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MRCOG Antenatal Part 2 Revision - Hay > Twin and Triplet pregnancy NICE > Flashcards

Twin and Triplet pregnancy NICE Flashcards

1
Q

When determining GA, which baby size to use?

A

Use the largest baby

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2
Q

What does lamda sign and T sign tell you

A

Lamda - Dichorio
T sign Mono

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3
Q

When to performed FBC in multiple pregnancy?

A

20-24 and 28 weeks

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4
Q

How many appointments for DCDA, MCDA twins, TA triplets

A

DCDA
8 AN app, 2 with specialist

MCDA
11 AN app, 2 with specilist

Triplets
uncomplicated TCTA: 9 AN appointments, 2 with specilist
DCTA or MCTA: 11 AN, 5 with specialist

Shared amnion - tertiary level

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5
Q

How many scans for DCDA

A

11-14 weeks
Every 4 weeks from 20 weeks

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6
Q

How many scans MCDA twins

A

11+2-14+2 weeks
Every 2 weeks from 16 weeks

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7
Q

TCTA twins scans

A

11-14
20, 24 then evert 2 weeks

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8
Q

DCTA or MCTA scans

A

Every 2 weeks from 16 weeks

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9
Q

How to offer screening for chromosomal abnormalities in triplet pregnancy

A

High risk of false positive and being offered invasive testing
Use NT and maternal age when CRL 45-84,, (11+2-14+1)

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10
Q

Can you use FFN in twin triplet pregnancy?

A

No

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11
Q

From when can offer screening for FGR in DC twins or TC triplets?
How often

A

From 24 weeks
Every 4 weeks DC twins
Every 2 weeks in TC triplets

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12
Q

How to calculate discordance for DCDA twins

A

(EFW largest / EFW smallest) x 100

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13
Q

How to calculate discordance in triplets

A

([EFW largest fetus − EFW smallest fetus] ÷ EFW largest fetus) × 100
and
([EFW largest fetus − EFW middle fetus] ÷ EFW largest fetus) × 100

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14
Q

When to increase the scanning to weekly assessing for discordance?

A

If EFW >20%
Any baby <10th

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15
Q

When to refer to tertiary unit for discordance of DCDA twins or TCTA triplets

A

If discordance >25% and EFW of a baby is <10th centile

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16
Q

Mains risks with shared placenta

A

Risk TTS, FGR, TAPs

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17
Q

How often to scan assessing for TTS, when to increase scanning to weekly

A

Scan every 2 weeks from 16 weeks
Scan weekly if difference >4cm

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18
Q

When to refer to tertiary unit for TTS when

A

Amniontic sac DVP <2cm

and

Amniotic sac of another baby
>8cm <20 week sor >10cm from >20 weeks

19
Q

In TTS, when to refer to specilist obstetrician for multiple pregnancy

A

Amniotic sac of 1 baby has DVP in normal ranger

and

Other baby DVP <2vm or >8cm

20
Q

What part of USS assess for twin anaemia polycythamia sequence?

A

MCA-PSV

21
Q

Who should be offered weekly USS assessing for TAPs?

A

TTS that has been treated by fetoscopic laser therapy

sGR (discordance >25% and EFW <10th)

22
Q

Which other cases should TAPs be assessed with MCA-PSV

A

Monochorionic and evidence
- Cardiovascular compromise
- Unexplained isolated polyhydramnios
- abnormal umbilical artery

23
Q

Do multiple pregnancies need aspirin?

A

Moderate RF, so only if other RF present

24
Q

When should you discuss timing of birth/plans for birth

A

By 28 weeks

25
Q

What % twin pregnancies delivery < 37 weeks

A

60%

26
Q

What % triplet pregnancies delivery < 35 weeks?

A

75%

27
Q

When to delivery
DCDA twins

A

37 weeks

28
Q

When to delivery
MCDA

A

36 weeks

29
Q

When to delivery
MCMA

A

32-34 weeks, offer CS

30
Q

When to delivery TCTA twins by

A

35 weeks, offer CS

31
Q

If patient declines delivery at the preposed time how often to offer ANC and USS

A

Weekly

32
Q

Which uncomplicated DC or MC twins can have VD

A

If 1st twin cephalic
No significant size difference between the twin
No obstetric contraindications
>32 weeks

33
Q

> 32 weeks DC or MC twins having vaginal delivery, how many will require EMCS?

A

1/3
Small number will need CS for delivery oft he 2nd twin after vaginal delivery of 1st

34
Q

Who to offer CS DC or MC twins

A

Planned CS 1st baby not cephalic
EMCS Preterm labour 26-32 weeks

35
Q

From what gestation to offer CTG in labour for multiple pregnancy?

A

26 weeks
Located on USS 1st

36
Q

Can scalp stimulation be performed for pathological CTG

A

No

37
Q

What to do if difficult monitoring twins

A

Bedside USS
Fetal scalp electrodes from twin 1 >34 weeks
If remains unclear - consider CS

38
Q

1st baby CTG suspicious

A

correct reversible causes
Fetal scalp electrode if >34 weeks

39
Q

If CTG pathological 1st baby

A

Consider fetal blood sampling >34 weeks
CS
If secondary stage - consider vaginal birth if can be achieved within 20 mins

40
Q

2nd baby suspicious/pathological before the first baby is born

A

If VD cannot be achieved within 20 mins, consider CS

41
Q

Why to offer epdiural

A

Improve chance of success and otimal timing of assisted vaginal delivery
Quicker birth by CS

42
Q

Risk reduction PPH

A

Offer active blood stage consider additional uterotonics

43
Q

How many AN appointments for primps and multip?

A

P0 10 An appointments
Multip 7 AN appointment

MRCOG Antenatal Part 2 Revision - Hay (72 decks)

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