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OBSTETRICS > Multiple pregnancies > Flashcards

Multiple pregnancies Flashcards

1
Q

Define Dizygotic

A

Two different oocytes fertilised by two different sperm

Embryo can be different sex and are NOT identical

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2
Q

Define Monozygotic

A

when one sperm fertilise one egg and the embryo decides into 2

Can share the same placenta and amnion depending on time of separation

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3
Q

Define monochorionic

A

When twins share the same placenta

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4
Q

Define Dichorionic

A

When twins have 2 separate placentas

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5
Q

Define Monoamniotic

A

When twins share the same amniotic membrane

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6
Q

Define Diamniotic

A

When twins have 2 separate amniotic membranes

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7
Q

Describe dizygotic twins in terms of amniotic and chorionic composition

A

Diamniotic Dichorionic - DCDA

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8
Q

When does the embryo split to produce Dichorionic Diamniotic twins

A

Before Day 3 - before implantation

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9
Q

When does the embryo split to produce Monochorionic Diamniotic

A

Between days 4-8 - after implantation

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10
Q

When does the embryo split to produce Monochorionic Monoamniotic

A

Between days 9-13 - after implantation

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11
Q

What happens when there is incomplete division of an embryo?

A

Conjoined twins

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12
Q

List 4 symptoms associated with multiple pregnancy

A
  1. Hyperemesis gravidum
  2. Uterus large for dates
  3. 3+ foetal poles palpable >24 weeks
  4. Multiple foetal hearts heard on auscultation
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13
Q

How are multiple pregnancies diagnosed?

A

US scan during the first trimester (GS)

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14
Q

How is Dichorionicity diagnosed on US? Which sign do we see?

A
  1. Two separate placentas seen
  2. Lamda sign seen <14 weeks
  3. Different sex babies
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15
Q

What maternal complications are associated with multiple pregnancies? (6)

A
  1. Pre-eclampsia (5x)
  2. Gestational diabetes
  3. PPH/APH
  4. Anaemia
  5. operative delivery
  6. Placenta privea
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16
Q

Which type of twins has a higher foetal risk?

A

Monochorionic twins

17
Q

What are the foetal complications associated with multiple pregnancies?

A
  1. Miscarriage
  2. Congenital abnormalities
  3. IUGR
  4. Pre-term labour - increased risk of death
  5. increased risk of death - intranatally and postnatally
  6. Disability
18
Q

What problems can you get with MC twins?

A
  1. Twin to twin transfusion syndrome
  2. Twin reversed arterial perfusion (TRAP)
  3. IUGR
19
Q

What is Twin to twin transfusion syndrome?

A

Occurs due to vascular anastomosis in the shared placenta where one twin takes up all the blood supply (recipient) from the other twin (Donor twin)

20
Q

What happens to the Donor twin in TTTS

A

Fluid depleted

IUGR

oligohydraminous

21
Q

What happens to the Recipient twin in TTTS

A

Fluid overload

Polycythemia

Cardia faliure

Death

22
Q

What treatment options are there for TTTS?

A
  1. Laser ablation of the placental anastomosis - lowest risk of handicap
  2. selective foeticide by cord occlusion
23
Q

What is twin reversed arterial perfusion?

A

One twin is genetically abnormal (No/non functioning heart) therefore receives blood from the other twin and the umbilical artery blood supply is reversed.

Pumper twin has a high risk of developing cardiac failure

24
Q

What is the risk on a twin if the other one dies in a dichorionic pregnancy?

A

In the first trimester: No effect

In the second/third: precipitates labour

25
Q

What is the risk on a twin if the other one dies in a Monochorionic pregnancy?

A

Subsequent death or neurological damage due to hypovolemia occurs (shared circulation)

26
Q

What are the intrapartum risks associated with multiple pregnancies? (5)

A
  1. Malpresentation
  2. Foetal hypoxia in second twin after first one is delivered
  3. Cord prolapse
  4. Operative delivery
  5. PPH
27
Q

What do you need to do in the antepartum period in any twin pregnancy?

A
  1. Consultant led care
  2. Iron, folic acid and aspirin
  3. Early US to determine type
28
Q

At what weeks do you need to do serial scans for twins?

A

28, 32 and 36

29
Q

When is it recommended to deliver DCDA twins?

A

37 weeks

30
Q

When is it recommended to deliver MC twins?

A

36 weeks

31
Q

When is CS indicated?

A
  1. Breech or transverse lie

2. All monochorionic twins

32
Q

How are twins vaginally delivered?

A
  1. In theatre usually to allow speedy surgical intervention
  2. First twin delivered normally
  3. EXTRA CTG monitoring for second twin.
  4. Recommended to monitor first twin VIA head and second twin via abdomen
  5. SCAN/feel for the presentation of the second twin after the first one is delivered
  6. Consider CS/breech extraction if second baby is in a weird position
  7. Give oxytocin if the contractions are reduced after the delivery of the first twin
33
Q

Is TVS measurement of cervical length advised in preterm labour of twins?

A

NO

34
Q

Can progesterone prevent preterm twin labour?

A

NO

35
Q

What are the complications of laster ablation/coagulation in TTTS? (4)

A
  1. Rupture of membranes
  2. Infection
  3. Pre-term delivery
  4. Miscarriage
36
Q

When is selective reduction advised for multiple pregnancies?

A

12 weeks

37
Q

How do we terminate DC twins?

A

KCL injection before 14 weeks of gestation

38
Q

How do we terminate MC twins?

A

Umbilical cord occlusion using diathermy

39
Q

What increases the risk of having multiple pregnancies? (4)

A
  1. Assisted conception
  2. Genetics
  3. Increased maternal age
  4. IVF

OBSTETRICS (11 decks)

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