-13 >13 What do we expect the sac and placenta to be?
- 2 sac & 2placenta
- 2sac 1 placenta
- 1 sac 1 placenta
- risk of congoined
MC monozygotic twin sac and placenta
2 sacs & 1 placenta
Which type of monozygotic twins carry the highest risk of complication?
The later 9-13
1 sac and 1 placenta
MC twins are (mono or dizygotic)
Dizygotic
Which one is influnced by family hx, ethnicity & maternal age
(MZ or DZ)
DZ
What is the relation between maternal age and twinning
With increase there’s increase in twining
What can be contrirbuting factor to twinning (DZ)
- use of clomiphene
- gonadotropic therapy
What could give you a clue of MZ or DZ in early fetal US
- monochornioc: MZ
- dichorionic & different sex: DZ
What does lambda sign indicate in US
DC twins
What does T sign indicate in US
Monochrionic
Name abn of the twinning process
- conjoined twins
- interplacental vascular anastomosis
- TTTS
- fetal malformation
- umbilical cord abnormalities
- retained dead fetus syndrome
What is the majority of cases of conjoined twin
Thoracopagus
What is the mode of delivery in conjoined twin
CS
Interplacental vascualr anastomoses commonly occur in
MZ or DZ
Monochorionic
What is the MC type of interplacental vascular anastomses
Arterial-arterial
When do we start seeing compliactions in interplacental vascular anastomoses?
Twin-twin: unbalanced interplacental vascular anastomoses (arterial-venous)
What is twin-twin transfusion
Donor transfuse recepient
What is the outcome for the donor in TTTS?
- anemia
- IUGR\IUGD
- oligohydraminos
- hypovoulemia & hypotension
What is the outcome for the recipient in TTTS?
- Hypervoluemia, hyperviscosity, Polycythemia
- HF & Hydrops fetalis
- cardiomegaly
- thrombi
If one twin dies, the other will follow, why is this?
Hypovolemia
How to treat TTTs?
- serial amniocentesis
- laser photocoagulation of anastomotic vessels
- delivery
Which of the two treatments for TTTs is definitive
Photocoagulation
Name an important complication of TTTS
Acardiac twin
When is umbilical artery abn of great significance?
If the baby is small
What to screen in baby in case of umbilical cord abnormalitis?
Heart and renal system
With multiple gestations, there’s an increased risk of: (maternal)
- preterm labor & C\s
- anemia
- pre-eclampsia
- orthostatic hypotension
- compromised renal function
- post-partum uterine atony
How to clinically suspect multiple gestations
- worsening symptoms of morning sickness
- fundal height is larger than expected
How to confirm multiple
US
With multiple gestations, there’s an increased risk of: (fetal)
- Malpresentation
- placenta peevia & abruption
- PROM
- umbilical coed prolapse
- IUGR
- congenital anomalies
- morbidity & mortality
What is the antepartum management of multiple gestations?
- 1st\2nd: frequent visit, optimize diet, assess cervix
- 3rd: prevent preterm, follow growth & wellbeing, pre-eclampsia & DM.
How to prevent preterm labor
Vaginal progestrone
For a mother with multiple gestation who’s at risk of developing pre-eclampsia, we give her …. as prophylaxis
Asprin before 16 weeks
What are the pre-requisits for intrapartum management in multiple gestations
- 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
What if the mother with multiple gestations was to deliver preterm, how will you manage the baby?
1- steroid for lung maturity
2- MgSO4 for neuroprotection
3- EONGBS prophylaxis if unkown status
4- tocolysis if need for transportation
What are teh contrainidcations of tocolysis?
GA > 34 - preeclampsia - IUGR - abnormal fetal testing - chorioaminitis
When we can do vaginal delivery and when we must do C\S in multiple gestations
1- monoamniotic: C\S at 32-34
2- diamniotic: VD if first or both twin are cephalic
What are the causes of morbidity and mortality in twins
- RDS
- Cerebral hemorrhage
- birth aspyhxia & anoxia
- still birth
- prematurity
- conginital anomalies
