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Reproductive > Multiple pregnancy & problems > Flashcards

Multiple pregnancy & problems Flashcards

1
Q

What is the natural rate for twinning?

A

1:90

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2
Q

Why is there an increased incidence in twinning?

A

Assisted reproductive techniques and ovulation induction

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3
Q

What does the incidence of dizygotic twins increase with?

A

Age, parity, weight, height, familial

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4
Q

When do you suspect multiple pregnancy?

A 
Large for date uterine size
Multiple fetal heart rates detected
Multiple fetal parts felt
HCG + maternal serum AFP elevated for gestational age
Pregnancy with ART
Confirmed with USS
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5
Q

What is monozygotic?

A

Twins derived from single ovum - so identical

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6
Q

What is dizygotic?

A

Twins derived from two separate ova - not identical

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7
Q

What is diamniotic?

A

Has its own amniotic sac

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8
Q

What is dichorionic?

A

Has own chorionic sac

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9
Q

What is a dichorionic, diamniotic pregnancy?

A

Where each twin has its own chorionic and amniotic sacs - most twins

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10
Q

What does monozygotic depend on?

A

Cleavage of single fertilized ova

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11
Q

What does placentation of monozygotic twins depend on?

A

Timing of cleavage determines placentation

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12
Q

What is the timing of cleavage for monzygotix dichorionic/diamniotic twins?

A

Cleavage in first 3 days after fertilisation

Each fetus has own placenta

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13
Q

Which type of placentation has lowest mortality rate of monozygotic twins?

A

Dichorionic/diamniotic

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14
Q

What is the timing of cleavage for monozygotic monochorionic/diamniotic twins?

A

Cleavage between day 4 and 8 after fertilisation

Share single placenta but seperate amniotic sac

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15
Q

What is the timing of cleavage for monozygotic monochorionic/monoamniotic twins?

A

Cleavage after the 8th day of fertilisation

Share single placenta and single sac

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16
Q

What day does cleavage happen in conjoined twins?

A

Cleavage after day 12

17
Q

What is the most common way of conjoined twins being joined?

A

Chest and/or abdomen

18
Q

What are complications of multiple pregnancy?

A 
High perinatal mortality and morbidity
Abortion
Nausea & vomiting
Preterm labour
IUGR
Pre-eclampsia
Polyhydramnious
Congenital anomalies
PPH
Placental abruption
Placenta praevia
Discordant twin growth
Malpresentation, cord prolapse, operation delivery
19
Q

What are some causes of perinatal mortality and morbidity?

A 
Prematurity
Birth trauma
Cerebral haemorrhage
Birth asphyxia
Congenital anomalies
Still birth
20
Q

What is a twin-twin transfusion (TTN)?

A

One fetus donates blood to the other due to vascular anastomosis

21
Q

What will happen to the recipient twin in TTN?

A

Heart failure, polyhydramnious and hydrops

22
Q

What will happen to the donor twin in TTN?

A

IUGR and oligohydramnios

23
Q

What is hydrops?

A

Hydropsfetalis, orhydrops, is a condition that occurs when large amounts of fluid build up in a baby’s tissues and organs causing extreme swelling

24
Q

What is the management for TTN?

A

Amnio-reduction of recipient twin
Intra-uterine blood transfusion for the donor twin
Selective fetal reduction
Fetoscopic laser ablation of placental anastomosis

25
Q

What is the antenatal management of multiple pregnancy?

A

Adequate nutrition
Prevent anaemia
More frequent antenatal visits
USS: assess chorionicity, nuchal translucency, fetal growth, fetal wellbeing
Multifetal reduction offered
Preterm labour risk: serial cervical length assessment, steroids for fetal lung maturation

26
Q

What is the twin peak sign characteristic of on USS?

A

Dichorionic twins

27
Q

What is the T sign characteristic of on USS?

A

Monochorionic twin

28
Q

What is management of labour in multiple pregnancy?

A 
First fetus cephalic - normal delivery
Non vertex first - C-section
Locked twins (breech-vertex) - C-section
29
Q

What is the average pregnancy length for twins?

A

36-37wks

30
Q

What is the average birth weight for twins?

A

2.5kg

31
Q

What are some complications of multiple pregnancy?

A 
Clubfoot
Cleft lip/palate
TTS
Fetal growth problems
Preterm labour

Reproductive (20 decks)

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