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Module 203, Theme 2- Reproductive System, Fetal Development, Pregnancy and Birth > T2 L15 Multiple Pregnancies > Flashcards

T2 L15 Multiple Pregnancies Flashcards

1
Q

What is the incidence of twin births (per 1000 deliveries) in the following regions:

1) Far East
2) Europe
3) Nigeria

A

1) Far East = 2-7
2) Europe = 9-20
3) Nigeria = 20-45

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2
Q

Why was there a big increased in multiple births between 1986 and 1998?

A

More embryos were being put back in IVF treatment.

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3
Q

What factors contribute to increased likelihood of a multiple pregnancy? (aetiology)

A
  • Ethnicity
  • Increasing maternal age
  • Increasing parity
  • Family history
  • Fertility treatment

NOTE: All these are factors for ‘super ovulation’

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4
Q

What is a monozygous twin pregnancy?

A

1 fertilised egg further divides to form identical embryos

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5
Q

What fraction of twin pregnancies are monozygous?

A

1/3

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6
Q

What is a dizygous twin pregnancy?

A

2 eggs fertilised by 2 sperms to form non-identical embryos

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7
Q

What fraction of twin pregnancies are dizygous?

A

2/3

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8
Q

Why type of pregnancy are dizygous twins?

A

Diaminotic

Dichorionic / two placentae

a.k.a DCDA

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9
Q

Why type of pregnancy are monozygous twins if splitting occurs at the two cell stage?

A

Dichorionic / two placentae

Diamniotic

a.k.a DCDA

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10
Q

Why type of pregnancy are monozygous twins if splitting occurs at the early blastocyst level (with 2 inner cell mass)?

A

Monochorionic / “joined” or same placentae

Diamniotic

a.k.a MCDA

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11
Q

How many days after fertilisation does the blastocyst form?

A

4 days

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12
Q

Why type of pregnancy are monozygous twins if splitting occurs when there is one inner cell mass?

A

Monochorionic / “joined” or same placentae

Monoamniotic

a.k.a MCMA

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13
Q

How are twin pregnancies diagnosed?

A

Uterine size

Up to 50% at delivery worldwide

Ultrasound

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14
Q

What is the lambda plate / sign?

A

The area where the two chorions meet. It strongly suggests a dichorionic twin pregnancy

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15
Q

COMPLETE THE SENTENCE

All ______ are dichorionic

A

Dizygous twins

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16
Q

COMPLETE THE SENTENCE

All dichorionic twins are __________

A

Diamniotic

17
Q

Describe the circulation in dichorionic pregnancies?

A

The circulation is separate, due to separate placantae and chorions

18
Q

What ratio of monozygous twins are dichorionic?

A

1 : 3

19
Q

Describe monochorionic pregnancies

A

Monozygous twins may be monochorionic (2/3) or dichorionic

MC have vascularly joined placentae

MC twins have 3x increased loss rate

MC twins usually diamniotic, but the membrane dividing the twins is usually very thin

20
Q

What are the complications of a multiple pregnancy?

A

“Everything except post-dates”

  • Symptoms of pregnancy
  • Anaemia
  • Hypertension
  • Intrauterine growth restriction
  • Pre-term labour
  • Delivery problems
  • Perinatal mortality
21
Q

What are the different mortality types in twin pregnancies?

A

Stillbirth (SB) – after 24 weeks (dies utero)

Early neonatal – first 7 days

Neonatal – in first 28 days

Perinatal – SB + early neonatal

Infant – first year

Rates are per 1000 births

22
Q

Compare the risk of different mortality types in a singleton pregnancy with a twin pregnancy

A

Mortality rates for all types increases in a twin pregnancy compared with a singleton pregnancy

23
Q

Compare the risk of different mortality types in a twin pregnancy with a triplet pregnancy

A

Mortality rates for all types increases in a triplet pregnancy compared with a twin pregnancy

24
Q

Describe the 1st trimester management in twin pregnancies

A

Discuss screening for chromosomal anomalies

Determine chorionicity

Discuss fetal reduction if triplets or more

25
Q

Describe the 2nd trimester management in twin pregnancies

A

Detection of fetal abnormality

Serial scans for growth for all
-DC monthly from 24 weeks

Serial scans for TTTS if MC twins
-2 weekly 16-28 weeks then monthly

Maternal complications

26
Q

What risks are increased in monochorionic twins?

A

More fetal malformation

More fetal growth restriction

Twin to twin transfusion

27
Q

What is unidirectional A-V shunt in twin to twin transfusion?

A

Blood is shunted from the umbilical artery to the umbilical vein

28
Q

What is result of unidirectional A-V shunt in twin to twin transfusion?

A

Unbalanced placental vascular anastamoses

The baby that is getting too little blood (donor) fails to thrive and is smaller

The baby that gets too much (the recipient) can go into cardiac failure and has a higher mortality rate

29
Q

How is a unidirectional A-V shunt treated)

A

Laser treatment or amnio-reduction

Early delivery by caesarean

30
Q

Describe the 3rd trimester management in twin pregnancies

A

Scanning as in 2nd trimester

Monitor blood pressure (of mother)

Pre-term labour

Delivery planning

31
Q

At what week of gestation are dichorionic twins delivered? What method of delivery is used?

A

37-38 weeks

Vaginal or caesarean

NOTE: If the first baby is not head down, then a caesarean section is carried out. The mode of delivery is dependent on the first baby.

32
Q

At what week of gestation are monochorionic twins delivered? What method of delivery is used?

A

36-37 weeks

Caesarean

33
Q

Describe the labour management in twin pregnancies

A

Monitoring both twins

Problems delivering twin II (twin II often does slightly worse than twin I and are often at more risk)

Risk of postpartum bleed

NOTE: Twin I and twin II are determined by the position of their placenta in the womb

34
Q

What is puerperium?

A

The period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition.

35
Q

What problems are encountered during puerperium by the mother? How can she be supported?

A

Feeding difficulties

Emotional & social support

36
Q

Describe the factors of high order multiple pregnancies (i.e. three or more foetuses)?

A

DURING PREGNANCY

  • Determine chorionicity
  • Consider fetal reduction

DURING AND AFTER DELIVERY

  • High risk of preterm labour
  • Deliver preterm by caesarean
  • Postpartum haemorrhage
  • Difficult puerperium & after

Module 203, Theme 2- Reproductive System, Fetal Development, Pregnancy and Birth (17 decks)

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