Multifetal Pregnancy Flashcards
(93 cards)
1
Q
A
2
Q
Incidence of Multifetal Pregnancy
A
3
Q
Determination of zygosity
A
4
Q
RF for Dizygotic Twins
A
5
Q
Complications of Multifetal Pregnancy
A
- Maternal
- Fetal
6
Q
Complications of Multifetal Pregnancy During Pregnancy
- Maternal
A
- During pregnancy
- During Labor
- During Puerperium
7
Q
Maternal Complications of Multifetal Pregnancy During Pregnancy
A
8
Q
Maternal Complications of Multifetal Pregnancy During Pregnancy
- PROM
A
- 3 times more common than singleton pregnancy specially if associated è polyhydramnios or abnormal presentation.
9
Q
Maternal Complications of Multifetal Pregnancy During Pregnancy
- APH
A
- Due to placenta previa (due to large placenta encroaching on LUS) or placental abruption (due to higher incidence of PIH).
10
Q
Maternal Complications of Multifetal Pregnancy During Pregnancy
- PIH
A
Usually of early onset.
11
Q
Maternal Complications of Multifetal Pregnancy During Pregnancy
- Anemia
A
Due to increased requirements & plasma expansion.
12
Q
Maternal Complications of Multifetal Pregnancy During Pregnancy
- Malpresentation
A
13
Q
Maternal Complications of Multifetal Pregnancy During Pregnancy
- Pressure Manifestations
A
14
Q
Maternal Complications of Multifetal Pregnancy During Pregnancy
- Psychological
A
Due to prolonged rest & hospitalization.
15
Q
Maternal Complications of Multifetal Pregnancy During labor
A
16
Q
Maternal Complications of Multifetal Pregnancy During Puerperium
A
17
Q
Fetal Complications of Multifetal Pregnancy
A
18
Q
Fetal Complications of Multifetal Pregnancy
- IUFD
A
- More in monozygotic type than in dizygotic type due to less placental perfusion & increases chance of vascular connections.
19
Q
Fetal Complications of Multifetal Pregnancy
- Intrapartum Fetal Death
A
Death of 1st fetus:
- Due to cord prolapse or locked twin.
Death of 2nd fetus:
- Due to excessive sedation, premature separation of placenta, hypoxia, constriction ring or operative manipulation.
20
Q
Fetal Complications of Multifetal Pregnancy
- IUGR
A
Due to relatively deficient resources that may affect one fetus > other.
21
Q
Fetal Complications of Multifetal Pregnancy
- TTTS
A
….
22
Q
Fetal Complications of Multifetal Pregnancy
- Increased Incidence of Congenital Anomalies
A
- Major anomalies develop in 2% & minor anomalies develop in 4% of twins.
- Incidence in monozygotic type is twice that in dizygotic type.
- Incidence increaeses in monoamniotic type.
23
Q
Fetal Complications of Multifetal Pregnancy
- umbilical Cord Problems
A
24
Q
Fetal Complications of Multifetal Pregnancy
- Cerebral Palsy
A
- times more common in twins than in singleton pregnancy & it occurs due to single fetal demise, IUGR, discordant growth or TTTS.
25
Fetal conditions unique to multifetal pregnancy
- Vanishing Twin syndrome
- Single fetal Demise
- Discordant Growth
- TTTS
- Conjoint Twins (Siamese twins or disomata)
- Locked Twins
- Retained 2nd Twin
26
Def of **TTTS**
- Blood transfusion from one fetus (donor) to the other (recipient) due to presence of uncompensated intraplacental A-V shunts è preferential blood flow () 2 fetuses.
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Incidence of **TTTS**
15% of monochorionic twins (it is rare in dichorionic twins).
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Pathology in **TTTS**
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Dx of **TTTS**
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Managment of **TTTS**
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Synonyms of **Conjoint Twins**
Siamese twins or disomata
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Def of **Conjoint Twins**
- Twins bodies are fused in certain sites.
- 0.5% of monozygotic twins & is more in female than male fetuses (3:1)
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Types of **Conjoint Twins**
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Dx of **Conjoint Twins**
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Managment of **Conjoint Twins**
CS or vaginal delivery in extreme prematurity.
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Def of **Locked Twins**
One fetus impedes descent & delivery of the other.
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Incidence of **Locked Twins**
1/50000 of deliveries & it is more common in primigravidas.
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Types of **Locked Twins**
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Risks of **Locked Twins**
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Dx of **Locked Twins**
Early diagnosis is rare but it must be anticipated.
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Prevention of **Locked Twins**
By performing elective CS if 1st twin is breech & 2nd twin is cephalic.
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Managment of **Locked Twins**
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Managment of **Locked Twins**
- Collision, impaction & compaction
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Managment of **Locked Twins**
- Chin to chin interlocking
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Dx of **Multifetal Pregnancy**
- During Pregnancy
- During Labor
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Dx of **Multifetal Pregnancy**
- During Pregnancy
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Dx of **Multifetal Pregnancy** During pregnancy
- Hx
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Dx of **Multifetal Pregnancy** During pregnancy
- General Ex
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Dx of **Multifetal Pregnancy** During pregnancy
- Abdominal Examination
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Dx of **Multifetal Pregnancy** During pregnancy
- US
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US of **Multifetal Pregnancy** During pregnancy
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US of **Multifetal Pregnancy** During pregnancy
- frequency
Frequency:
- In dichorionic twins: Every 4-6 weeks.
- In monochorionic twins: Every 2 weeks.
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US of **Multifetal Pregnancy** During pregnancy
- Value
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US of **Multifetal Pregnancy** During pregnancy
- determination of Chorionicity & Amnionicity
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US of **Multifetal Pregnancy** During pregnancy
- Lambda Sign
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US of **Multifetal Pregnancy** During pregnancy
- T sign
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Dx of **Multifetal Pregnancy** During Labor
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Managment of **Multifetal Pregnancy**
- During Prenancy
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Managment of **Multifetal Pregnancy** During Pregnancy
- Adequate ANC
- As any high-risk pregnancy (visits are every 2 weeks till 28 weeks then every week till 36 weeks then hospitalization).
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Managment of **Multifetal Pregnancy** During Pregnancy
- General Lines
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Managment of **Multifetal Pregnancy** During Pregnancy
- Observation
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Managment of **Multifetal Pregnancy** During Pregnancy
- Selective Fetal Reduction
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**Selective Fetal Redution** in Multifetal Pregnancy
- Def
Reduction of selected fetus or fetuses in dichorionic multifetal pregnancy to enhance survival of other fetuses.
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**Selective Fetal Redution** in Multifetal Pregnancy
- Time
Performed at 9-12 weeks.
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**Selective Fetal Redution** in Multifetal Pregnancy
- Techniques
Ultrasound guided KCI injection into heart or thorax of each selected fetus.
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**Selective Fetal Termination** in Multifetal Pregnancy
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**Selective Fetal Termination** in Multifetal Pregnancy
- Def
Selective destruction of abnormal fetuses.
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**Selective Fetal Termination** in Multifetal Pregnancy
- Time
- Performed later in pregnancy than selective reduction (because anomalies are typically not discovered till 2nd trimester).
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**Selective Fetal Termination** in Multifetal Pregnancy
- Techniques
a) Ultrasound guided intracardiac KCI injection.
b) Fetoscopic ligation or laser coagulation of umbilical cord.
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Managment of Multifetal Pregnancy
- Delivery
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**Managment of Multifetal Pregnancy in Delivery**
- Time
- The ideal time for delivery of uncomplicated multifetal pregnancy is uncertain however, pregnancies shouldn't go beyond 40 weeks because postmaturity is difficult to deal è in twin pregnancy.
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**Managment of Multifetal Pregnancy in Delivery**
- Place
In well-equipped hospital.
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**Managment of Multifetal Pregnancy in Delivery**
- Methods
- Vaginal or CS
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Vaginal Delivery in **Multifetal Pregnancy**
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Vaginal Delivery in **Multifetal Pregnancy**
- Indications
It is the rule in twin pregnancies unless CS is indicated.
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Vaginal Delivery in **Multifetal Pregnancy**
- Prerequesities
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Vaginal Delivery in **Multifetal Pregnancy**
- managment of 1st stage
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Vaginal Delivery in **Multifetal Pregnancy**
- Managment of 2nd Stage
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Vaginal Delivery in **Multifetal Pregnancy**
- Delivery of 1st fetus
Is according to ordinary rules of labor è avoidance of
AROM, difficult forceps or ventouse (if cephalic) & breech extraction (if breech).
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Vaginal Delivery in **Multifetal Pregnancy**
- After Delivery of 1st fetus
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Vaginal Delivery in **Multifetal Pregnancy**
- delivery of 2nd Fetus
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Vaginal Delivery of 2nd Fetus in multifetal Pregnancy
- If there is amniotic Sac (diamniotic twins & no ROM) & there is no fetal distress
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Vaginal Delivery of 2nd Fetus in multifetal Pregnancy
- If there is amniotic Sac (diamniotic twins & no ROM) & there is no fetal distress
- Cephalic
Moderate fundal pressure to guide head in birth canal then do AROM & leave for spontaneous delivery.
84
Vaginal Delivery of 2nd Fetus in multifetal Pregnancy
- If there is amniotic Sac (diamniotic twins & no ROM) & there is no fetal distress
- Breech
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Vaginal Delivery of 2nd Fetus in multifetal Pregnancy
- If there is amniotic Sac (diamniotic twins & no ROM) & there is no fetal distress
- Oblique & Transverse
1. ECV or EPV then delivery as cephalic or breech.
2. IPV on intact membrane during period of uterine quiescence then AROM followed by breech extraction.
86
Vaginal Delivery of 2nd Fetus in multifetal Pregnancy
- If there is NO amniotic Sac (monoamniotic twins or ROM) or there is cord prolapse or fetal distress or if delivery of 2nd fetus is delayed > 1/2 an hour
87
Vaginal Delivery of 2nd Fetus in multifetal Pregnancy
- If there is NO amniotic Sac (monoamniotic twins or ROM) or there is cord prolapse or fetal distress or if delivery of 2nd fetus is delayed > 1/2 an hour
- Cephalic
Cephalic presentation:
1. Head is engaged: Ventouse or forceps.
2. Head isn't engaged: IPV followed by breech extraction.
88
Vaginal Delivery of 2nd Fetus in multifetal Pregnancy
- If there is NO amniotic Sac (monoamniotic twins or ROM) or there is cord prolapse or fetal distress or if delivery of 2nd fetus is delayed > 1/2 an hour
- Breech
Breech extraction.
89
Vaginal Delivery of 2nd Fetus in multifetal Pregnancy
- If there is NO amniotic Sac (monoamniotic twins or ROM) or there is cord prolapse or fetal distress or if delivery of 2nd fetus is delayed > 1/2 an hour
- Oblique or transverse
IPV followed by breech extraction.
90
Vaginal Delivery in **Multifetal Pregnancy**
- managment of 3rd Stage
91
CS in **Multifetal Pregnancy**
- indications
92
Managment of **Multifetal Pregnancy**
- Neonatal Care
For detection & management of any complication.
93
Managment of **Multifetal Pregnancy**
- Postnatal Care
1. Observation of patient during puerperium.
2. Contraception.
