multiple pregnancies

Question 1

what is multiple pregnancies ?

Answer 1

when more than none embryo implants in the uterus

Question 2

what is a heterozygotic pregnancy ?

Answer 2

more than one ovum is released during the menstrual cycle and each ovum is fertilized by a sperm

Question 3

what is a monozygotic pregnancy ?

Answer 3

the spontaneous splitting of a single fertilized ovum resulting into identical embryos

Question 4

what are some of the factors that increase the risk of having multiple pregnancies ?

Answer 4

1. ovulating-stimulating medications such as clomiphene citrate
2. assisted reproductive techniques
3. old age
4. high parity

Question 5

when splitting happens of the ovum happens within two days of fertilization what type of pregnancy occurs ?

Answer 5

monozygotic pregnancy , resulting in a di-amniotic and di-chorionic pregnancy

Question 6

when splitting of the ovum happens after 3-8 days after fertilization what type pf pregnancy occurs ?

Answer 6

monochorionic and diamniotic

Question 7

what type of pregnancy occurs if splitting happens at 9-12 after fertilization ?

Answer 7

monochorionic

monoamniotic placentation

Question 8

what happens is splitting of the ovum happens more than n12 days after fertilization n?

Answer 8

results in conjoined twins

Question 9

how do we make a clinical diagnosis of multiple fetal pregnancies ?

Answer 9

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

Question 10

what is the most reliable examination for the detection of multiple fetal pregnancies ?

Answer 10

ultrasound

Question 11

when should routine antenatal care be performed for women with multiple pregnancies ?

Answer 11

a FCBC should be performed at 20 to 24 weeks and then repeated again nat 28 weeks

Question 12

what can we classify the complications of multiple pregnancies to fall under ?

Answer 12

maternal complications
fetal complications
placental complications
delivery complications

Question 13

what are the fetal complications that may occur due to multiple pregnancies ?

Answer 13

preterm birth 
birth defects 
intrauterine growth restriction and stillbirth 
spontaneous abortion
vanishing twin syndrome

Question 14

what is the optimum time to make a diagnosis of multiple pregnancies ?

Answer 14

1st trimester or early second trimester

Question 15

what is the management in the case of vanishing twin syndrome ?

Answer 15

no treatment necessary

Question 16

what are the maternal complications associated with multiple pregnancies ?

Answer 16

increased risk of :
hyperemesis gravidarum 
ironn ndeficiency anemia 
gestational diabetes 
pre-eclampsia 
pregnancy induced hypertensionn 
maternal anemia 
VTE

Question 17

what problems occur with the placenta during multiple pregnancies ?

Answer 17

the placenta ages early , so not enough nutrition reaches each fetus

Question 18

what is one of the most common complications of monochorionic multiple pregnancies ?

Answer 18

feto-fetal transfusion syndrome

Question 19

what is feto-fetal transfusion syndrome ?

Answer 19

occurs when blood moves from one baby to another, which is also called twin to twin transfusion

Question 20

what is twin anemia polycythemia ?

Answer 20

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

Question 21

what are the consequences of twin anemia polycythemia ?

Answer 21

one baby is anemic whilst the other baby suffers from polycythemia

Question 22

what is TRAP syndrome ?

Answer 22

twin reversed arterial perfusion syndrome , this is a more severe form of twin to twin transfusion

Question 23

what is the pathology in TRAP syndrome ?

Answer 23

artery to artery anastomosis between the umbilical arteries of both twins ( one heart two babies)

Question 24

what is the most common complication associated with mono-amniotic pregnancies ?

Answer 24

cord entanglement

Question 25

how do we treat twin to twin transfusion syndrome ?

Answer 25

intrauterine laser ablation of placental vessels , vessels that are found to communicate between the twins are then coagulated using the laser

Question 26

what are the delivery complications associated with multiple pregnancies ?

Answer 26

postpartum haemorrhage
locked twins
abnormal fetal positioning raises the chances for the performance of a c section

Question 27

what is locked twins ?

Answer 27

twin a is in a cephalic position

twin b is in a breech position

Question 28

when do we offer planned birth ?

Answer 28

1. uncomplicated dichorionic diamniotic at 37 weeks
2. uncomplicated monochorionic diamniotic at 36 weeks
3. uncomplicated monochorionic monoamniotic at 32-34 weeks

Question 29

when can we offer a vaginal delivery ?

Answer 29

if the first twin is cephalic presentation
no significant size discordance between twins
no obstetric contraindications

Question 30

when should we offer caesarian section?

Answer 30

monochorionic monoamniotic pregnancy