Multiple Pregnancy Flashcards
(16 cards)
Define dizygotic twins:
Non-identical
Define Monozygotic twins
Identical twins
Define chorionicity
Number of outer membranes surrounding membranes
Define Amnionicity:
Number of inner membranes surrounding the pregnancy
Define DCDA
Dichornic diamniotic
2 chorions and amnions
Define MCDA
Monochronic diamniotic
One chorion and two amnions
Define MCMA
Monochronic monoamniotic
One chorion and one amnion
Factors that increase chance of monozygotic (identical) pregnancy
-no known factors (NHS, 2020)
- more monozygotic pregnancy from use of drugs that assist with ovulation
Factors increasing chance of dizygotic (non-identical) pregnancy
-releasing more than one egg during ovulation
-being over 35 years old
-more than one embryo implanted with IVF
- BMI over 40.
Early pregnancy care with confirmed multiple pregnancy
-specialist referral and booking by 10 weeks
-aspirin from 12 weeks for PET risk
-higher folic acid dose for anaemia
Twin to twin transfusion syndrome
-imbalanced blood flow between artery and vein due to abnormal vascular connections
Effects on donor vs recipient twin with TTTS
Hypovolemia vs hypervolemia
-oligohydramnios vs polyhydramnios
-oligouria vs polyuria
Intrapartum consideration for multiple pregnancy
-CTG
-ensure fetal synchronicity isn’t happening and label which trace belongs to which baby
-offer analagesia and inform that this will increase success of operative vaginal or quick CS
Considerations of second stage of labour
-can be vaginal if first baby is cephallic (DCDA, MCDA)
—Offer CS for MCMA pregnancy
-appropriate equipment in the room
-after t1, check position of T2 and perform ECV or breech extraction
-consider CS if T2 is high or not born within 30 min
Third stage of labour:
-active third stage once T2 is born
-controlled cord traction
-syntocinon infusion prepped in case of PPH
-examine and document placental examination findings
Breastfeeding support
-offer all information
-support with feeds
-encourage top ups and feed babies separately
