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Obstetrics and gynaecology > Multiple pregnancy > Flashcards

Multiple pregnancy Flashcards

1
Q

How many pregnancies are multiple in the UK?

A

1 in 63

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2
Q

What are some factors which increase the chance of multiple pregnancy

A

Maternal age - use of assisted reproductive technologies

Ethnicity

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3
Q

Define dizygotic

A

Ovulation and fertilisation of 2 oocytes

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4
Q

Define monozygotic

A

Ovulation and fertilisation of a single oocyte with subsequent division of the zygote

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5
Q

How are twins defined?

A

Number of chorions (placentas) and amnions (sacs)

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6
Q

List and describe the 3 classifications of twins

A

MCMA - Monochorionic monoamniotic - 1 placenta, 1 amniotic sac
MCDA - Dichorionic monoamniotic - 1 placenta, 2 amniotic sacs
DCDA - Dichorionic diamniotic - 2 placentas and 2 amniotic sacs

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7
Q

Why is it important to define the type of twin pregnancy?

A

Risks are dependent on whether or not the twins share the same placenta or amniotic space

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8
Q

Describe how DCDA twins are formed

A

Either dizygotic or monozygotic twins with cleavage of the zygote in the first 3 days after fertilisation

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9
Q

Describe how MCDA twins are formed

A

Monozygotic twins with cleavage of the zygote 4-8 days after fertilisation

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10
Q

Describe how MCMA twins are formed

A

Monozygotic twins with cleavage of the zygote from the 8th-12th day after fertilisation

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11
Q

How is chronicity diagnosed?

A

USS

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12
Q

When is the optimal time to diagnose chronicity

A

In the first trimester after 7 weeks

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13
Q

Which sign on USS indicates dichorionic pregnancy

A

Lambda sign

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14
Q

Which sign on USS indicates monochorionic pregnancy?

A

T sign

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15
Q

What are the maternal risks from multiple pregnancy?

A

Miscarriage
Hyperemesis
Maternal haemodynamic changes - dilutional anaemia
Gestational hypertension and pre-eclampsia
Gestational diabetes
Venous thromboembolism
Complications in labour - higher risk of intervention, caesarean section
Post partum haemorrhage

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16
Q

What are the foetal risks from multiple pregnancy for all twin pregnancies?

A 
Premature delivery
Malposition 
Miscarriage/stillbirth
Growth restriction 
Congenital abnormalities
17
Q

What are the foetal risks from monochorionic pregnancy?

A 
Selective IUGR
Twin to twin transfusion syndrome 
Twin to twin polycythaemia sequence
Twin reversed arterial perfusion sequence
Higher rates of congenital anomalies
Death of one twin
18
Q

What is the foetal risk from a monoamniotic pregnancy?

A

Cord entanglement

19
Q

Describe the antenatal care offered to women with multiple pregnancy

A

Referral to obstetrician and specialist twin midwife or twin clinic. Referral to TAMBA - charity which give good information
Increased scanning programme 2-4 weeks depending on the type of twin pregnancy
Fetal medicine cardiac scans for monochorionic twins
Early referral to fetal medicine in case of any discrepancies
Birth planning discussions

20
Q

What percentage of MC twin pregnancies does twin to twin transfusion syndrome affect?

A

15%

21
Q

What is twin to twin transfusion syndrome?

A

Vascular connection between the babies at the placenta - allowing blood to transfer from one twin to another and can become unbalanced

22
Q

What effects does twin to twin transfusion syndrome have on the recipient twin?

A

Large
Fluid overload
Cardiac failure
Excess liquor - increased urine output

23
Q

What effects does twin to twin transfusion syndrome have on the donor twin?

A

IUGR

Reduced liquor - reduced urine output

24
Q

How is twin to twin transfusion syndrome managed?

A

Regular USS
Referral to specialist fetal medicine unit
Laser therapy - separate connections in the placenta using fetoscope and laser. Excess amniotic fluid is removed. However the imbalance can return so monitor throughout pregnancy

25
Q

What are the risks of foetal surgery

A

Rupture of membranes

Preterm birth

26
Q

When are uncomplicated DCDA twins delivered?

A

37-38 weeks

27
Q

When are uncomplicated MCDA twins delivered?

A

36-37weeks

28
Q

Which mode of delivery is used for DCDA twins?

A

Vaginal birth if one baby is in cephalic position
Induction of labour
However risk of emergency C section even after 1st twin born

C-section if 1st baby not in cephalic presentation

Obstetrics and gynaecology (67 decks)

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