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My MRCOG Part 2 > Multiple Pregnancy (NICE +GTG) > Flashcards

Multiple Pregnancy (NICE +GTG) Flashcards

1
Q

How long should scan appointments be for multiples?

A

45 mins for anomaly scan.
30 mins for growth scans.

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2
Q

If a woman presents after 14/40, how should chronicity be determined?

A
  1. Number of placental masses.
  2. Membranes and the thickness.
  3. Labmda/T sign.
  4. Discordant foetal sex.
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3
Q

If chronicity cannot be determined, how should the pregnancy be treated?

A

As mono-chorionic.

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4
Q

When estimating gestational age, should the larger or smaller twin be used? Why?

A

The larger twin should be used to determine gestational age to avoid over-estimating FGR.

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5
Q

How is chronicity assessed?

A
  1. No. placental masses.
  2. Presence of amniotic membranes and thickness

(T and Lambda sign)

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6
Q

How should 3D scans be used to determine chronicity?

A

3D scans should not be used to assess chronicity.

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7
Q

When should an additional FBC be carried out in multiple pregnancy and why?

A

20-24/40
To detect early anaemia.

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8
Q

In Monochorionic twins, when should US assessment be carried out?

A

11-14/40 dating and chronicity.
18-22/40 anomaly and growth.
2 weekly growth scans after anomaly US (i.e. from 22/40).

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9
Q

When should uncomplicated DCDA twins aim to be delivered?

A

37/40

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10
Q

When should uncomplicated MCDA twins be delivered?

A

36/40

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11
Q

When should uncomplicated TCTA triplets aim to be delivered?

A

35/40

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12
Q

When should uncomplicated DCTA / MCTA triplets be delivered?

A

35/40

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13
Q

Can FASP be offered in twin pregnancies?

A

Yes.

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14
Q

Can FASP be offered in triplet pregnancies?

A

Yes, but:
- greater chance of trisomy in triplets.
- increased false positive rate of FASP.

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15
Q

Can foetal fibronectin be used to assess risk of pre-term labour in multiple pregnancies?

A

Foetal fibronectin should not be used alone.

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16
Q

Is discordance in NT or CRL in first trimestser an accurate predictor of 2nd and 3rd trimester discordance?

A

No.

17
Q

When can US for FGR and feto-feoetal transfusion syndrome be used in DCDA twins?

A

2nd and 3rd trimester.
(I.e. not in 1st trimester).

18
Q

How often should uncomplicated DCDA twins have a growth scan?

A

4 weekly from 24 weeks.

19
Q

How is EFW Discordance calculated?

A

((EFW largest - EFW smallest)/(EFW largest)) *100

20
Q

At what EFW discordance be referred to a tertiary unit?

A

Discordance 25% or more
AND one EFW 10th centile or less.

21
Q

What 3 conditions should be screen for at every US in monochorionic twins?

A
  1. Feto-feotal transfusion syndrome.
  2. FGR.
  3. TAPS (twin anaemia polycythaemia sequence).
22
Q

How is feto-foetal transfusion syndrome identified?
What is the ongoing monitoring?

A

One baby has DVP <2cm and the other baby has DVP >8cm (before 20/40) or >10cm (after 20/40).

increase to weekly US if either DVP is >4cm.

All mono twins should have US every 2 weeks from 16/40.

23
Q

What is twin anaemia polycythemia sequence?

A

A form of TTTS that can complicate mono pregnancies.

Unequal blood counts between babies.

Caused by a few small AV anastomoses in the placenta.

Causes recipient twin becoming polycythemic and donor becoming anaemic.

24
Q

What is seen in the amniotic fluid levels between babies suffering with TAPS?

A

Amniotic fluid levels are equal.

25
Q

How is TAPS staged?

A

Leiden Staging System (includes maximum blood flow speed through MCA).

26
Q

Is the routine use of vaginal progesterone recommended to prevent preterm birth in multiple pregnancies?

A

No, there are no recommendations about vaginal progesterone as routine use in preventing preterm birth in multiples.

27
Q

What is the rate of spontaneous delivery in twins <37/40?

A

60%

28
Q

From what gestation is there an increased risk of foetal death in DCDA twins?

A

From 38/40
(therefore deliver from 37/40)

29
Q

From what gestation is there an increased risk of foetal death in MCDA twins?

A

37/40

(therefore deliver from 36/40)

30
Q

From what gestation is there an increased risk of foetal death in MCMA twins?

A

34/40

(Therefore deliver 32-33+6)

31
Q

From what gestation is there an increased risk of foetal death in triplet pregnancies?

A

36/40

Therefore deliver at 35/40

32
Q

What is the rate of spontaneous delivery before 35/40 in triplet pregnancies?

A

75% before 35/40

33
Q

What is vaginal delivery safe for multiples?

A

DCDA twins: >32/40, if no obstetric CI, cephalic first twin and no significant size discordance.

Offer LSCS to MCDA and MCMA unless the head is on the perineum.

34
Q

What is the risk of requiring LSCS for the second twin after a vaginal delivery of the first twin?

A

10%

35
Q

From what gestation can FSE be appled?

A

34/40

36
Q

Can physiological management of the third stage of labour be offered after vaginal twin delivery?

A

NO! Therefore discuss active management early in pregnancy.

My MRCOG Part 2 (37 decks)

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