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Obgyne > Multiple pregnancies > Flashcards

Multiple pregnancies Flashcards

1
Q

Types of twins pregnancy.

A
  1. Number of conceptions Zygosity
    (monozygotic/dizygotic)
    • 2. Number of placenta Chorionicity
    (monochorionic/dichorionic)
    Number of amniotic cavities Amnionicity
    (monoamniotic/diamniotic)
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2
Q

2 type of zygotes

A
  1. (DIZYGOTIC/ FRATERNAL /BINOVULAR ) : Twins resulting from ovulation and subsequent fertilization of more than one oocyte.
  2. (MONOZYGOTIC/IDENTICAL/MONOVULAR): Splitting of one embryonic mass to form two or more genetically identical fetuses.
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3
Q

If the fetus share of the placenta what type of the zygotes

A

Monozygous

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4
Q

The characteristic of the dizygotic twins 5.

A
  1. 2/3rd of all
  2. May/may not be of the same sex
  3. Genetically similar to other siblings
  4. Always have separate placentae &
    amniotic membranes (dichorionic
    diamniotic …DCDA)
  5. Incidence varies by factors like age,
    parity& ethnicity, etc.
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5
Q

What’s the characteristic of the monozygotic twins? 5

A
  1. 1/3rd of all
  2. Same sex
  3. Genetically identical
  4. Sharing of placenta and amniotic cavity depend on the time of splitting
  5. Incidence is relatively fixed i.e. 1/250
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6
Q

How much placenta and amniotic in the di-chorionic?

A

2 placenta , 2 amniotic

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7
Q

How much placenta and amniotic in mono chorionic?

A

Single placenta
2 amniotic
1 amniotic

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8
Q

If monozygotic twins, splitting within three days, what’s the results?

A

DCDA

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9
Q

If monozygotic twins, splitting within 4 to 8 days, what’s the results?

A

MCDA

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10
Q

Monozygotic twins, splitting with the 9 to 12 days what’s the results?

A

MCMA

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11
Q

If monozygotic twins, splitting with that more than 12 days, what’s the result?

A

Conjoined twins.

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12
Q

The longer the time between fertilization & splitting, what’s the result?

A

more structures the fetuses will share.

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13
Q

How to determine chorionicity ?

A

By US in late 1st and early 2nd (10-14 weeks )

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14
Q

By the ultrasound, if you see triangular projection of the chorion projecting between the two layer of the inter-twin membrane, what’s the type of placenta mono or di ?
What’s the name of the sign ?

A

Dichorionic.
Lambda sign.

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15
Q

If you see by the ultrasound The intertwin membrane ends
abruptly at the edge in a T
configuration.
what does it mean?
What’s the name of the sign?

A

Monochorionic
T sign

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16
Q

What’s the factors affecting dizygotic twins?

A
  1. Race Nigeria > Japan
  2. Increases maternal age. :
    <20 (( 6:1000 ))
    >35 (( 22 :1000 ))
    >45 (( 57 : 1000 ))
  3. Assistant reproduction:
    IUI 10-20%
    IVF 20-30%
  4. Parity > in multipara
  5. Heredity +ve maternal family history
  6. Nutritional status
  7. Conception after stopping OCP
17
Q

Maternal Complications ?

A
  1. Hyperemesis gravidarum
  2. Pre-eclampsia
  3. Gestational diabetes
  4. Anemia (iron & folate)
    5.Thromboembolic disease 6.Antepartum hemorrhage – placenta previa and placental abruption
    7.Cholestasis of pregnancy
  5. Malpresentations
    9.Mechanical distress such as palpitation, dyspnea, varicosities, and
    hemorrhoids
  6. Preterm labor (50%)
    twins –37 weeks, triplets –34 weeks, quadruplets –30 weeks • Pre-labour rupture of the membranes • Cord prolapse • Increased cesarean delivery (50%) • Postpartum hemorrhage
18
Q

What are the 2 obstetrical complications that are never seen in
multiple pregnancy?

A

Postpartum
Macrosomia

19
Q

Fetal Complications

A
  1. Spontaneous Miscarriages
  2. Congenital Anomalies
  3. Conjoined twins
  4. IUGR
  5. Twin-twin Transfusion Syndrome
  6. Twin Anemia Polycythemia Sequence
  7. Twin Reversed Arterial Perfusion Sequence
  8. Monoamniotic Twin Pregnancy
20
Q

Spontaneous Miscarriages more in

A

monochorionic twins

21
Q

Spontaneous Miscarriages
Types

A

➢VanishingTwinSyndrome/FetalResorption during first10weeks(anabortedfetus
absorbedcompletely,sonosigns/remainsvisibleinlaterscans)
➢Fetus Papyraceous/Compressus during early (12-20 weeks) 2nd trimester
(a dead flattened fetus compressed against the uterine wall by the second
alivetwin)

22
Q

Fetus Papyraceous/Compressus

A

12-20wks

23
Q

VanishingTwinSyndrome/FetalResorption

A

during first10weeks

24
Q

Congenital Anomalies
What’s the classification?

A

Chromosomal like Down syndrome
• Structural : Neural tube defects – anencephaly, microcephaly, hydrocephaly, cardiac anomalies
etc
Because of over crowding of uterine space like talipes, hip dislocation etc) Unique to twins : acardiac twin, conjoined twins

25
Q

Conjoined twins
What’s the treatment?

A

CS

26
Q

What’s the complication of

Dichorionic Twins

A

preterm labor

27
Q

What’s the complication of

Monochorionic Twins

A

immediate death or neurological deficit.

28
Q

Twin-twin Transfusion Syndrome what’s the cause?

A

Monochorionic twin

vascular anastomoses exist between two fetal circulations • Vascular anastomoses, A-V, V-A, A-A, V-V. Mostly, these are balanced • In About 10-15% of monochorionic twins, an imbalance

29
Q

Twin-twin Transfusion Syndrome Management

A

• Serial amnioreduction from the recipient sac
• Septostomy
• Selective feticide by umbilical cord occlusion
• Selective laser ablation of abnormal vascular connections

30
Q

Diagnostic markers for TTTS

A

• Ø both fetuses of the same gender
• Ø polyhydramnios/oligohydramnios
• Look for the bladder size and liquor volume of each twin (Quintero Staging)

31
Q

Management of labour
• First stage: 4

A

• Same as in singleton pregnancy but with more vigilance
• Avoid supine hypotension
• Blood to be cross-matched and ready
• Intrapartum fetal monitoring separately for both fetuses

32
Q

Management of labour
SECOND STAGE– Delivery of the first baby
6

A

• As in singleton pregnancy
• maintain an IV line
• No oxytocic (AMTSL) after delivery of the first baby*
• Secure cord clamping
• Ensure labeling of 1st baby*
• 2 separate neonatal resuscitation teams

33
Q

Management of labour
Second stage
Delivery of second twin

A

• FHS of second baby
• Lie and presentation of the second twin
• Wait for uterine contractions
• Oxytocin infusion to ensure adequate uterine contraction
Transverse lie - external cephalic version/internal podalic version
Breech presentation - breech extraction
Cephalic presentation – amniotomy once the head is in the pelvis
complete the delivery

34
Q

Management of the labor third stage

A

-Continue oxytocin drip
-Carboprost250 gm/ Oxytocin 10 units IM
-Delivery of placenta following delivery of both twins, by controlled cord
traction (CCT) method
- Monitor for at least 2 hours
-Exam of placenta & membranes

35
Q

Indications for c-section twins:👯

A

• Non cephalic presentation of first twin
• Monoamniotic twins
• Conjoined twins
• Locked twins
• Other obstetric conditions like placenta previa
• Second twin –closure of cervix (rarely)

36
Q

Antenatal management twins

A

✓Aim is to early detection & management & prevention (where possible)
✓More frequent A/N visits
✓Advice regarding diet, rest, physical activity
✓Folic acid, iron & calcium supplements
✓Ultrasound:
✓ 1st trimester for dating, no of fetuses, viability & chorionicty
✓ 2nd trimester for congenital anomalies
✓ 3rd trimester for serial growth ✓Corticosteroids when preterm labor is suspected

37
Q

INVESTIGATION

A

(ultrasound)
• 1st trimester-no of fetuses, viability, chorionicity, nuchal translucency
• 2nd trimester-congenital anomalies
• 3rd trimester- serial growth scan, fetal complications like TTTS etc.

38
Q

Monoamniotic Twin Pregnancy how you can diagnosed

A

Ultrasound, no divide membrane

39
Q

Monoamniotic Twin Pregnancy
What’s the management?

A

Frequent antenatal visits and ultrasound scans with Doppler
study
• Give corticosteroids
• CTG to detect bradycardia or deceleration.
• Delivery by caesarean section at 32 to 34 weeks.

Obgyne (26 decks)

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