Multiple Pregnancy Flashcards Preview

Toni's Obs and Gynae > Multiple Pregnancy > Flashcards

Flashcards in Multiple Pregnancy Deck (11):
1

Predisposing factors for multiple pregnanc

Increasing maternal age + parity
Personal / fhx
Assisted conception

2

Risks of multiple pregnancy

Mat: hyperemesis, miscarriage, htn, pre-eclampsia, gestDM, polyhydramnios, anaemia, APH, PPH, placenta praevia
Fetal: incr perinatal mortality, congenital abnormality, preterm labour, placental insufficiency, IUGR, malpresentation, TTTS, bp vanishing twin syndrome

3

Twin-twin transfusion

Anastomosis of vessels in monochorionic twin pregnancy -> unequal haemodynamics
Donor: anaemic, hypovolaemic, oligohydramniotic, growth restricted
Recipient: policythaemia, hypervolaemia, polyuria, polyhydramnios
Occurs in up to 35% monochorionic twins
Accounts for 15% perinatal mortality

4

Managing TTTS

Frequent Us monitoring
Therapeutic amniocentesis to reduce amniotic fluid pressure
Laser ablation of placental vessels (risk demise/congenital abn)

5

Vanishing twin syndrome

Fetus in multiple gestation pregnancy dies in utero
Subsequently resorted by mother, partially or completely

6

Delivery

1st twin cephalic: trial of labour
1st twin breech/transverse lie: Caesarean section
Risks: cord prolapse, entanglement/knotting, locking, PPH, thrombosis, fetal distress, inefficient uterine activity after 1st twin delivered

7

Monozygotic twins

Due to mitotic division of single fertilised ovum
40%

8

Monozygotic, monochorionic, monoamniotic twins

Mitotic division after 8 days
3%
Prior to formation of primitive streak= single amniotic cavity and chorion
1%
After formation of primitive streak= conjoined twins

9

Monozygotic, monochorionic, diamniotic twins

Mitotic division between 4 -7 days
66%
During formation of inner cell mass
Single placenta
Own amniotic membrane

10

Monozygotic, dichorionic, diamniotic twins

Mitotic divison

11

Dizygotic twins

Fertilisation of two different ova by two different sperm
60%
Not identical