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Year 2 RE > Multiple Pregnancies > Flashcards

Multiple Pregnancies Flashcards

1
Q

What is a multiple pregnancy?

A
  • when you are expecting two or more babies at the same time
  • twins, triplets etc…
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2
Q

What is perinatal?

A
  • perinatal is time from pregnancy and up to 1 year following birth
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3
Q

What is perinatal mortality?

A
  • death of a foetus or baby

- during time from birth through to 1 year old

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4
Q

Perinatal mortality refers to the death of a foetus or baby. Is perinatal mortality higher in individual or multiple pregnancy (twins etc..)?

A
  • multiple pregnancy
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5
Q

What are dizygotic twins?

A
  • di = two
  • zygotic = formation of a zygote from 2 gametes
  • pregnancy but with 2 separate embryos , so NOT identical
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6
Q

What are monozygotic twins?

A
  • mono = one
  • zygotic = formation of a zygote from 2 gametes
  • one zygote splits into 2 separate groups of cell = can be IDENTICAL TWINS but not always
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7
Q

What are a number of risk factors for increase perinatal mortality in dizygotic twins?

A
  • genetics (African decent)
  • BMI
  • maternal age
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8
Q

Is the risk of developing morbidities such as cerebral palsy higher in single pregnancy or multiple pregnancy n dizygotic twins?

A
  • multiple pregnancy
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9
Q

What is a stillbirth?

A
  • baby dies in the womb after 20 weeks
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10
Q

A stillbirth is when a baby dies in the womb after 20 weeks. Does the risk of stillbirth increase with the number of multiple pregnancy?

A
  • increases as number of multiple pregnancy increases
  • singleton 6-8/1000 births
  • twins 37/1000
  • triplets 52/1000
  • > 3 pregnancy 231/1000
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11
Q

In a women with multiple pregnancy the risk of morbidities such as neurological disorders such as cerebral palsy increases as the number of pregnancies increases. What are the 2 main reasons identified for this increase in morbidities with multiple pregnancy?

1 - high BMI and lower birth weight
2 - high BMI and premature births
3 - lower birth weight and premature birth
4 - lower birth weight and low BMI

A

3 - lower birth weight and premature birth

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12
Q

What does zygosity refer to?

A
  • the genetic make up of a pregnancy

- in twins, this can be mono or dizygotic

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13
Q

What does mono and dizygotic mean?

A
  • mono = 1 egg and 1 sperm form a zygote which then splits into 2 separate groups of cells
  • di = 2 eggs and 2 sperm form seperate zygotes
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14
Q

What does chorionicity refer to?

A
  • the chroion is the double layer membrane (trophoblasts) that form the placenta
  • chorionicity refers to the number of placenta that are present
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15
Q

Chorionicity refers to the number of placenta present during pregnancy. What do mono and di-chorionic refer to?

A
  • monochorionic = 1 placenta is shared

- dichorionic = there are 2 separate placenta

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16
Q

What does amnionicity refer to?

A
  • the amniotic sacs that a foetus develops within
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17
Q

Amnionicity refers to the amniotic sacs that a foetus develops within. What does mono and diamniotic refer to?

A
  • monoamniotic = foetus share the same amniotic sac

- dioamnioitc = foetus have their own individual amniotic sacs

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18
Q

Dizygotic twins are where there are 2 separate eggs and each gets fertilised by a separate sperm, forming 2 separate zygotes. Which of the following are dizygotic twins able to become:

1 - dichorionic monoamniotic
2 - dichorionic diamniotic
3 - monochorionic monoamniotic
4 - monochorionic diamniotic

A

2 - dichorionic diamniotic

- everything is separate so there will be 2 of everything

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19
Q

In monozygotic pregnancies we need to be aware of the different types of chorionicity and amnionicity, such as:

  • chorionicity = mono or dichorionic
  • amnionicity = mono or diamniotic

In a monozygotic pregnancy (identical twins) what types chorionicity and amnionicity can monozygotic twins have?

A
  • dichorionic-diamniotic = separate placenta and amniotic sac
  • monochorionic-diamniotic = same placenta BUT separate amniotic sac
  • monochorionic-monoamniotic = same placenta and same amniotic sac
20
Q

In monozygotic pregnancies we need to be aware of the different types of chorionicity and amnionicity. Monozygotic twins can be the following:

  • dichorionic-diamniotic = separate placenta and amniotic sac
  • monochorionic-diamniotic = same placenta BUT separate amniotic sac
  • monochorionic-monoamniotic = same placenta and same amniotic sac

What determines which forms of chorionicity and amnionicity monozygotic twins develop into?

A
  • the timing of when the embryonic cells divide
21
Q

In monozygotic pregnancies we need to be aware of the different types of chorionicity and amnionicity. Monozygotic twins can be the following:

  • dichorionic-diamniotic = separate placenta and amniotic sac
  • monochorionic-diamniotic = same placenta BUT separate amniotic sac
  • monochorionic-monoamniotic = same placenta and same amniotic sac

The timing of when the embryonic cells divide determines which forms of chorionicity and amnionicity a monozygotic twins develop into. What are the time points for each of the options above where the cells of the embryo divide?

A
  • dichorionic-diamniotic = 2-3 days
  • monochorionic-diamniotic = 3-8 days
  • monochorionic-monoamniotic = 8-13 days
22
Q

In monozygotic pregnancies we need to be aware of the different types of chorionicity and amnionicity. Monozygotic twins can be the following:

  • dichorionic-diamniotic = separate placenta and amniotic sac
  • monochorionic-diamniotic = same placenta BUT separate amniotic sac
  • monochorionic-monoamniotic = same placenta and same amniotic sac

The timing of when the embryonic cells divide determines which forms of chorionicity and amnionicity a monozygotic twins develop into. Generally the splitting occurs before 13 days for all 3 variations. However, if there is no splitting, what can this lead to?

A
  • conjoined twins
23
Q

In a diochorionic diamniotic pregnancy how many babies, placentas and amnionic sacs would be present?

1 - 1 baby, 2 placenta, 2 sacs
2 - 2 baby, 1 placenta, 2 sacs
3 - 2 baby, 2 placenta, 2 sacs
4 - 2 baby, 2 placenta, 1 sac

A

3 - 2 baby, 2 placenta, 2 sacs

24
Q

In a monochorionic diamniotic pregnancy how many babies, placentas and amnionic sacs would be present?

1 - 1 baby, 2 placenta, 2 sacs
2 - 2 baby, 1 placenta, 2 sacs
3 - 2 baby, 2 placenta, 2 sacs
4 - 2 baby, 2 placenta, 1 sac

A

2 - 2 baby, 1 placenta, 2 sacs

25
Q

In a monochorionic monomniotic pregnancy how many babies, placentas and amnionic sacs would be present?

1 - 2 baby, 1 placenta, 1 sac
2 - 2 baby, 1 placenta, 2 sacs
3 - 2 baby, 2 placenta, 2 sacs
4 - 2 baby, 2 placenta, 1 sac

A

1 - 2 baby, 1 placenta, 1 sacs

26
Q

In a trichorionic triamniotic pregnancy how many babies, placentas and amnionic sacs would be present?

1 - 3 baby, 1 placenta, 1 sac
2 - 3 baby, 3 placenta, 3 sacs
3 - 3 baby, 2 placenta, 2 sacs
4 - 2 baby, 2 placenta, 1 sac

A

2 - 3 baby, 3 placenta, 3 sacs

27
Q

In a dichorionic triamniotic pregnancy how many babies, placentas and amnionic sacs would be present?

1 - 3 baby, 1 placenta, 1 sac
2 - 3 baby, 3 placenta, 3 sacs
3 - 3 baby, 2 placenta, 2 sacs
4 - 3 baby, 2 placenta, 3 sac

A

4 - 3 baby, 2 placenta, 3 sac

28
Q

Are more twins mono or dizygotic?

A
  • monozygotic twins = 1 in 3

- dizygotic twins = 2 in 3

29
Q

In monozygotic pregnancies we need to be aware of the different types of chorionicity and amnionicity. Monozygotic twins can be the following:

  • dichorionic-diamniotic = separate placenta and amniotic sac
  • monochorionic-diamniotic = same placenta BUT separate amniotic sac
  • monochorionic-monoamniotic = same placenta and same amniotic sac

What is the incidence of each of the above 3 scenarios?

A
  • dichorionic-diamniotic = 25%
  • monochorionic-diamniotic = 75%
  • monochorionic-monoamniotic = 2%
30
Q

Why is it important to determine the chorionicity (number of placenta) of a multiple pregnancy?

A
  • need to know if a placenta and blood supply are shared

- shared blood supply has implications of adverse outcomes

31
Q

It important to determine the chorionicity (number of placenta) of a multiple pregnancy to determine if the foetus are sharing the same blood supply. What is the optimal time to determine this and what imaging modality if generally used?

A
  • 10-13 weeks

- ultrasound

32
Q

Why is it important to determine the zygosity?

A
  • monozygotes have higher risk of congenital anomalies

- monozygotes have higher risk of still birth and neonatal death

33
Q

In monozygotic pregnancies we need to be aware of the different types of chorionicity and amnionicity. Monozygotic twins can be the following:

  • dichorionic-diamniotic = separate placenta and amniotic sac
  • monochorionic-diamniotic = same placenta BUT separate amniotic sac
  • monochorionic-monoamniotic = same placenta and same amniotic sac

Does mono or dichorionic pregnancy generally have a higher associated risk?

A
  • monochorionic (sharing placenta) due to sharing blood supply
34
Q

If a woman is pregnant with a multiple pregnancy, what are some of the most common risks to her whilst pregnant?

A
  • pre-eclampsia (high BP and coagulation)
  • gestational diabetes
  • gestational hypertension
  • anemia
  • post-partum haemorrhage
  • caesarean section
  • death
35
Q

One key foetal risk in a multiple pregnancy is the twin to twin transfusion syndrome. What is this?

A
  • a rare pregnancy condition affecting identical twins or other multiples
  • occurs in monochorionic (sharing a placenta) twins
  • there is abnormal sharing of blood vessels where one twin becomes a donor and the other twin becomes a recipient
36
Q

One key foetal risk in a multiple pregnancy is the twin to twin transfusion syndrome. This is a rare pregnancy condition affecting identical twins or other multiples and occurs in monochorionic (sharing a placenta) twins. There is abnormal sharing of blood vessels where one twin becomes a donor and the other twin becomes a recipient. Why can this be dangerous?

A
  • the donor does not develop as quickly and could die

- the recipient will be larger and develop quicker

37
Q

One key foetal risk in a multiple pregnancy is the twin to twin transfusion syndrome. This is a rare pregnancy condition affecting identical twins or other multiples and occurs in monochorionic (sharing a placenta) twins. There is abnormal sharing of blood vessels where one twin becomes a donor and the other twin becomes a recipient. This can this be dangerous because the donor does not develop as quickly and could die and the recipient will be larger and develop quicker. How can this be treated effectively?

A
  • abnormal blood vessels or anastomosis will be laser ablated
38
Q

Are women who have multiple pregnancy more or less at risk of going into early labour and delivering prematurely?

A
  • increased risk
  • twin pregnancies = 60% deliver <37 weeks (premature)
  • triplet pregnancies = 75% deliver <35 weeks (premature)
39
Q

Generally when do dichorionic-diamniotic (2 placenta and 2 amniotic sacs) twins deliver?

1 - <37 weeks
2 - 37 weeks
3 - <35 weeks
4 - >37 weeks

A

2 - 37 weeks

- anything beyond 37 weeks is associated with death

40
Q

Generally when do monochorionic-diamniotic (1 placenta and 2 amniotic sacs) twins deliver?

1 - 36 weeks
2 - 37 weeks
3 - <35 weeks
4 - >37 weeks

A
  • 36 weeks

- anything beyond 36 weeks is associated with death

41
Q

Generally when do monochorionic-monoamniotic (2 placenta and 2 amniotic sacs) twins deliver?

1 - 36 weeks
2 - 37 weeks
3 - <35 weeks (32-34)
4 - >37 weeks

A

3 - <35 weeks (32-34)

  • babies generally get admitted to NICU
  • beyond 33+6 weeks is associated with increased risk of fetal death
42
Q

For each of the following, what are the delivery options?

  • dichorionic-diamniotic
  • monochorionic-diamniotic
  • monochorionic-monoamniotic
A
  • dichorionic-diamniotic = vaginal or caesarean (depends on presentation)
  • monochorionic-diamniotic = vaginal or caesarean (depends on presentation)
  • monochorionic-monoamniotic = caesarean
43
Q

Chorionicity in twins is best and most accurately determined at:

1 - 6-8 weeks of gestation
2 - 6-12 weeks of gestation
3 - 12-14 weeks of gestation
4 - 16-20 weeks of gestation
5 - 30 weeks of gestation
A

3 - 12-14 weeks of gestation (10-13 weeks is optimal)

44
Q

The majority of monozygotic twins will result in a monochorionic pregnancy with one placenta?

1 - True
2 - False

A

1 - True

45
Q

Cleavage of monozygotic twins between days 4 and 8 will result in a monochorionic monoamniotic pregnancy:

1 - True
2 - False

A

2 - False

- days 4-8 cleavage will form monochorionic diamniotic

Year 2 RE (53 decks)

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