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Y4 - GOSH > Multiple Pregnancy > Flashcards

Multiple Pregnancy Flashcards

1
Q

What is meant by multiple pregnancy?

A

a pregnancy with more than one foetus

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2
Q

What is the main factor in determing pregnancy outcome?

How is this identified?

A
  • chorionicity is the main factor influencing pregnancy outcome
  • this can be identified on US at 10-14 weeks

chorionicity = the number of placentas

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3
Q

What is the difference between a monozygotic and dizygotic pregnancy?

A

monozygotic:

  • identical twins that have come from the same zygote

dizygotic:

  • non-identical twins that have come from 2 different zygotes

dizygotic - 2 eggs are fertilised by 2 different sperm

monozygotic - the fertilised ovum splits to develop into 2 embryos

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4
Q

What is the difference between monoamniotic and diamniotic?

A

monoamniotic:

  • there is a single amniotic sac

diamniotic:

  • there are 2 separate amniotic sacs
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5
Q

What is the difference between monochorionic and dichorionic?

A

monochorionic:

  • there is a single placenta

dichorionic:

  • there are 2 separate placentas
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6
Q

What type of twin pregnancy has the best outcome?

A

diamniotic dichorionic

  • this is because each fetus has their own nutrient supply
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7
Q

What type of pregnancy is dizygotic pregnancy associated with?

A
  • this involves the fertilisation of 2 separate oocytes with 2 different sperm
  • this produces a diamniotic dichorionic pregnancy
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8
Q

In a monozygotic pregnancy, how may a diamniotic dichorionic pregnancy result?

A
  • this occurs if the zygote divides within the first 3 days of conception
  • this results in each fetus having its own placenta and own amniotic cavity
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9
Q

What is the most common outcome of monozygotic pregnancies?

How does this occur?

A

monochorionic diamniotic

  • this accounts for 70% of monozygotic pregnancies
  • there is sharing of a placenta, but each twin has its own amniotic sac

  • this occurs when the blastocyst divides between day 4 to 7 after conception
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10
Q

What are the other potential outcomes of monozygotic pregnancy and why do they occur?

A

monochorionic monoamniotic:

  • occurs when the implanted blastocyst divides between day 8 and 13

conjoined twins:

  • occurs when there is division of the formed embryonic disc after 13 days
  • in both these cases there is sharing of the placenta and amniotic sac
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11
Q

How is multiple pregnancy diagnosed?

A
  • on the booking ultrasound scan
  • US can also be used to identify the chorionicity (number of placentas) and amnionicity (number of amniotic sacs)
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12
Q

What US sign is associated with dichorionic diamniotic twins?

A

lambda / twin peak sign

  • this occurs as there is a membrane between the twins
  • separation of the chorionic + amniotic sacs resembles a lambda
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13
Q

What US sign is associated with monochorionic diamniotic twins?

A

T sign

  • there is a membrane between the twins
  • the T represents separation of the amniotic sacs
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14
Q

What are the potential risks to the mother associated with multiple pregnancy?

A
  • anaemia
  • polyhydraminos
  • hypertension / pre-eclampsia
  • malpresentation
  • spontaneous preterm birth
  • instrumental delivery / CS
  • antepartum / postpartum haemorrhage
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15
Q

What are the major risks to foetuses associated with multiple pregnancy?

A
  • miscarriage / stillbirth
  • fetal growth restriction
  • congenital abnormalities
  • twin-twin transfusion syndrome
  • twin anaemia polycythaemia sequence

structural abnormalities are 2-3x higher in monozygotic twins

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16
Q

What must the circumstances be for twin-twin transfusion syndrome to occur?

A

it only occurs in monochorionic pregnancies in which the twins share the placenta

17
Q

What happens in twin-twin transfusion syndrome?

A
  • there is a connection between the blood supplies of the 2 fetuses
  • one fetus receives the majority of the blood from the placenta and is the “recipient”
  • the other fetus is starved of blood and is the “donor”
18
Q

What are the consequences for the donor and recipient twin in TTTS?

A

donor twin:

  • growth restriction
  • anaemia
  • oligohydraminos

recipient twin:

  • polyhydraminos
  • cardiac failure
19
Q

What is the management for TTTS?

A

laser ablation

  • this may be used in severe cases to destroy the connection between the 2 blood supplies
20
Q

What is twin anaemia polycythaemia syndrome?

A
  • it is similar to TTTS, but less acute
  • one twin develops anaemia
  • the other develops polycythaemia (raised Hb)
21
Q

What additional blood tests are required in multiple pregnancy?

A
  • additional monitoring for anaemia is required
  • FBC is performed at booking clinic
  • and at 20 weeks and 28 weeks gestation
22
Q

What additional US scans are needed in multiple pregnancy?

A

monochorionic twins:

  • US scans every 2 weeks from 16 weeks gestation

dichorionic twins:

  • US scans every 4 weeks from 20 weeks gestation
23
Q

Why are additional US scans required in multiple pregnancy?

A

to assess for evidence of:

  • fetal growth restriction
  • unequal growth
  • twin-twin transfusion syndrome
24
Q

What other additional tests are offered to women with multiple pregnancy?

A

regular BP measurements and urine dips to check for pre-eclampsia

25
Q

What additional medication is offered in multiple pregnancy?

A
  • folic acid 5mg to reduce the risk of congenital abnormalities
  • aspirin 75mg as prophylaxis against pre-eclampsia
  • oral iron to prevent anaemia
26
Q

When is planned birth offered for DCDA twins?

A

between 37 and 37+6 weeks gestation

27
Q

When is planned birth offered for MCDA twins?

A

between 36 and 36+6 weeks gestation

28
Q

When is planned birth offered for MCMA twins?

A

between 32 and 33+6 weeks gestation by planned caesarean-section

29
Q

What are the delivery options for multiple pregnancies?

A
  • if the presenting twin is cephalic, vaginal delivery is recommended
  • if the presenting twin is breech / transverse lie, C-section is performed
30
Q

Why is planned delivery performed in multiple pregnancy?

What additional medication may be required?

A
  • waiting beyond the recommended dates is associated with increased risk of fetal death
  • corticosteroids are given prior to delivery to mature the fetal lungs

Y4 - GOSH (62 decks)

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