Multiple pregnancy Flashcards
What is the definition of a multiple pregnancy?
A pregnancy that involves the presences of two or more fetuses
What are the incidences of Multiple pregnancies?
twins is 1 in 90 pregnancies
Triplets are 1 in 8,100 pregnancies
multiple pregnancy accounts for 3% of live births
What are women with multiple pregnancy at an increased risk of?
Anaemia •Pre eclampsia / PIH •Gestational Diabetes •Prematurity •Placental Insufficiency •Placenta praevia •PPH •Trauma associated with fetal manipulation
What is the role of the midwife and the obstetric team?
./, Provide guidance regarding expected pregnancy
•Discuss physical and emotional changes
•Describe measures to alleviate backache, round ligament pain, leg ache or oedema, breathlessness, constipation
•Encourage attendance at TAMBA meetings, local twins club, bespoke parentcraft classes for parents expecting multiples
What is Dizygotic twinning
dizygotic multiple pregnancies, each fetus has its own placenta (either separate or fused), amnion and chorion.
What is Monozygotic twinning
The situation is more complex depending on the timing of the division of the ovum:
–embryo splits at 3 days - two chorions, two amnions
–embryo splits at 4-7 days - single placenta, one chorion, two amnions
–embryo splits at 8-12 days - single placenta, one chorion and one amnion (rare)
–embryo splits at 13 days - conjoined or Siamese twins (very rare)
What can happen in monochorionic twinning
–one twin can receive a reduced blood supply and have a slower growth rate (twin-twin transfusion).
–Sometimes, one fetus dies and forms a mummified fetus papyraceous or is reabsorbe
‘Monozygotic is Non-identical’
true or false?
False
‘Dizygotic is Non-identical’
true or false?
True
What does super-fecundation mean?
Twins resulting from two coital acts in the same menstrual cycle
What does Superfetation mean?
Twins resulting from two coital acts in different cycle
What steps would take in Initial diagnosis of twins?
- News should be given sensitively;
- Avoid any delay in interpreting an US Scan;
- Explain ‘vanishing twin syndrome’ (20% of early twin pregnancies);
- Provide information re local and national support organization
As a midwife, what should be your key priorities of childbirth
–Antenatal and postnatal mental health and wellbeing
–Antenatal nutrition
–The risks, symptoms and signs of preterm labour and the potential need for corticosteroids for fetal lung maturation
–Likely timing and possible modes of delivery
–Breastfeeding
–Parenting
What would your provide within antenatal care as a midwife?
Glucose Tolerance Test (GTT) at 28 weeks (ALL)
•Regular BP monitoring and urinalysis
•Antenatal steroids should be considered in all cases if other risk factors for a preterm pregnancy occur
•Routine cervical cerclage / oral tocolytics / bed rest / progesterone should not be used to prevent preterm labour
•Labour and Mode of Delivery Discussed
What are the indications for referral to a FMC
Seek a consultant opinion:
–Monochorionic monoamniotic twin pregnancies
–Monochorionic monoamniotic triplet pregnancies
–Monochorionic diamniotic triplet pregnancies
–Pregnancies complicated by any of the following •Poor fetal growth •Fetal anomaly •Discordant fetal death •Feto-fetal transfusion syndrome
If twins had congenital anomalies what would u explain to the parents ?
The nature of the anomaly; –Implications for pregnancy; –Implications for the child in the long and short term; –Options available; –Implications for future pregnancies
What can Twin-Twin Transfusion cause for the recipient?
polyycythemia, circulatory overload, polyhydramnios (recipient)
What can Twin-Twin Transfusion cause for the Donor?
Anemia, oedema, growth retardation, oligohydramnios (donor)
What would u be looking for an abdominal examination
•On Inspection Size of uterus larger than per weeks – after 20/40Multiplicity of movements –Broad uterus –Polyhydramnios –Excess Striae Gravidarum
•On Palpation –Fundus larger than dates –Two fetal poles •Auscultation –Simultaneous auscultation – Difference of 10 beats
What is the optimal timing of birth for uncomplicated diamonitic twins?
37-38weeks
What is the optimal timing of birth for Monochorionic twins?
should have timing of birth discussed and be offered elective delivery from 36/40 with the administration of antenatal steroids, unless there is an indication to deliver early
What is the optimal timing of birth for monochorionic diamniotic (MCDA) twins
appropriate to aim for a vaginal birth.
What are the incidences of presentation of twins?
Both Vertex 50%
One vertex, one breech 40%
Both Breech 8%
Others 2%
What 4 main things would u need to Labour and delivery
–The obstetric registrar on-call is responsible for the management of labour and birth
–Paediatrician
–Two resuscitaires
–US machine outside of room
If both babies vertex what would u do?
aim for a vaginal delivery
If first baby vertex and second baby breech or transverse what would you do?
vaginal delivery attempted with an external or internal version of Twin 2 (Use of Syntocinon)
If both twins breech
what would u do?
recommend C-section
What are the 11 things you would consider during Labour and delivery?
•Premature Rupture of Membranes •Prolapsed Cord •Delay in Birth of Second Twin •Prevention of Asphyxia •Premature Separation of the placenta •Sepsis •Premature Expulsion of the Placenta •PPH •If relevant Check Premature Delivery Policy –Group B Strep Prophylactic antibiotics –Magnesium Sulphate to prevent cerebral palsy should be considered
What are the 11 things you would advice parents on?
- Written information re support (TAMBA, MBF)
- Topics for Classes
- Facts and figures
- Prenatal complications
- Labour and delivery
- Possible preterm birth (Visit to NNU)
- Feeding
- Zygosity
- Prams, car seats etc
- Coping with twins
- Developing individuality
