Multiple Pregnancy Flashcards
(25 cards)
Zygosity
Determining whether the multiple in the pregnancy are dizygotic ( non identical) or monozygotic (identical)
Chorionicity
Number of chorion membranes present that surround the multiple pregnancy
Aminionicity
Number of amniotic membranes present that surround the multiple
DCDA
Two chorions and two amnions
MCDA
One chorion and two amnions
MCMA
One chorion and one amnion
Factors that increase chance of multip pregnancy -monozygotic
No know factors that consistently increase the chances of having a monozygotic pregnancy
Factors that increase Dizygotic pregnancy
Genetics releasing more than one egg during ovulation can be genetic and passed on through the mothers side of family
Age being over the age of 35increases likelihood of releasing more than one egg during ovulation
Ethnicity highest occurrence on Nigerian women , lowest occurrence in Japanese women
IVFmore than one embryo may be implanted during the procedure of IVF sometimes resulting in a multiple pregnancy
Potential link to bmi, with highest occurrence in those with a a bmi of over 40 however this can be explained by the increased use of ART
Incidence in uk
Increasing due to
- increase in mat age and ivf pregnancy
Early pregnancy carer fro suspected or confirmed multiple pregnancy
Booking appt by 10/40
Aspirin daily from 12/40 reduces risk of pre eclampsia
Higher dose of folic acid will help fight iron defiency anaemia which is common in multiple pregnancy
USS at 11-14 weeks
Chorionic it’s confirms viability, multiple pregnancy and measures nuchal transparency
Booking to 20/40
MDT
Offered 8 antenatal apppt in total and 2 with obstretric Ian
Fbs to identify if neeed supplements
Sfh not to measure growt
At each USS after 16 weeks offer diagnostic monitoring for fetal wight
Discuss cervixlength and offer progesterone
Blood pressure and urinalysis performed at every appt
Lose dose aspirin from 12/40 if risk factors
Screening
Chorionicuty nad amnionicity - 11+2 - 14+1/40
Chromosomal condition
Structural abnormalities - 18-20/40
Preterm birth - cervical lengt onitoring
Maternal complications. - be checks and FBC
Twin to twin transfusion syndrome
Cause by abnormality with vascular connections within shared placenta
Leads to imbalance in artery to vein anastomoses where blood is disproportionally transferred from donor to recipient
Donors twin arterial blood enters placenta and is shutter via av anasamoses to recipient
TTTs effects
Donor = hypovoleamia, oliguria, obligohydramnious, growth restriction, anaemia
Recipient = hhypervolemia, polyuria, polyhydramnious. Hypertension
Ttts diagnosis
USS to look for
- signs of heart restraint
- enlarged kidney n recipient fetus
Poly or oligohydramnious
Dangers of tts
Without treatment can lead to
Pre term due to poly
Heart failure in recipient twin
Growth restriction or death in one or both twins
Treatment for ttts
Fetocscopic laser ablation - seals offf bloood vessel connection
Amino reduction
Close monitoring USS every 2 weeks
First stage of labour aanagement
Continuous cardiography when established labour
Bedside USS to establish which twin I which
Esclate if concerns with ctg
Anaegsiea
Epidural early can improve success and optimialtiming of assisted vaginal births and enable quicker birth by emcs
Progress of labour
Vaginal exam every 4hrs
Second stage of labour DCDA mcda
DCDA or MCDA twins
- vag or c section are safe options if
- pregnancy remains uncomplicated and progresses past 32 weeks
No obstretric complication
First baby cephalic
No sign in at size difference between the babies
Offer c section if first baby is not cephalic at time of planned birth
Women in preterm labour 26-32 weeks if first baby not cephalic
Mcma 2nd stage
Offer a C-section
At time of planned birth Women- 32- 33+6/40
After any diagnosed complication that would require earlier delivery
Established preterm labour and gestational age suggest chance of survival;
Delivery
After delivery of twin 1 identify cord at vulva with marked clans twin 2 stabilised, correct tra serve r oblique lie with ECV
USS to confirm presenting part
If arm necessary t should not be completer unitil presenting art confirmened to prevent cord prop lapse
Delivery of t2in 3 should not exceed 30 mins
3rd stage
Do not offer physiological management
Offer active 3rds stage - reduces risk of PPH
Uteri tonic drug given after birth of last babay
Controlled cord traction applies to cord
Syntocinion infusion prepared in case of excessive bleeding
