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A. MLA Map Obstetrics and Gynaecology > Multiple Pregnancies > Flashcards

Multiple Pregnancies Flashcards

1
Q

What is multiple pregnancy?

1 - 1 or more babies expected
2 - 2 or more babies expected
3 - 3 or more babies expected
4 - 4 or more babies expected

A

2 - 2 or more babies expected
- twins, triplets etc…

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2
Q

Which of the following increases the risk of multiple pregnancies?

1 - age
2 - nutrition
3 - ethnicity / geography
4 - assisted conception
5 - family history
6 - all of the above

A

6 - all of the above

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3
Q

Perinatal refers to the time from becoming pregnant to the 1 year following birth. Perinatal mortality is death of a foetus from becoming pregnany to 1 year following birth. Is this more common in singular or multiple pregnancies?

A
  • multiple pregnancies
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4
Q

Which of the following is NOT a risk factors that can increase the risk of perinatal mortality?

1 - genetics (African decent)
2 - BMI
3 - ethnicity
4 - maternal age

A

3 - ethnicity

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5
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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6
Q

A stillbirth is when a baby is born dead after completing 24 weeks of pregnancy. Is this more common in singular or multiple pregnancies?

A
  • multiple pregnancies
  • singleton = 6-8/1000 births
  • twins = 37/1000
  • triplets = 52/1000
  • > 3 pregnancy =231/1000
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7
Q

In pregnancy, what does zygosity refer to?

1 - the number of eggs (zygotes) that have been fertilised
2 - the number of placentas
3 - the number of amniotic sacs
4 - the number of sperm that fertilised the egg

A

1 - the number of eggs (zygotes) that have been fertilised

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8
Q

Are mono or dizygotic twins identical?

A
  • monozygotic
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9
Q

In pregnancy, what does chorionicity refer to?

1 - the number of eggs (zygotes) that have been fertilised
2 - the number of placentas
3 - the number of amniotic sacs
4 - the number of sperm that fertilised the egg

A

2 - the number of placentas

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10
Q

In pregnancy, what does amnionicity refer to?

1 - the number of eggs (zygotes) that have been fertilised
2 - the number of placentas
3 - the number of amniotic sacs
4 - the number of sperm that fertilised the egg

A

3 - the number of amniotic sacs

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11
Q

What are dizygotic twins?

1 - 1 egg
2 - 2 eggs
3 - 2 placentas and 1 egg
4 - 1 egg and 2 amniotic sacs

A

2 - 2 eggs
- zygotic = zygote from 2 gametes (egg and sperm)
- pregnancy but with 2 separate embryos , so NOT identical

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12
Q

What are monozygotic twins?

1 - 1 egg
2 - 2 eggs
3 - 2 placentas and 2 eggs
4 - 2 eggs and 2 amniotic sacs

A

1 - 1 egg
- zygotic = zygote from 2 gametes (egg and sperm)
- one zygote splits into 2 separate groups of cell = can be IDENTICAL TWINS but not always

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13
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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14
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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15
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) which type of chorionicity and amnionicity can monozygotic twins NOT have?

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

A

2 - dyzygotic dichorionic diamniotic

  • dichorionic-diamniotic = separate placenta and amniotic sac
  • monochorionic-diamniotic = same placenta BUT separate amniotic sac
  • monochorionic-monoamniotic = same placenta and same amniotic sac
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16
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?

1 - family history
2 - time of ovulation
3 - division of zygote
4 - all of the above

A

3 - division of zygote
- the timing of when the embryonic cells divide

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17
Q

In monozygotic twins the fertilised egg can divide. The timepoint at which this division takes place determines the chorionicity (number f placentas) and amnionicity (number of amniotic sacs). What time period do all variations of the this seperation occur?

1 - 5 days
2 - 7 days
3 - 10 days
4 - 13 days

A

4 - 13 days
- when the split occurs determines chorionicity and amnionicity

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18
Q

There are 2 signs that can be used to help identify the type of twins a women is carrying, the Lambda and T sign. Does Lambda or T-sign identify diamniotic pregnancy?

A

T-sign = diamniotic
- has thin membrane on ultrasound

Lambda = monoamniotic
- has a thick membrane on ultrasound

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19
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. Match the time points below with the options above?

1 - 8-13 days
2 - 3-8 days
3 - 2-3 days

A

1 - 8-13 days = monochorionic-monoamniotic
2 - 3-8 days = monochorionic-diamniotic = 3-8 days
3 - 2-3 days = dichorionic-diamniotic

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20
Q

In a dizygotic 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

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21
Q

In a monozygotic 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

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22
Q

In a monozygotic 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

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23
Q

In a monozygotic 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

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24
Q

In a monozygotic 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

25
Q

Are more twins mono or dizygotic?

A
  • monozygotic twins = 1 in 3
  • dizygotic twins = 2 in 3
26
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
27
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

Which of the above scenarios is most common?

A
  • monochorionic-diamniotic accounting for 75%
  • dichorionic-diamniotic = 25%
  • monochorionic-monoamniotic = 2%
28
Q

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

1 - shared blood supply foetus have lower risk of adverse outcomes
2 - shared blood supply foetus have higher risk of adverse outcomes
3 - just for monitoring on ultrasounds etc.
4 - all of the above

A

2 - shared blood supply foetus have higher risk of adverse outcomes
- monochronic will be be higher risk

29
Q

Which of the following typically have worse outcomes?

1 - dizygotic diochorionic diamniotic
2 - monozygotic diochorionic diamniotic (DCDA)
3 - monozygotic monochorionic diamniotic (MCDA)
4 - monozygotic monochorionic monoamniotic (MCMA)

A

4 - monozygotic monochorionic monoamniotic (MCMA)

  • everything is shared so there are increased risks
30
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. Abdominal ultrasound is used to assess this, but at what time can this be determined from?

1 - 6-12 weeks
2 - 10-13 weeks
3 - 12-16 weeks
4 - 16-24 weeks

A

2 - 10-13 weeks

31
Q

Identifying zygosity, 1 egg or 2 is important as it affects the risk of congenital anomalies, stillbirths and neonatal death. Do mono or dizygotic twins have a greater risk of all of these?

A
  • monozygotes
32
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
  • for example a >20% difference in twin size suggests growth restriction
33
Q

In women with multiple pregnancies they should be advised about increased risk of all of the following except which one?

1 - prematurity
2 - macrosomnia
3 - intrauterine growth restriction
4 - polyhydramnios
5 - cord prolapse

A

2 - macrosomnia

  • polyhydramnios = excess amniotic fluid
34
Q

In women with multiple pregnancies they should be advised about increased risk of all of the following that could occur to mum during pregnancy except which one?

1 - hypertension (pre-eclampsia)
2 - gestational diabetes
3 - anaemia
4 - CKD
5 - post-partum haemorrhage
6 - caesarean section required

A

4 - CKD

35
Q

Post-partum haemorrhage (PPH) risk is increased in multiple pregnancies. Which of the following is NOT one of the 4 Ts to help remember the causes of PPH?

1 - Tone
2 - Trauma
3 - Thrombin
4 - Time
5 - Tissue

A

4 - Time

  • Tone = uterine atony
  • Trauma = lacerations, uterine rupture
  • Thrombin = haemophilia
  • Tissue = retained placenta
36
Q

The 4 Ts can be remembered to identify the most likley cause of post partum haemorrhage. Which of the following is the most common cause accounting for aprox 70-80% of PPH?

  • Tone = uterine atony
  • Trauma = lacerations, uterine rupture
  • Thrombin = haemophilia
  • Tissue = retained placenta
A
  • Tone = uterine atony
  • specifically uterine atony
37
Q

All of the following are management of post-partum haemorrhage. Typically which is 1st?

1 - balloon or suture
2 - tranexamic acid
3 - oxytocin
4 - ergometrine
5 - uterine rub/compression

A

5 - uterine rub/compression
- uterus may feel boggy and not contracted

  • then it would be tranexamic acid and oxytocin
  • then ergometrine
  • then balloon or suture
38
Q

March the following values with diagnosis:

  • postpartum haemorrhage (PPH)
  • major PPH
  • major obstetric haemorrhage

1 - >1500ml
2 - >500ml
3 - >1000ml

A

1 - >1500ml = - major obstetric haemorrhage
2 - >500ml = postpartum haemorrhage (PPH)
3 - >1000ml = major PPH

39
Q

Is Hb a good measure of blood loss in an acute setting?

A
  • no
  • Hb gives a concentration, not fluid loss, so can be falsely reassuring
40
Q

In pregnancy there is an anomaly scan, which typically takes place when?

1 - 12-16 weeks
2 - 18-21 weeks
3 - 16-24 weeks
4 - 21-28 weeks

A

2 - 18-21 weeks
- in multiple pregnancies, they are also given scans every 2 weeks after this

41
Q

Twin to twin transfusion syndrome is a rare but dangerous syndrome. One twin becomes a donor to the other twin for blood, nutrients, etc, meaning one twin grows and develops much faster.

1 - dizygotic diochorionic diamniotic
2 - monozygotic diochorionic diamniotic (DCDA)
3 - monozygotic monochorionic diamniotic (MCDA)
4 - monozygotic monochorionic monoamniotic (MCMA)

A

4 - monozygotic monochorionic monoamniotic (MCMA)
- but can occur in any monochorionic twins
- the donor twin could ultimately die

  • discordance calculation is:
    (large foetus - small foetus)/large foetus x 100
42
Q

How can twin to twin transfusion syndrome be treated?

1 - open surgery to seperate/repaid abnormal blood vessels
2 - hysteroscopy to seperate/repaid abnormal blood vessels
3 - fetoscopic laser ablation through the umbilicus
4 - any of the above

A

3 - fetoscopic laser ablation through the umbilicus
- abnormal blood vessels or anastomosis will be laser ablated

43
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)
44
Q

Generally when do dizygtotic dichorionic-diamniotic (2 eggs or 1 egg with 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

45
Q

Generally when do monozygotic 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
46
Q

Generally when do monozygotic monochorionic-monoamniotic (1 placenta and 1 amniotic sac) 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
47
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
48
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)

49
Q

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

1 - True
2 - False

A

1 - True
- monochorionic-diamniotic accounts for 75% for babies

50
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

51
Q

If DCDA and MCDA babies are uncomplicated they can be delivered via a vaginal or C-section. True or False?

A
  • True
  • 2nd baby may still have to have a C-section though
52
Q

Once labour begins, why is it important to identify twin number 1?

1 - twin 1 is the biggest so should be delivered first
2 - twin 1 is the baby not in a cephalic position so must be delivered 1st
3 - twin 1 is baby closest to cervix in cephalic position
4 - can be any one of these

A

3 - twin 1 is baby closest to cervix in cephalic position

  • must also monitor maternal and foetal HR on CTG
53
Q

In women with multiple pregnancies, are they more or less likely to need assistance with the 3rd stage of labour?

A
  • more likely to need assistance
54
Q

If a woman presents to the community midwife, prior to her 1st scan. The patient has excessive vomiting, abdominal pain and vomiting, and the fundal height is larger than expected. We can come up with 3 key differentials. Which one of these is least Linley?

1 - ovarian cancer
2 - multiple pregnancy
3 - molar pregnancy
4 - hyperemesis gravidarum

A

1 - ovarian cancer

  • multiple and molar pregnancy would account for the larger than expected fundal height and sickness
  • hyperemesis gravidarum would account for sickness
55
Q

Are multiple pregnancies more likely in natural or assisted conception?

A
  • assisted conception as some practices involve using multiple eggs
56
Q

Which medication is given to pre-term babies to reduce the risk of cerebral palsy and patients at risk of eclampsia?

1 - Calcium gluconate
2 - Magnesium sulphate
3 - Carbamazepine
4 - Calcium carbonate

A

2 - Magnesium sulphate
- antidote is calcium gluconate

57
Q

Foetal fibronectin is a protein made during pregnancy found between the lining of your uterus and the amniotic sac that’s protecting your baby. Fetal fibronectin works as a glue to hold the amniotic sac to the uterine lining. This can be measured at 24-35 weeks to rule out what?

1 - pre-term labour
2 - twin-twin transfusion syndrome
3 - infection
4 - HPV

A

1 - pre-term labour
- high levels suggest baby is coming early
- has a high negative predictive value, rules out pre-term labour if low or not there

58
Q

What class of medication can be given to mother when there is a high liklihood that baby is going to be delivered early?

1 - hormone inhibitors
2 - corticosteroids
3 - antibiotics
4 - antihypertensives

A

2 - corticosteroids
- helps babies lungs and neurons develop and mature quicker

A. MLA Map Obstetrics and Gynaecology (34 decks)

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