multiple pregnancies Flashcards
what is multiple pregnancies ?
when more than none embryo implants in the uterus
what is a heterozygotic pregnancy ?
more than one ovum is released during the menstrual cycle and each ovum is fertilized by a sperm
what is a monozygotic pregnancy ?
the spontaneous splitting of a single fertilized ovum resulting into identical embryos
what are some of the factors that increase the risk of having multiple pregnancies ?
- ovulating-stimulating medications such as clomiphene citrate
- assisted reproductive techniques
- old age
- high parity
when splitting happens of the ovum happens within two days of fertilization what type of pregnancy occurs ?
monozygotic pregnancy , resulting in a di-amniotic and di-chorionic pregnancy
when splitting of the ovum happens after 3-8 days after fertilization what type pf pregnancy occurs ?
monochorionic and diamniotic
what type of pregnancy occurs if splitting happens at 9-12 after fertilization ?
monochorionic
monoamniotic placentation
what happens is splitting of the ovum happens more than n12 days after fertilization n?
results in conjoined twins
how do we make a clinical diagnosis of multiple fetal pregnancies ?
by inspection: abdominal girth is larger than expected
by palpation: multiple fetal poles and limbs can be felt
by auscultation of the FHS : multiple FHS can be heard
what is the most reliable examination for the detection of multiple fetal pregnancies ?
ultrasound
when should routine antenatal care be performed for women with multiple pregnancies ?
a FCBC should be performed at 20 to 24 weeks and then repeated again nat 28 weeks
what can we classify the complications of multiple pregnancies to fall under ?
maternal complications
fetal complications
placental complications
delivery complications
what are the fetal complications that may occur due to multiple pregnancies ?
preterm birth birth defects intrauterine growth restriction and stillbirth spontaneous abortion vanishing twin syndrome
what is the optimum time to make a diagnosis of multiple pregnancies ?
1st trimester or early second trimester
what is the management in the case of vanishing twin syndrome ?
no treatment necessary
what are the maternal complications associated with multiple pregnancies ?
increased risk of : hyperemesis gravidarum ironn ndeficiency anemia gestational diabetes pre-eclampsia pregnancy induced hypertensionn maternal anemia VTE
what problems occur with the placenta during multiple pregnancies ?
the placenta ages early , so not enough nutrition reaches each fetus
what is one of the most common complications of monochorionic multiple pregnancies ?
feto-fetal transfusion syndrome
what is feto-fetal transfusion syndrome ?
occurs when blood moves from one baby to another, which is also called twin to twin transfusion
what is twin anemia polycythemia ?
it is a rare and chronic form of feto-fetal transfusion , caused by the joining of the blood vessels connecting the fetal circulation on the placenta
what are the consequences of twin anemia polycythemia ?
one baby is anemic whilst the other baby suffers from polycythemia
what is TRAP syndrome ?
twin reversed arterial perfusion syndrome , this is a more severe form of twin to twin transfusion
what is the pathology in TRAP syndrome ?
artery to artery anastomosis between the umbilical arteries of both twins ( one heart two babies)
what is the most common complication associated with mono-amniotic pregnancies ?
cord entanglement
how do we treat twin to twin transfusion syndrome ?
intrauterine laser ablation of placental vessels , vessels that are found to communicate between the twins are then coagulated using the laser
what are the delivery complications associated with multiple pregnancies ?
postpartum haemorrhage
locked twins
abnormal fetal positioning raises the chances for the performance of a c section
what is locked twins ?
twin a is in a cephalic position
twin b is in a breech position
when do we offer planned birth ?
- uncomplicated dichorionic diamniotic at 37 weeks
- uncomplicated monochorionic diamniotic at 36 weeks
- uncomplicated monochorionic monoamniotic at 32-34 weeks
when can we offer a vaginal delivery ?
if the first twin is cephalic presentation
no significant size discordance between twins
no obstetric contraindications
when should we offer caesarian section?
monochorionic monoamniotic pregnancy
