Multiple Pregnancy Flashcards

1
Q

What is the incidence of multiple pregnancy?

A
  • overall - twins 1-90 pregnancies
    - triplets 1-8100 pregnancies
  • more common in women of African origin
  • less common in Asian women
  • recent OCP discontinuation
  • assisted conception
  • DZ twins more common in older mothers, increased parity, maternal family history
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2
Q

What are dizygotic twins?

A
  • non-identical
  • each twin is a separate individual with its own placenta, amnion and chorion
  • from two separate fertilized eggs
  • fraternal twins (essentially just siblings)
  • DCDA (dichorionic diamniotic)- fused or separate placenta
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3
Q

What are monozygotic twins?

A
  • identical
  • occurs in roughly 1/3 of all pregnancies
  • around 1% of these are conjoined
  • connection between fetal circulations via the placenta
  • same genes, blood group and physical features
  • may be separated by chorion
  • 3 kinds of MZ twins dependent on when divide occurs
  • DCDA, DCMA, MCMA
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4
Q

What are monchorionic monoamniotic MCMA?

A
  • risks are conjoined risks
  • arcadiac twin, twin reversal arterial perfusion syndrome
  • TTTS - begins with renal system, ends with haemodynamic alteration
  • IUGR - usually in 1 twin
  • cord entanglement
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5
Q

What are some of the maternal complications that may occur?

A
  • exacerbation of minor disorders
  • anaemia
  • PIH
  • APH
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6
Q

What are some of the fetal problems that may occur?

A
  • fetal malpresentation
  • locked twins
  • cord problems - prolapse, velamentous insertion, vasa praevia, entanglement
  • preterm labour
  • mode of delivery
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7
Q

How would birth be managed?

A
  • likely to labour early
  • ?IOL
  • if 1st twin cephalic vaginal birth encouraged
  • CTG monitoring
  • mobilisation encouraged
  • may require epidural analgesia in case of manipulation of 2nd twin
  • poor uterine action - consider oxytocics
  • may be preterm
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