Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CP2 OBS > Multiple Pregnancy > Flashcards

Multiple Pregnancy Flashcards

1
Q

In how many pregnancies do twins occur?

A

1 in 80

considerable geographic variation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why are the incidence of twins increasing?

A

because of sub fertility treatment and the increasing number of older mothers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two kinds of twins?

A

Dizygotic twins

Monozygotic twins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the cause of dizygotic twins?

A

fertilisation of different oocytes by different sperm - such foetuses may be of different sex and are no more genetically similar than siblings from different pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the cause of monozygotic twins?

A

Result from mitotic division of a single zygote into ‘identical twins’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which type of twins have the best outcome?

A

the best outcomes are with diamniotic, dichorionic twin pregnancies, as each fetus has their own nutrient supply.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the factors that cause twins?

A

assisted conception
genetic factors
increasing maternal age
parity

IVF conceptions / clomiphene-assisted conceptions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the effects of twins In early/late pregnancy?

A

Vomiting more marked

larger uterus than expected for the dates and palpable <12 weeks

later in pregnancy, there will be three of more foetal poles - but most are diagnosed only at USS
Dichorionic diamniotic - a lambda sign or twin peak sign
Monochorionic diamniotic: T sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the maternal complications of multiple pregnancy?

A 
Anaemia
Polyhydramnios
Hypertension
Malpresentation
Spontaneous preterm birth
Instrumental delivery or caesarean
Postpartum haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the foetal antenatal complications of multiple pregnancies?

A 
Miscarriage
Stillbirth
Fetal growth restriction
Prematurity
Twin-twin transfusion syndrome
Twin anaemia polycythaemia sequence
Congenital abnormalities

IUGR - more common

Congenital abnormalities - not more common per baby in dichorionic - but they are monochorionic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the major risk factors for complications in all multiple pregnancies?

A

Preterm delivery - main cause of perinatal mortality
IUGR - much more common
Monochrorionicity

Miscarriage - one of a twin pregnancy can ‘vanish’ where there is a 1st trimester death - late miscarriage is also more common, particularly in MC twins

congenital abnormalities - not more common per baby in dichorionic, bu they are in monochorionic pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the cause of monochorionic pregnancy?

A

shared blood supply in the single placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the cause of Twin-twin transfusion syndrome?

A

occurs when the fetuses share a placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the effects of TTTS?

A

One fetus (the recipient) may receive the majority of the blood from the placenta, while the other fetus (the donor) is starved of blood. The recipient gets the majority of the blood, and can become fluid overloaded, with heart failure and polyhydramnios. The donor has growth restriction, anaemia and oligohydramnios. There will be a discrepancy between the size of the fetuses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is TTTS staged?

A

Staged according to Quintero in stages 1-5

both twins are at very high risk of in utero death or severely preterm delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is twin anaemia polycythaemia sequence?

A

Twin anaemia polycythaemia sequence is similar to twin-twin transfusion syndrome, but less acute. One twin becomes anaemic whilst the other develops polycythaemia (raised haemoglobin).

can follow incomplete laser ablation for TTTS

17
Q

What is twin revered arterial perfusion?

A

Rare abnormality of MC twins - an abnormal, often cardiac foetus is perfused by a normal ‘pump’ twin - therefore is at risk of cardiac failure

18
Q

In what kind of twins is IUGR more common?

A

MC twins in the absence of clear blood volume discordancy

particular problem - umbilical artery waveform of the smaller twin = erratic

which may be the result of the superior artery-artery anastomoses. sudden in utero death occurs in up to 20% and handicap in 8%

19
Q

What is the result of co twin death?

A

If one of an MC twin pair dies due to TTTS or any other causes, the drop in its blood pressure allows acute transfusion of blood from the other twin

this rapidly leads to hypovolaemia and in 30% cases, death or neurological damage

20
Q

What is the common complication of mono amniotic twins?

A

The cords are always entangled

in utero demise is common, probably because of this and/or sudden acute shunting of blood between the two babies anastomoses between the close cord insertions

21
Q

What are the common complications of multiple birth intrapartum?

A

Malpresentation - one of the 1st twins occurs in 20% and this is an indication for C-section

Foetal distress - common in labour. the 2nd twin has an increased risk of death after the first has been delivered because of hypoxia, cord prolapse, tetanic uterine contractions or placental abruption - may present as breech

PPH - more common

22
Q

Wha is the antepartum management of all multiples?

A

additional monitoring for anaemia, with a full blood count at:
Booking clinic
20 weeks gestation
28 weeks gestation

Additional USS:
2 weekly scans from 16 weeks for monochorionic twins
4 weekly scans from 20 weeks for dichorionic twins

Planned birth is offered between:
32 and 33 + 6 weeks for uncomplicated monochorionic monoamniotic twins
36 and 36 + 6 weeks for uncomplicated monochorionic diamniotic twins
37 and 37 + 6 weeks for uncomplicated dichorionic diamniotic twins
Before 35 + 6 weeks for triplets

Delivery at 37 weeks for DC and 36 for uncomplicated MC twins

23
Q

How can women with multiple pregnancy deliver?

A

Vaginal delivery is possible when the first baby has a cephalic presentation (head first)
Caesarean section may be required for the second baby after successful birth of the first baby
Elective caesarean is advised when the presenting twin is not cephalic presentation

24
Q

What is the management of monochorionic twins?

A

USS surveillance for MC twins starts by 12 weeks - USS is advised every 2 weeks until 24 weeks and ever 2-3 weeks after that

25
Q

How is diagnosis TTTS in monochorionic twins done?

A

Commonly diagnosed between 16-24 weeks

Growth and liquor volume discordances with polyhydramnios are evident

26
Q

What is the management of TTTS in monochorionic twins?

A

laser ablation of the entire placental interface in a foetal medicine centre, using USS and fetoscopy.

27
Q

What are the outcomes/effects of laser ablation for TTTS in monochorionic twins?

A

even with optimal treatment, survival of both twins is 50%, one twin is 80%

10% survivors have neurological disability.

IUGR is managed by careful surveillance and iatrogenic preterm delivery - occasionally laser ablation or umbilical cord occlusion are appropriate if at ‘pre-viable gestations

28
Q

What is the management of high order multiple pregnancy?

A

Selective reduction to a twin pregnancy should be discussed with women with triplets or higher order pregnancies.

Slightly increases early miscarriage rates, reduces the chances of preterm brith and therefore cerebral palsy. Safest before 14 weeks.

Surveillance according to the chronicity - delivery by 36 weeks is usually advised

29
Q

What is the management of foetal abnormality?

A

Before 14 weeks - intracardiac injection of KCL can be used in DC twins. Can be offered up to 32 weeks if late termination of pregnancy is legal

In MC twins - cord must be occluded using bipolar diathermy or its insertion ablated as the circulation is shared

30
Q

Key counselling points for twins?

A
  1. Antenatal care: more checks for anaemia and increased number of scans
  2. Complications
  3. Delivery:
    PLANNED DELIVERY around 36 weeks
    if first twin = cephalic then can do vaginal delivery
    If first twin is breech - C-section

May need to do a C section after the delivery of the first twin anyway

31
Q

What is the method of delivery in multiple pregnancy?

A

Induction - usually at 37 weeks (DC twins) or 36 weeks (MC twins)

after which time perinatal mortality is increased

CTG monitoring is advised - risk of intrapartum hypoxia is increased, particularly in 2nd twin

epidural - not mandatory, but helpful if difficulty is encountered with the 2nd twin

Oxytocin if contractions diminish

Avoid excessive delay/haste between twins

After delivery - prophylactic oxytocin infusion is used to prevent postpartum haemorrhage

CP2 OBS (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions