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DM2 Prep- Obstetrics > Multiple Pregnancy > Flashcards

Multiple Pregnancy Flashcards

1
Q

Incidence of monozygous twin

A

3-5:1000

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2
Q

Triplet birth rate

A

0.24: 1000 live births

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3
Q

Twin birth rate

A

15.8 :1000 LB

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4
Q

Perinatal mortality : twins

A

37 : 1000

3 times higher than singleton

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5
Q

Perinatal mortality: triplets

A

52: 1000

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6
Q

Perinatal mortality: higher order

A

231: 1000

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7
Q

Cerebral palsy in twins

A

8 fold

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8
Q

Cerebral palsy triplets

A

47 fold

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9
Q

What percentage if monozygotic twins are DCDA

A

25-30%

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10
Q

What percentage of monozygotic twins are monochorionic

A

75%

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11
Q

What cleavage phase results in MCMA

A

Cleavage between days 8 and 13

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12
Q

Most reliable time to determine chorionicity

A

10-13 weeks

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13
Q

Ultrasound features if monochorioninc twin (4)

A
  • early pregnancy 1 placental mass
  • T sign (thin intertwin membrane)
  • twin membrane <1.8mm
    -non discordant sex
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14
Q

Incidence of congenital malformation in monozygotic twins compared to dizygotic twins

A

3 fold compared to dizygotic

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15
Q

When should screening for TTTS begin?

A

16 weeks

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16
Q

How often should ultrasounds be performed in TTTS screening

A

Baseline: Every 2 weeks from 16 weeks

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17
Q

When is the most common time for TTTS to develop

A

16 - 24 weeks
(Only 1% of cases happen after 24 weeks)

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18
Q

When should fetal surveillance begin for DCDA twins

A

24 weeks

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19
Q

How often should ultraosund be done in DCDA

A

Baseline: every 4 weeks

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20
Q

What has been proven to prevent preterm birth in multiple pregnancy?

A

Nothing.

Studies have found no clinical benefits of bedrest, tocolytics, progesterone and cerclage in multiple pregnancies.

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21
Q

What are maternal complications of twin pregnancies
Antepartum (3)

A
  • preeclampsia
  • anemia
  • gestational diabetes mellitus
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22
Q

What screening should be offered in twin pregnancies?

A

Aneuploidy
- first trimester combined (NT, hcg, pappa)

  • integrated screening ( NT + t1 screen + t2 screen)
  • cfdna ( 99% sensitive for trisomy 21)
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23
Q

Advantages of NIPT (4)

A
  • Higher detection rate
  • High negative predictive value for trisomy 21
  • Lower false positive rate
  • Less dependent on gestational age
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24
Q

What are the most common complications of monochorionic placentation

A
  • TTTS
  • TRAP
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25
Q

What percentage of MC are complicated by TTTS

A

10-15%

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26
Q

What is the postulated pathophysiology of TTTS

A

The presence of deep unidirectional flow through arterio-venous communications and minimal or no superficial bidirectional flow

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27
Q

How does oligohydramnios occur in TTTS

A

Hypovolemia of the donor twin results in activation of the renin- angiotensin system resulting in
Vasoconstriction, oliguria, iugr

28
Q

What system is used to classify TTTS

A

Quintero classification

29
Q

Stage 1 TTTS

A

Oligohydramnios (<2cm DVP) one twin
Polyhydramnios (>8cm DVP) other twin.
Both bladders visible

30
Q

Stage 2 TTTS

A

Bladder absent for donor twin

31
Q

Stage 3 TTTS

A

Abnormal dopplers in either twin

32
Q

Stage 4 TTTS

A

Fetal hydrops in either twin

33
Q

Stage 5 TTTS

A

Death if one or both twins

34
Q

What is the fetal mortality for untreated moderate-severe TTTS

A

up to 90%

35
Q

What are the neonatal long term implications of TTTS (3)

A
  • cardiac
  • renal
  • neurological complications
36
Q

Treatment options for TTTS (5)

A
  • laser ablation
  • serial amnioreduction
  • selective fetocide
  • septostomy
  • termination of pregnancy
37
Q

What is the survival rate of MCT with TTTS following laser coagulation

A

Up to 70 %

38
Q

What was the Eurofetus trial

A

RCT comparing laser therapy vs amnioreduction for TTTS before 26 weeks.

39
Q

What were the findings of the eurofetus trial (3)

A

1) laser group had a higher likehood of Infant survival(of at least one twin) to 28days of life and 6mnths of age.
76% vs 56%

2) laser group has less periventricular leukomalacia

3) median gestational age of delivery laser 33.3 weeks and amnioreduction 29 weeks

40
Q

How many MCT are affected by twin reversed arterial perfusion sequence

A

5%

41
Q

What is TRAP

A

An acardiac “perfused twin” receives its blood supply from a large arterio-arterial anastamosis from the “pump twin” resulting in absent or rudimentary development of the head, heart and upper limb

42
Q

What is the mortality rate of the pump twin in TRAPS

A

> 50%

43
Q

What is the cause behind mortality of TRAPS

A

High output congestive heart failure and hydrops

44
Q

Definitive management on TRAP

A

Separation of the Cardiovascular circulation by diathermy occlusion of the cord of the acardiac twin

45
Q

What is a significant twin discordance

A

20%

46
Q

How is twin discordance calculated

A

(EFW larger twin - EFW smaller twin)÷ EFW larger twin x 100

47
Q

What percentage of monchorionic twins are complicated by selective growth restriction

A

10-15%

48
Q

What percentage of MCMA twins have cord entanglement in T3

A

Up to 100%

49
Q

What feature is seen on doppler confirming cord entanglement

A

Galloping sign - two asynchronous heart beats

50
Q

What is the perinatal loss rate of MCMA twins

A

10-15%

51
Q

Incidence of conjoined twins

A

1: 90,000- 100,000

52
Q

Overall risk of congenital malformations in twins

A

600 per 10000 twin births

53
Q

What congenital anomalies are associated with monozygotic twins (3)

A
  • holoprosencephaly
  • neural tube defects
  • cloacal extrophy
54
Q

Risk of cardiac anomalies
1) MCDA
2) MCMA

A

MCDA: 7%
MCMA: 57%

55
Q

What percentage of live births are twin pregnancies

A

3%

56
Q

What percentage of twins deliver before 37 weeks

A

50%

57
Q

What percentage of twins deliver before 32 weeks

A

10%

58
Q

What is the risk of neurological abnormality in surviving twin of iufd mcda

A

26%

59
Q

What is the risk of second twin death if one twin dies in a monochorionic pregnancy

A

15%

60
Q

Incidence of conjoined twins

A

1:100,000

61
Q

What percentage of live births are twin

A

3%

62
Q

What is the associated perinatal mortality of a twin compared to singleton

A

3 times higher

63
Q

What percentage of ivf pregnancies are multiple preg

A

24%

64
Q

What percentage of twins in the uk are monochorionic

A

30%

65
Q

What percentage of live births are twins

A

3%

DM2 Prep- Obstetrics (23 decks)

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