Multiple Pregnancy Flashcards

1
Q

What is the incidence of twins?

A

1/105

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2
Q

What is the incidence of triplets?

A

1/10,000

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3
Q

What does dizygotic mean?

A

Non identical

Develop from 2 separate ova that were fertilised at the same time

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4
Q

What monozygotic twins mean?

A

Identical twins

Develop from a single ovum which has divided to form 2 embryos

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5
Q

Is dizygotic or monozygotic more common?

A

80 = dizygotic

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6
Q

What are monoamniotic twins?

A

Twins that share the same amniotic sac
Always identical
Always monochorionic - share the same placenta, but have 2 separate umbilical cords

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7
Q

Monoamniotic monozygotic twins are associated with…

A

Increased spontaneous miscarriage, perinatal mortality rate
Increased malformations, IUGR, prematurity
Twin to twin transfusions

The more the twins share, the higher the risk

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8
Q

The incidence of dizygotic twins is increasing, mainly due to…

A

Infertility treatment

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9
Q

What predisposing factors are there for twins?

A
Previous twins
FH of twins (dizygotic only)
Increased maternal age 
Induced ovulation and IVF 
Race - Afro Caribbean especially Nigerian Yoruba women 
Multigravida
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10
Q

What pregnancy features are associated with twins?

A

Early features:
Uterus large for dates
Hyperemesis
Later there may be polyhydramnios

Signs: > 2 poles felt, multiplicity of fetal parts felt, 2 fetal heart rates heard (reliable if rates differ by > 10 beats/min)
US confirms diagnosis

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11
Q

What antenatal complications can occur?

A

Polyhydramnios
Pregnancy induced HTN, pre-eclampsia more common
Anaemia commoner - increased iron and folate requirements
Antepartum haemorrhage incidence rises - from both abruption and placenta praevia (large placenta)
Gestational diabetes

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12
Q

What fetal complications can occur?

A

Perinatal mortality 5x higher than singleton
Prematurity = main problem - 60% before 37w
Growth restriction
Malformation rates higher, especially monozygotic

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13
Q

What is the mean gestation for twins?

A

37 w

For triplets: 33w

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14
Q

What complications can occur in labour?

A

PPH increased
Malpresentation is common
Cord prolapse
Uterus has more to contract, so increased risk of atony

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15
Q

How is it managed?

A

US at 11-14 weeks for viability, chorionicity, amnioticity, nuchal translucency, malformations

DCDA -dating scan every 4 weeks from 24-26
MCDA -dating scan every 2 weeks from 16-34

Check FBC at 20-24w
Give aspirin >12w if other risks for pre-eclampsia
More antenatal visits - weekly from 30w
Offer elective at 37w for uncomplicated dichorionic twins, 36w plus steroids for uncomplicated monochorionic twins
(Most women spontaneously deliver before these dates)

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16
Q

What precautions at labour should be made?

A

2 obstetricians present
IV access
Anaesthetist available are delivery
Paediatricians one per baby at delivery in case resuscitation needed - 2nd twin has higher chance of asphyxia

17
Q

What is twin to twin transfusion syndrome?

A

It can effect monochorionic identical multiples
Abnormal blood connections form in the placenta and allow blood to flow unevenly between babies
One twin called the donor, becomes dehydrated and the other, called the recipient, develops high BP and produces too much urine

18
Q

Multiple pregnancies in the same sac are managed…

A

By consultants at tertiary centres - very high risk

19
Q

Is screening for genetic conditions more or less reliable in multiple pregnancy?

A

Less reliable as HCG and AFP raised anyway

20
Q

Vaginal or elective CS is fine for both DCDA or MCDA twins, but what is advised for MCMA?

A

Advise CS - increased risk of TTTS especially at time of delivery

21
Q

Why is epidural recommended?

A

Stabilising second twin can be painful