Multiple pregnancies Flashcards

1
Q

Risk factors

A

Hx and Fx
Increased parity and maternal age

Assisted reporuction:

  • clomiphene = 10%
  • IUI - 15%
  • IVF - 25% (NB. IVF now only 2 embryos)
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2
Q

Classification of monozygotic twins

A

Divide by:

  • day 3 (30%) - dichorionic, diamniotic
  • day 4-8 (70%) - monochronionic, diamniotic (shared placenta)
  • 9-13 days (rare) - monochronioic, monoamniotic
  • 13+ days - conjoined twins

NB. Monochorionic has increased risk of foetal loss, especially <24weeks

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3
Q

Clues for diagnosis

A

Hyperemesis gravidarium
Large uterus
3+ poles felt at 24 weeks
2 foetal HS

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4
Q

Diagnosis

A

USS in first trimester (dating or nuchal translucency scan)

Determine chronicity - 1st/2nd trimester scan

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5
Q

Antepartum complciations

A

Foetal:

  • mortality (6x) and handicap (5x)
  • Preterm delivery (40% twins, 80% triplets)
  • IUGR
  • IUD - monochorionic = death in 20%, cerebral damage in 25%
  • congenital abnormalities -
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6
Q

Monochorionicity twins

A

20% twin to twin transfusion syndrome (TTSS) - unequal blood distribution though placenta

Donor twin - volume depleted, amaemic, IUGR and oligohydramnios

Recipient twin - volume overload, polycythaemia, cardiac failure, massive polyhydramnios

Both have high risk of IUD or preterm delivery and IUGR

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7
Q

intrapartum complications

A

Malpresentation - 20% of 1st twin

Foetal distress

PPH

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8
Q

Maternal complications

A
Pre-eclampsia (x5)
Hyperemesis gravidarum
Anaemia
GDM
Polyhydramnios
Placenta praevia
Operative delivery
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9
Q

Antenatal management

A

Serial growth scans - 28, 32, 36
More frequent ANC checks
Give aspirin 75mg for pre-eclampsia

Adequate diet - 5mg folic acid, iron supplements,

Fetal abnormality - discuss TOP (intracardiac injection with KCl) must be done before 14 weeks

MC twins: USS surveillance from 12 weeks - scan every 2 weeks

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10
Q

Management of TTSS

A

Laser ablation of anastomoses
Selective foeticide
Serial amnio-reductions
Septostomy

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11
Q

Intrapartum management

A

MOD - CS - esp. if first twin is malpositioned
Triplets always = CS

Timing:
DC = 37-38 weeks
MC = 34-37 weeks

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12
Q

Management of labour

A

CTG both twins
2 paeds staff, 2 midwives, anaesthetist

Syntocin for 2nd twin
ECV for 2nd twin

2nd twin normally delivered 20 mins after first - if distressed use forceps

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