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Obstetrics > Multiple pregnancy > Flashcards

Multiple pregnancy Flashcards

1
Q

What are dizygotic twins?

A

non-identical

develop from two separate ova fertilised at the same time

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2
Q

What are monozygotic twins>?

A

identical, develop from single ovum which has divided to form two embryos

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3
Q

What is the most common twin type

A

dizygotic

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4
Q

What is monoamniotic?

A

share same amniotic sac

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5
Q

what is monochorionic

A

share same placenta

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6
Q

what are predisposing factors to multiple pregnancy?

A
  • Prev. twins
  • FHx (dizygotic only)
  • maternal age
  • Induced ovulation + IVF
  • Race (Nigerian Yoruba and Japanese)
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7
Q

What are features of multiple pregnancy (early + late)

A

early - uterus large for date, hyperemesis

later - polyhydramnios

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8
Q

What are signs of multiple pregnancy

A

⎫ >2 fetal poles felt
⎫ Multiple fetal parts felt
⎫ 2 fetal heart rates

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9
Q

How and when is the type of multiple pregnancy usually diagnosed?

A

US at 11-13+6 weeks

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10
Q

what sign indicates dichorionic twins

A

lambda sign

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11
Q

What are complications of multiple pregnancy

A 
→	Polyhydramnios
→	Pre-eclampsia
→	Anaemia
→	APH (both abruption and praevia)
→	Gestational DM
→	Operative delivery
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12
Q

What are complications of multiple pregnancy to the fetus

A
  1. prematurity
  2. IUGR
  3. malformation
  4. twin-twin Transfusion syndrome
  5. fetus papyraceous
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13
Q

What is the mean gestation of twins

A

37w

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14
Q

what is the mean gestation of triplets

A

33w

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15
Q

What is twin to twin transfusion syndrome

A

monochorionic, disparate twin size w one twin acting as ‘donor’ and other as ‘recipient’ due to placental vascular anastomoses, these can be ablated by laser coagulation in utero

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16
Q

What is fetus papyraceous

A

fetus dying in utero shrinks and mummifies, delivers prematurely

17
Q

What are the complications of labour due to multiple pregnancy

A 
PPH
Malpresentation
Vasa praevia rupture
cord prolapse
placental abruption 
cord entanglement
18
Q

What is the management of multiple pregnancy

A

US 11-13+6 for viability, chorionicity nuchal translucency, malformation
US monthly from 20w

19
Q

How often should monochorionic twins be monitored>?

A

every 2 weeks

20
Q

When is elective birth for
uncomplicated triplets
uncomplicated monochorionic twins
uncomplicated dichorionic twins

A

37+0 if uncomplicated dichorionic twins
36+0 if uncomplicated monochorionic twins
35+0 if uncomplicated triplets

21
Q

What are features suggesting twin to twin transfusion syndrome

A

− Membrane folding

− Discordant growth >25%

22
Q

what are the two most common malpresentation in twins

A

cephalic: cephalic
cephalic: breach

Obstetrics (30 decks)

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