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Multiple pregnancies Flashcards

1
Q

What is meant by multiple pregnancy

A

Pregnancy with more than 1 foetus

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2
Q

Incidence of twin pregnancy

A

1:80-

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3
Q

Incidence of triplet pregnancy

A

1:10,000

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4
Q

What increases risk of multiple pregnancy

A
  • Assisted conception (Usually abroad)
  • African
  • Family history
  • Increased maternal age
  • Increased parity
  • Tall women
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5
Q

What is chorionicity

A

The number of placentas

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6
Q

What is amniocity

A

The number of amniotic sacs

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7
Q

Def: Monozygotic

A

Identical twins (From single zygote)

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8
Q

Def: Dizygotic

A

Non-identical twins (From 2 different zygotes)

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9
Q

Def: Monoamniotic

A

Single amniotic sac

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10
Q

Def: Diamniotic

A

2 separate amniotic sacs

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11
Q

Def: Monochorionic

A

Single placenta

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12
Q

Def: Dichorionic

A

2 separate placentas

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13
Q

What is the best outcome for chorionicity and amniocity in multiple pregnancy

A

Diamniotic dichorionic (Each foetus has its own nutrient supply)

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14
Q

What is the chorionicity and amniocity of dizygous twins

A

Dichorionic diamniotic (DCDA)

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15
Q

What chorionicity and amniocity can monozygous twins be?

A

Monochorionic Monoamniotic (MCMA)
Monochorionic Diamniotic (MCDA)
Dichorionic Diamniotic (DCDA)
Conjoined twins

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16
Q

What determines chorionicity and amniocity of a twin pregnancy

A

The day of splitting of the 2 eggs
- Day 0-3 → DCDA (2 placenta, 2 sacs)
- Day 4-7 → MCDA (1 placenta, 2 sacs)
- Day 8-14 → MCMA (1 placenta, 1 sac)
- Day 15+ → Conjoined twins

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17
Q

USS findings in DCDA twins

A

Membrane between twins with a lambda sign or twin peak sign

18
Q

USS findings in MCDA twins

A

Membrane between the twins
T sign

19
Q

USS findings in MCMA twins

A

No membranes

20
Q

What is a lambda sign (Twin peak sign) on USS

A

a triangular appearance where themembranebetween the twins meets thechorion, as the chorion blends partially into the membrane (Dichorionic pregnancy)

21
Q

What is a T sign on USS

A

where the membrane between the twins abruptly meets the chorion, giving a T appearance.

22
Q

Symptoms of multiples pregnancy

A

Exaggerated pregnancy symptoms (E.g. Hyperemesis gravidarum)

23
Q

Signs of multiple pregnancy

A

High AFP
Large for date uterus
Multiple foetal poles

24
Q

Maternal risks of multiple pregnancy

A
  • Anaemia
  • Polyhydramnios
  • Hypertension
  • Malpresentation
  • Spontaneous preterm birth
  • Instrumental delivery or caesarean
  • Postpartum haemorrhage
25
Foetal risks of multiple pregnancy
- Miscarriage - Stillbirth - Fetal growth restriction - Prematurity - Twin-twin transfusion syndrome - Twin anaemia polycythaemia sequence - Congenital abnormalities
26
What occurs in twin-twin transfusion syndrome?
If foetuses share a placenta, one may receive more of the blood from it than the other The recipient can be overloaded The donor can be starved of blood
27
What are some complications for the recipient foetus in twin-twin transfusion syndrome
Heart failure Polyhydramnios
28
What are some complications for the donor foetus in twin-twin transfusion syndrome
Growth restriction Anaemia Oligohydramnios
29
How is twin-twin transfusion syndrome managed
Teriary foetal medicine care centre treatment Laser treatment to destroy the connection between the 2 blood supplies
30
What is twin anaemia polycythaemia sequence?
Twin anaemia polycythaemia sequence is similar to twin-twin transfusion syndrome, but less acute. One twin becomes anaemic whilst the other develops polycythaemia (raised haemoglobin).
31
What investigations are required in multiple pregnancy
FBC Additional USS
32
When are FBCs taken in multiple pregnancy
Booking clinic 20 weeks gestation 28 weeks gestation
33
When are additional USS performed in multiple pregnancy
2 weekly scans from 16 weeks in monochorionic twins 4 weekly scans form 20 weeks for dichorionic twins
34
What is given prior to delivery in multiple pregnancy
Corticosteroids (Lung maturation)
35
When is planned birth offered in uncomplicated MCMA
32 - 33+6 weeks
36
When is planned birth offered in uncomplicated MCDA twins
36 - 36+6 weeks
37
When is planned birth offered in uncomplicated DCDA twins
37 and 37+6 weeks
38
When is planned birth offered in triplets
Before 35+6 weeks
39
How are mono amniotic twins usually delivered
Elective C-section
40
How are diamniotic twins usually delivered
Vaginal if 1st baby cephalic C-section for 2nd baby C-section if 1st baby not cephalic

Reproductive and sexual medicine (78 decks)

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