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Year 2 Medicine > Multiple Pregnancies > Flashcards

Multiple Pregnancies Flashcards

1
Q

Incidence of Twin Pregnancy (per 1000 deliveries)

  • …-… Far East
  • …-… Europe
  • …-… Nigeria
A
  • 2-7 Far East
  • 9-20 Europe
  • 20-45 Nigeria
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2
Q

Multiple Births - England & Wales

A
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3
Q

Twinning rates - Netherlands

A

1978 - first IVF baby

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4
Q

Triplets and higher order births E&W (per 1000 maternities)

A
  • law limited no of embryos put back - avoid triplets if possible - explains the fall
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5
Q

Aetiology of Multiple Pregnancy

  • E…
  • Increasing … …
  • Increasing …
  • … Hx
  • … treatment
    • All factors for ‘super ovulation’
A
  • Ethnicity
  • Increasing Maternal Age
  • Increasing Parity
  • Family Hx
  • Fertility treatment
    • All factors for ‘super ovulation’
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6
Q

Multiple Pregnancy - Need to know…

  • Zygosity - how many …
  • Chorionicity - how many …
  • Amnionicity - how many …
A
  • Zygosity - how many eggs
  • Chorionicity - how many placentas
  • Amnionicity - how many amniotic saces
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7
Q

Monozygous twin pregnancy - the twins are…

A

Monozygous twin pregnancy - the twins are identical (1 egg)

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8
Q

Dizygous twin pregnancy - the twins are …

A

Dizygous twin pregnancy - the twins are non-identical (2 eggs)

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9
Q

What proportion of twin pregnancies are monozygous?

A

1/3 (identical)

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10
Q

What proportion of twin pregnancies are dizygous?

A

2/3 (non-identical)

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11
Q

Early Primordia - 14 days

A
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12
Q

Folding of the embryo in Week 4

A
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13
Q

The Endometrium and Fetal Membranes

A
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14
Q

Dizygotic twins

  • How many eggs?
  • Identical/Non-identical Twins?
  • Accounts for … of all twin pregnancies
A
  • How many eggs? - 2
  • Accounts for 2/3 of all twins
  • non-identical
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15
Q

Monozygotic Twins

  • How many eggs?
  • Identical/Non-identical Twins?
  • Accounts for … of all twin pregnancies
A
  • 1 egg
  • Identical
  • 1/3
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16
Q

Monozygotic Twins - 3 Different Outcomes

  • DCDA / MCDA / MCMA
A
  • Splitting at 2 cell stage: DCDA (seperate chorions, amnions and placentae)
  • OR
  • Splitting in early blastocyst yields 2 inner cell masses but common chorion, seperate amnions and joined placentae MCDA
  • OR
  • Later splitting yields 2 embryos from one inner cell mass - common chorion, amnion and ‘joined’ placentae MCMA
17
Q

What is a dichorionic diamniotic (DCDA) twin pregnancy?

A

a type of twin pregnancy where each twin has its own chorionic and amniotic sacs (can be as a result of dizygotic twin or monzygotic twin)

  • So, DCDA twins can be identical or non-identical
18
Q

What are monochorionic, diamniotic twins?

A

Monochorionic, diamniotic (MCDA) twins are the product of a single fertilized ovum (egg), resulting in genetically identical offspring. MCDA twins share a single placenta (blood supply) but have separate amniotic sacs.

19
Q

What is a monochorionic monoamniotic (MCMA) twin pregnancy?

A

This rare type of identical twins not only share a placenta, but also share the same amniotic sac (pocket of fluid).

20
Q

Twin pregnancy - Dichorionic

A
  • All dizygous twins are dichorionic
  • Dichorionic twins must be diamniotic
  • Dichorionic = separate circulations
  • 1:3 monozygous twins are dichorionic
21
Q

Twin pregnancy - Monochorionic

A
  • Monozygous twins may be monochorionic (2/3) or dichorionic
  • MC have vascularly joined placentae
  • MC twins 3x increased loss rate
  • MC twins usually diamniotic
22
Q

Diagnosis of Twin Pregnancy

  • Size of …
  • By … scan
  • Up to …% at delivery worldwide
A
  • Uterine size
  • Ultrasound scan
  • Up to 50% at delivery worldwide
23
Q

What type of pregnancy?

A

dichorionic pregnancy

24
Q

What type of pregnancy?

A

monochorionic diamniotic - only one chorion

25
Q

What type of pregnancy?

A

rare - MCMA (monochorionic monoamniotic)

26
Q

Multiple pregnancy - Complications

A
  • “Everything except post-dates”
  • Symptoms of pregnancy
  • Anaemia
  • Hypertension
  • Intrauterine growth restriction
  • Pre-term labour
  • Delivery problems
  • Perinatal mortality
27
Q

Twin pregnancy - Mortality

  • Stillbirth – defined as after …. weeks
  • Early neonatal – first … days
  • Neonatal – in first … days
  • Perinatal mortality – … risk + early … risk
  • Infant – first …
    • Rates shown are per 1000 births
A
  • Stillbirth – after 24 weeks
  • Early neonatal – first 7 days
  • Neonatal – in first 28 days
  • Perinatal mortality – SB risk + early neonatal risk
  • Infant – first year
  • Rates are per 1000 births
    • Twins and triplets - higher risk as shown
28
Q

Twin pregnancy - First trimester management

  • Discuss … for … anomalies
  • Determine …
  • Discuss … … if triplets or more
A
  • Discuss screening for chromosomal anomalies
  • Determine chorionicity
  • Discuss fetal reduction if triplets or more
29
Q

Twin pregnancy - Second trimester management

  • Detection of fetal …
  • Serial scans for growth for all
    • – DC monthly from … weeks
  • Serial scans for TTTS (Transfusion syndrome) if … twins
    • 2 weekly 16-28 weeks then monthly
  • Maternal …
A
  • Detection of fetal abnormality
  • Serial scans for growth for all
    • –DC monthly from 24 weeks
  • Serial scans for TTTS if MC twins
    • 2 weekly 16-28 weeks then monthly
  • Maternal complications
30
Q

Twin pregnancy - Monochorionic twins

  • More fetal …
  • More fetal … restriction
  • Twin to twin …
A
  • More fetal malformation
  • More fetal growth restriction
  • Twin to twin transfusion
31
Q

What is Twin-to-twin transfusion syndrome (TTTS) ?

A

Twin-to-twin transfusion syndrome (TTTS) is a rare pregnancy condition affecting identical twins or other multiples. TTTS occurs in pregnancies where twins share one placenta (afterbirth) and a network of blood vessels that supply oxygen and nutrients essential for development in the womb. (MC twins, second trimester risk)

32
Q

Monochorionic twin pregnancy - Twin to twin transfusion

  • Unbalanced placental vascular a…
  • Donor twin is …, decreased liquor
  • High … (esp recipient)
  • Rx - laser or amnio-reduction
  • Early delivery by …
A
  • Unbalanced placental vascular anastamoses
  • Donor smaller, decreased liquor
  • High mortality (esp recipient)
  • Rx - laser or amnio-reduction
  • Early delivery by caesarean
33
Q

Twin pregnancy - Third trimester management

  • Scanning as in … trimester
  • Monitor … …
  • …-… labour
  • … planning
A
  • Scanning as in 2nd trimester
  • Monitor blood pressure
  • Pre-term labour
  • Delivery planning
34
Q

Twin pregnancy - Delivery planning

  • 37-38 weeks for … twins
    • –vaginal birth or caesarean
  • Presentation of twin I
  • 36-37 weeks for … twins
    • ?all … twins by caesarean?
  • Pregnancy complications
A
  • 37-38 weeks for DC twins
    • – can be via vaginal birth or caesarean
  • Presentation of twin I
  • 36-37 weeks for MC twins
    • ?all MC twins by caesarean?
  • Pregnancy complications
35
Q

Twin pregnancy - Labour management

  • Monitoring … twins
  • Problems delivering twin …
  • Risk of … bleed
A
  • Monitoring both twins
  • Problems delivering twin II
  • Risk of postpartum bleed
36
Q

Twin pregnancy - Puerperium

  • … difficulties
  • … & … support
A
  • Feeding difficulties
  • Emotional & social support
37
Q

Puerperium is …

A

the period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition

38
Q

Multiple pregnancy - Higher order multiples

  • Consider fetal …
  • Determine …
  • High risk of … labour
  • Deliver preterm by …
  • Postpartum …
  • Difficult … & after
A
  • Consider fetal reduction
  • Determine chorionicity
  • High risk of preterm labour
  • Deliver preterm by caesarean
  • Postpartum haemorrhage
  • Difficult puerperium & after

Year 2 Medicine (162 decks)

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